Patients' Perspectives on the Development of Prescription Opioid Use Disorder in Patients with Chronic Non-Cancer Pain.

INTRODUCTION: In the past decade, prescription opioid use increased exponentially and concomitantly opioid use disorders (OUD) are becoming more common. Several risk factors for developing OUD have been identified, but little is known regarding the patients' perspective on developing a prescription OUD. METHODS: We recruited 25 adults undergoing treatment for prescription OUD. In-depth, semi-structured interviews focussed on experiences with long-term opioid use, knowledge and attitudes regarding opioids, and access to opioids. A directed content analysis was conducted on the transcribed interviews using NVivo. RESULTS: Participants showed that the development of an OUD is affected by various factors which could be grouped into three themes: (1) experiences driving initiation, (2) experiences driving continuation, and (3) experiences with prescription OUD. Besides the need for pain management, the dynamics of patient-provider communication, care coordination, provider vigilance, and environmental support all contributed to the way patients used their opioids. CONCLUSION: Patients' experiences illustrate that the first stage of the development of prescription OUD differs from the development of other substance addictions. Negative reinforcement might play a more prominent role in the early phase of prescription opioid use. Patients expressed a lack of guidance, both at the start of use and long-term use, easy access to new prescriptions and a lack of monitoring as main drivers of the development. Poorly controlled pain and subjective stress fuelled continuous opioid use.

The Standardized Assessment of Personality-Abbreviated Scale as a screening instrument for personality disorders in substance-dependent criminal offenders.

Personality disorders (PDs) are considered to be potential predictors of treatment outcome in substance-dependent patients and potential treatment matching variables. There is a need for a brief and simple screening instrument for PDs that can be used in routine psychological assessment, especially in a treatment setting for previously substance-dependent criminal offenders, where a high prevalence of PDs is expected. This study investigated the psychometric properties of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), a commonly used screening interview for PDs, in a population of inpatient criminal offenders with a history of substance dependence. Various statistical procedures were used to establish reliability and validity measures, such as Kuder-Richardson 20, confirmative factor analysis, receiver operating characteristic analysis and multitrait multimethod matrix. The SAPAS was administered to 101 inpatient criminal offenders with a history of substance dependence at baseline. Within three weeks, participants were administered the Structured Interview for DSM-IV Personality in order to assess the presence of PDs. Results show limited evidence to make firm conclusions on the psychometric qualities of the SAPAS as a screening instrument for comorbid PDs in a substance dependence treatment setting for criminal offenders. Suggestions for improvement concerning the psychometric qualities of the SAPAS as a screening instrument for this population are noted.

Interpersonal aspects of personality disorders in opioid-dependent patients: the convergence of the ICL-R and the SIDP-IV.

This study aims to establish the convergence of the empirically based Diagnostic Statistical Manual (DSM)- and theory-based interpersonal behavioral approaches to personality, in opioid-dependent patients (n = 110), with the use of the Structured Interview for DSM-IV Personality [Pfohl et al.: Structured Interview for DSM-IV PD. Iowa City, UICM, 1995] and the Interpersonal Checklist-Revised (ICL-R) [DeJong and VandenBrink: ICL-R. St. Oedenrode/NL, Novadic, 1998]. As hypothesized, based on prior research, we found the two approaches to be complementary rather than interchangeable. However, some overlap was found between the SIDP-IV dimensions and the ICL-R, mainly with rebellious/distrustful, reserved/silent and masochistic/self-effacing styles. Results indicate that drug dependence in itself is not a predictor of interpersonal style, while personality pathology is. Patients with a personality disorder (PD) perceive themselves as hostile and submissive, while patients without a PD view themselves as friendly and controlling. The SIDP-IV seems informative in classifying PDs, in addition guidelines for behavioral change, in addicted patients, were provided based on the ICL-R.

Interrater reliability of the structured interview for DSM-IV personality in an opioid-dependent patient sample.

We examined the interrater reliability of the Structured Interview for DSM-IV Personality (SIDP-IV) in an opioid-dependent patient sample at the criterion as well as at the diagnostic level for both categorical and dimensional data. At the criterion level (Cohen's kappa ranging from 0.76 to 0.93 and intraclass correlation coefficient ranging from 0.67 to 0.97) as well as at the diagnostic level (Cohen's kappa ranging from 0.66 to 1.00 and intraclass correlation coefficient ranging from 0.88 to 0.99), the reliability was excellent. The results suggest the SIDP-IV to be an adequate instrument for the assessment of personality disorders in opioid-dependent patients.