Exploration of Associations Between Early Maladaptive Schemas, Impaired Emotional Regulation, Coping Strategies and Resilience in Opioid Dependent Poly-Drug Users.

BACKGROUND: Early Maladaptive Schema (EMS) are self-beliefs regarding oneself, others and the world, developed in childhood as the result of cumulative negative experiences (Young, 1993). High levels of EMS are present in the opioid using population along with high levels of emotional dysregulation and maladaptive coping alongside traits of resilience. OBJECTIVES: The study explored the associations between EMS in relation to emotional dysregulation, maladaptive coping, adaptive coping and resilience between a clinical group composed of opioid dependent polydrug users attending a facility for opioid substitution treatment (n = 52) and a healthy comparison group (n = 70). METHODS: A cross-sectional design was used to compare group differences using MANOVAs, and multiple regression analysis identified associations between EMS and emotional dysregulation, coping and resilience. RESULTS: The groups significantly differed in relation to emotional dysregulation, maladaptive coping, adaptive coping and resilience. Specific EMS were significant independent predictors in regards to high emotional dysregulation, maladaptive coping, adaptive coping and resilience. CONCLUSION: EMS appear to have a significant impact on emotional dysregulation, coping and resilience. Clinical implications suggest that EMS should be addressed when treating opioid dependent polydrug users.

Changes in psychological well-being among heroin-dependent adolescents during psychologically supported opiate substitution treatment.

AIM: Heroin-dependent adolescents demonstrate high rates of comorbid psychological problems. Among heroin-dependent adults, opiate substitution treatment (OST) programmes appear to reduce mental health problems. We sought to examine the impact of OST on psychological well-being in adolescents, as this is unknown. METHODS: We conducted a prospective study examining psychological well-being in heroin dependent adolescents, aged 18 years or younger, engaged in outpatient psychologically supported OST. Patients were treated with either methadone or buprenorphine. This was complimented with individual key working, counselling (motivational interviewing and cognitive behavioral therapy) and group work focusing on life skills. The Beck Youth Inventory was used to measure psychological well-being at treatment entry and repeated after 4 months of treatment. RESULTS: Among 55 consecutive treatment episodes, we examined the 32 episodes where the patient persisted with the OST programme. Polysubstance use was the norm at treatment entry. At follow-up, the median doses of methadone and buprenorphine were 50 mgs and 8 mgs, respectively. Only three patients were treated with antidepressant medication. There was significant improvement in the mean depression (65.0 to 57.9, P = 0.001), anxiety (61.7 to 57.0, P = 0.006) and anger (57.8 to 54.6, P = 0.009) subscale scores. The self-concept and disruptive behaviour subscale scores did not improve significantly. CONCLUSION: In this relatively short-term follow-up, psychosocially assisted OST appears to be associated with improved psychological well-being in heroin-dependent adolescents, especially in the area of depressive and anxiety symptoms.

The Impact of Sex Upon Needs and Quality of Life Within a Population on Methadone Treatment.

BACKGROUND: Best practice models are calling for a holistic, needs-led, and sex-informed treatment approach to substance misuse treatment. To date, research into the impact of sex on needs and quality of life within methadone-treatment populations using validated research tools is limited. OBJECTIVES: The aim of the study was to evaluate the impact of sex upon self-rated unmet need and quality of life among people on methadone treatment. METHODS: Cross-sectional survey of adults attending a specialist methadone treatment clinic, in Dublin, Ireland. Participants completed the Camberwell Assessment of Need Short Appraisal Schedule, Patient Version and the WHO Quality of Life-Brief Version. Ongoing drug use was determined using the Maudsley Addiction Profile and weekly supervised urine toxicology screens. A linear regression analysis was conducted. RESULTS: One hundred eight of 190 eligible service-users (57%) participated. No significant differences existed between the participants and the nonparticipants on demographic variables or measures of drug use. Among them, 33% were women. Women demonstrated lower levels of ongoing opiate use. Linear regression analysis indicated that women had a greater number of unmet needs (P = 0.02) and lower quality of life in the domains of physical health (P = 0.003), psychological well being (P < 0.001), environmental well being (P = 0.03), and social relationships (P = 0.007). When the Bonferroni adjustment was applied to account for multiple testing, the relationship between psychological well being and female sex remained statistically significant. CONCLUSIONS: Our study suggests that female sex may be associated with greater self-rated needs and poorer quality of life within a methadone-treated population, in particular, in the domain of psychological well being. Further research in this area is warranted to discover if these findings can be replicated and confirmed in larger samples.

Situational and psycho-social factors associated with relapse following residential detoxification in a population of Irish opioid dependent patients.

AIMS: To identify and describe the context and factors involved in the opioid lapse process following discharge from an Irish inpatient opioid detoxification treatment programme. Design, participants, setting: Prospective follow-up study of consecutive detoxified opioid dependent patients treated in a specialist inpatient drug dependency unit. MEASUREMENTS: The Maudsley Addiction Profile and a structured interview were administered to 109 patients, 18-36 months after discharge. FINDINGS: Of 109 people interviewed at follow-up, 102 (94%) reported at least one episode of opioid use after leaving the residential treatment programme. Eighty eight patients (86% of the lapsers) identified more than one major factor contributing to their recidivism. The median number of factors identified as having a major role in the lapse was four. The most frequently reported major contributors to lapse were low mood (62%), difficulties with craving (62%), ease of access to heroin (48%) and missing the support of the treatment centre (43%). CONCLUSIONS: Early lapse was common following inpatient treatment of opioid dependence. Lapse tended to result from a number of common, identifiable, high-risk situations, feelings and cognitions which may assist clinicians and patients develop lapse prevention strategies to anticipate and interrupt this process.