Short-term interpersonal psychotherapy in methadone-maintained opiate addicts.

A clinical trial was used to evaluate short-term interpersonal psychotherapy (IPT) as treatment for psychiatric disorders in opiate addicts who were also participating in a full-service methadone hydrochloride maintenance program. Seventy-two opiate addicts were randomly assigned to one of two treatment conditions for six months: (1) IPT, consisting of weekly individual psychotherapy, and (2) low-contact treatment, consisting of one brief meeting per month. Recruitment was a problem, as only 5% of eligible clients agreed to participate and only around half of the subjects completed the study treatment. The outcome was similar for the two study groups. However, in many of the outcome areas, subjects in both treatment conditions attained significant clinical improvement. Several factors limited the generalizability of findings and may have biased against showing a psychotherapy effect.

Imipramine as treatment for depression in addicts.

This report describes the results of a placebo-controlled double-blind clinical trial evaluating imipramine hydrochloride, a tricyclic antidepressant, as treatment for depression in methadone-maintained opiate addicts. Forty-six subjects were assigned randomly to either the imipramine or placebo group for up to eight weeks. All patients also received mandatory once weekly group therapy as part of the methadone program. Outcome measures included attrition, depressive symptoms, global improvement, side effects, social functioning, and urine specimen results positive for illicit drugs. The therapeutic response in the two conditions was similar. Addicts receiving either imipramine or placebo experienced a substantial reduction of depressive symptoms during the eight weeks of the study. These findings are compared with other studies that treat depression in addicts and nonaddicts.

Detecting depressive disorders in drug abusers: a comparison of screening instruments.

Previous investigators have reported a high prevalence of depressive symptoms in drug-dependent patients. Given the responsiveness of depressive disorders to both psychological and pharmacological treatments, it is desirable to find an economical, efficient screening instrument to detect depressive disorders in this population. In this study, 6 depression symptom screening scales (Beck Depression Inventory, Hamilton Depression Scale, Raskin Depression Scale, Degree of Illness Rating, Symptom Checklist 90 Overall, and Depression Subscale) based on either clinician interview or patient self report, were compared according to their utility in detecting cases of depression among 64 applicants for treatment at a substance abuse treatment unit of a community mental health center. The criteria for a case of depression were the Research Diagnostic Criteria (RDC) which are specified and operationalized. Cases identified using previously described cutoff scores on the screening scales were compared to rates based on the RDC and sensitivity and specificity were determined. The results showed that: (1) although the sensitivity of the symptom scales was applicable, ranging from 65--94%, the specificity was less impressive, ranging from 39--61%, and (2) the Beck Depression Inventory, a 13-item patient self report was the most sensitive and specific and is recommended for screening drug-dependent populations for depression.

Pathways to opiate addiction: an evaluation of differing antecedents.

This paper defines and tests a typology of addicts defined through assessment of the sequence of three types of key events: (a) traumatic childhood events such as death of a parent or child abuse; (b) onset of regular delinquent activity; and (c) initiation of illicit drug use. By evaluating the sequence of these events three groups are defined: (a) an initial childhood trauma group; (b) an early delinquency group; and (c) an initial drug use group. Data derived from a sample of treated opiate addicts are used to define and differentiate these three groups.

Ego development in opiate addicts. An application of Loevinger's stage model.

This paper reports findings from a study of ego functioning in a sample of 97 opiate addicts applying for treatment and a demographically matched control group of 29 applicants at a job training program. Level of ego development was evaluated using the Loevinger Sentence Completion Test. In addition, in the addict sample, we assessed the correlation between level of ego development and other clinical features including present and past drug use, criminal history, psychological symptoms, and social functioning. The mean ego development scores for the opiate addicts and controls were not significantly different although both groups achieved scores that were, on the average, one full stage lower than those obtained in other studies of nonclinical adult populations. Ego development ratings indicated that around one third of both addict and control groups seemed to be relying on internalized standards for self-regulation. Within the addict group, those at lower levels of ego development reported more psychological symptomatology, poorer social functioning, and heavier drug use. Implications for treatment planning and rehabilitative efforts are discussed.