Factors Associated with Opioid Use Disorder Diagnosis and Treatment Progress
Previous research has shown that various environmental aspects, such as a history of abuse, trauma, and pain can influence the incidence of opioid use disorder (OUD). The aims of this study were to determine risk factors associated specifically with opioid use disorder, and to identify factors that may predict treatment progress for opioid use disorder patients. Three-hundred six patients from an abstinence-based residential treatment center participated in this study. Participants completed a comprehensive battery, which included measures assessing quality of life, craving, abstinence self-efficacy, adverse childhood experiences, trauma exposure, and physical pain symptoms at treatment intake and again after 28 days of treatment. Independent t-test results showed significant differences between patients with and without opioid use disorders in social relationships, confidence abstaining from alcohol and drugs, pain intensity, and drug craving. Multiple regression analyses demonstrated that presence of an opioid use disorder predicted alcohol abstinence, social relationships, and baseline environment. Results revealed shifting attitudes towards substance use and social relationships during the opioid group’s time in treatment. Cravings and urges were identified as important focuses for future treatment of opioid use disorder. Hyperalgesia was seen as an effect of extended opioid use and its impact decreased through drug abstinence. Limitations included a small sample size, a large proportion of wealthy individuals, and age differences between the two groups.
Barahmand, U., Khazaee, A., & Hashjin G.S. (2016). Emotion dysregulation mediates between childhood emotional abuse and motives for substance use. Archives of Psychiatric Nursing, 30(6), 653–659. doi: https://doi.org/10.1016/j.apnu.2016.02.007
Blevins, C.A., Weathers, F.W., Davis, M.T., Witte, T.K., & Domino, J.L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. doi: https://doi.org/10.1002/jts.22059
Boscarino, J.A., Rukstalis, M., Hoffman, S.N., Han, J.J., Erlich, P.M., Gerhard, G.S., & Stewart, W.F. (2010). Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction, 105(10), 1776-1782. doi: 10.1111/j.1360-0443.2010.03052.x.
Brown, R., Deyo, B., Riley, C., Quanbeck, A., Glass, J.E., Turpin, R., … Agarwal, S. (2017). Screening in trauma for opioid misuse prevention (STOMP): study protocol for the development of an opioid risk screening tool for victims of injury. Addiction Science & Clinical Practice, 12(1), 28-36. doi: 10.1186/s13722-017-0097-6.
Conroy, E., Degenhardt, L., Mattick, R.P., & Nelson, E.C. (2009). Child maltreatment as a risk factor for opioid dependence: comparison of family characteristics and type and severity of child maltreatment with a matched control group. Child Abuse and Neglect, 33(6), 343-352. doi: https://doi.org/10.1016/j.chiabu.2008.09.009
Cragg, A., Hau, J.P., Woo, S.A., Liu, C., Doyle-Waters, M.M., & Hohl, C.M. (2017). Risk factors for addiction among patients receiving prescribed opioids: a systematic review protocol. Systematic Reviews, 6(1), 265-272. doi: 10.1186/s13643-017-0642-0
Daigre, C., Rodríguez-Cintas, L., Tarifa, N., Rodríguez-Martos, L., Grau-López, L., Berenguer, M. ..., Roncero, C. (2015). History of sexual, emotional or physical abuse and psychiatric comorbidity in substance-dependent patients. Psychiatry Research, 229(3), 743-749. doi: https://doi.org/10.1016/j.psychres.2015.08.008
DiClemente, C.C., Carbonari, J.P., Montgomery, R.P.G. & Hughes, S.O. (1994).The Alcohol Abstinence Self-Efficacy Scale. Journal of Studies on Alcohol, 55(2), 141-148.
Domino, K.B., Hornbein, T.F., Polissar, N.L.,Renner, G., Johnson, J., Alberti, S., & Hankes, L. (2005). Risk factors for relapse in health care professionals with substance use disorders. Journal of the American Medical Association, 293(12), 1453-1460. doi: 10.1001/jama.293.12.1453
Dore, G., Mills, K., Murray, R., Teesson, M., & Farrugia, P. (2012). Post-traumatic stress disorder, depression and suicidality in inpatients with substance use disorders. Drug and Alcohol Review, 31(3), 294-302. doi: https://doi.org/10.1111/j.1465-3362.2011.00314.x
Dube, S.R., Felitti, V.J., Dong, M., Chapman, D.P., Giles, W.H., & Anda, R.F. (2013). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564–572. doi: 10.1542/peds.2015-4016
Edlund, M.J., Steffick, D., Hudson, T., Harris, K.M., & Sullivan, M. (2007). Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain, 129(3), 355-362. doi: 10.1016/j.pain.2007.02.014
Flannery, B.A., Volpicelli, J.R., & Pettinati, H.M. (1999). Psychometric properties of the Penn Alcohol Craving Scale. Alcoholism, Clinical and Experimental Research, 23(8), 1289-1295.
Hedegaard, H., Warner, M., & Miniño, A.M. (2017, December 21). Drug overdose deaths in the United States, 1996-2016. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db294.pdf
Heffernan, K., Cloitre, M., Tardiff, K., Marzuk, P.M., Portera, L., & Leon, A.C. (2000). Childhood trauma as a correlate of lifetime opiate use in psychiatric patients. Addictive Behaviors, 25(5), 797-803. doi: https://doi.org/10.1016/S0306-4603(00)00066-6
Ives, T. J., Chelminski, P. R., Hammett-Stabler, C. A., Malone, R. M., Perhac, J. S., Potisek, N. M., … Pignone, M. P. (2006). Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Services Research, 6(1), 46. doi: 10.1186/1472-6963-6-46
Jacobsen, L.K., Southwick, S.M.,& Kosten, T.R., (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. The American Journal of Psychiatry, 158(8), 1184-1190. doi: 10.1176/appi.ajp.158.8.1184
Lai, H.M.X., Cleary, M., Sitharthan, T & Hunt, G.E. (2015). Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: A systematic review and meta-analysis. Drug Alcohol Dependence, 154(1), 1–13. doi: 10.1016/j.drugalcdep.2015.05.031.
McCauley, J., Mercer, M.A., Brady, K.T., & Back, S.E. (2014). Trauma histories of non-treatment-seeking prescription opioid-dependent individuals. Drug and Alcohol Dependence, 140(1), e139-e140. doi: https://doi.org/10.1016/j.drugalcdep.2014.02.396
Meier, A., Lambert-Harris, C., McGovern, M.P., Xie, H., & McLeman, B. (2014). Co-occurring prescription opioid use problems and posttraumatic stress disorder symptom severity. The American Journal of Drug and Alcohol Abuse, 40(4), 304-311. doi: 10.3109/00952990.2014.910519.
Mirhashem, R., Allen, H.C., Adams, Z.W., van-Stolk-Cooke, K., Legrand, A., & Price, M. (2017). The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems. Addictive Behaviors, 69(1), 98-103. doi: https://doi.org/10.1016/j.addbeh.2017.02.012
National Academies of Sciences, Engineering, and Medicine. (2017). Pain management and the opioid epidemic: Balancing societal and individual benefits and risks of prescription opioid use. Washington, DC: National Academies Press.
National Institutes of Health. (2017). PROMIS Pain Intensity Scoring Manual [PDF file]. Retrieved from http://www.healthmeasures.net/images/PROMIS/manuals/PROMIS_Pain_Intensity_Scoring_Manual.pdf
National Institutes of Health. (2018). PROMIS Pain Interference Scoring Manual [PDF file]. Retrieved from http://www.healthmeasures.net/images/PROMIS/manuals/PROMIS_Pain_Interference_Scoring_Manual.pdf
Rampakakis, E., Ste-Marie, P. A., Sampalis, J. S., Karellis, A., Shir, Y., & Fitzcharles, M. A. (2015). Real-life assessment of the validity of patient global impression of change in fibromyalgia. RMD Open, 1(e000146). doi:10.1136/rmdopen-2015-000146.
Robinson, J., Sareen, J., Cox, B., & Bolton, J. (2009). Self- medication of anxiety disorders with alcohol and drugs: Results from a nationally representative sample. Journal of Anxiety Disorders, 23(1), 38–45. doi: https://doi.org/10.1016/j.janxdis.2008.03.013
Rosenblum, A., Joseph, H., Fong, C., Kipnis, S., Cleland, C.,& Portenoy, R.K. (2003). Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. Journal of the American Medical Association, 289(18), 2370–2378. doi: 10.1001/jama.289.18.2370
Skala, K., Reichl, L., Ilias, W., Likar, R., Grögl-Aringer, G., Wallner, C…Walter, H. (2013). Can we predict addiction to opioid analgesics? A possible tool to estimate the risk of opioid addiction in patients with pain. Pain Physician, 16(1), 593-601.
Silverman, S. M., Hansen, H., Lee, M., Patel, V. B., & Manchikanti, L. (2011). A comprehensive review of opioid-induced hyperalgesia. Pain Physician, 14(2), 145-161.
Volkow, N. (2017). Federal efforts to combat the opioid crisis: a status update on CARA and other initiatives [Transcript]. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2017/federal-efforts-to-combat-opioid-crisis-status-update-cara-other-initiatives
Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M. (2013). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at www.ptsd.va.gov
Wilsey, B.L., Fishman, S.M., Tsodikov, A., Ogden, C., Symreng, I.,& Ernst, A (2008). Psychological comorbidities predicting prescription opioid abuse among patients in chronic pain presenting to the emergency department. Pain Medicine, 9(8), 1107–17. doi: https://doi-org.lp.hscl.ufl.edu/10.1111/j.1526-4637.2007.00401.x
World Health Organization. (1996). WHOQOL-BREF: Introduction, administration, scoring and generic version of the assessment. Geneva, Switzerland: WHOQOL group.
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