Understanding opiate dependence: The influence of personality disorders during detoxification

by Kevin Hamdullahpur

Institution: McGill University
Department: Department of Psychiatry
Degree: MS
Year: 2015
Keywords: Health Sciences - Mental Health
Record ID: 2059504
Full text PDF: http://digitool.library.mcgill.ca/thesisfile130694.pdf


Background: Dependence on opiates is a major health issue in North America. The recent increases in both prescription and illicit opiate abuse have exacted enormous tolls in terms of health care, mental illness, quality of life, unemployment, and crime, while the difficulty in treating opioid dependent patients with standard abstinence-based therapies is not well understood. Objectives: The objective of this study was to provide a novel approach to understanding the poor outcomes of opiate dependent patients. Addiction severity, medical, and psychiatric comorbidity among opiate-dependent patients was compared with a sedative-hypnotic control group. In addition, craving, mood, objective and subjective withdrawal symptoms, subjective experiences of pain, and objective measures of hyperalgesia were prospectively monitored during inpatient detoxification. Lastly treatment completion, entry into aftercare, and substance use at three and six months follow-up was examined. Methods: This study was conducted at the Addictions Unit of the McGill University Health Center in Montreal. A total of 106 patients were prospectively monitored during inpatient detoxification for opiate dependence or sedative-hypnotic dependence in terms of craving, mood, withdrawal symptoms, vital signs, subjective experiences of pain, and objective measures of hyperalgesia and allodynia. Patient psychiatric comorbidity (Axis I and Axis II disorders), chronic medical conditions (pain syndromes), and severity of substance dependence were also considered. Results: Opiate patients reported more subjective pain and hyperalgesia during inpatient detoxification. 76.7% reported chronic pain compared to 2.3% of sedative-hypnotic patients, and 39.5% of opiate-dependent patients had both chronic pain and a personality disorder. Cluster B personality disorders were particularly prevalent among both opiate (20.93%) and sedative-hypnotic(16.28%) patients. During treatment patients with cluster B personality disorders reported more negative mood symptoms (anger, anxiety, fatigue, confusion), craving and greater scores on objective measures of withdrawal. Completion rates of detoxification were high (83.5%), although at three months follow-up 51% of patients had slipped or relapsed.Conclusions: Together these findings suggest that hyperalgesic, highly sensitive opiate-dependent patients with cluster B personality disorders and chronic pain experience substantial difficulty tolerating both the physical and emotion symptoms of withdrawal. These particularly sensitive patients may benefit from the development of targeted interventions focusing on pain management and concurrent treatment of personality disorders. 2. 1. RésuméContexte : La dépendance aux opiacés est un problème de santé majeur en Amérique du Nord. Les récentes augmentations de cas d'abus d'opiacés prescrits ou illicites ont eu des impacts dramatiques au chapitre des soins de santé, de la santé mentale, de la qualité de vie, du chômage et de la criminalité. Par ailleurs, la difficulté de traiter les…