Influence of psychiatric disorders in the effectiveness of a long-term methadone maintenance treatment

Abstract

Objectives: To obtain knowledge of the psychiatric disorders of a heroin dependent population undergoing MMT and the influence of such on the outcomes of treatment for dependence.

Methods: 132 opiate dependents undergoing MMT in Drug Addiction Treatment Unit, Avilés (Spain) were followed-up over 6 years of treatment. At the beginning and after 6 years of treatment an «Ad hoc» protocol (sociodemographic and clinical variables) was administered. Analyses of HIV and urine (opiates, cocaine and benzodiacepines) were made throughout treatment. The Goldeberg Anxiety and Depression Scale (GADS) and the International Personality Disorder Examination (IPDE) were also administered.

Results: The effectiveness of MMT was high, with evident social and clinical improvement. The following disorders were diagnosed: affective 29.7%, anxiety 19.1%, psychotic 11.8% and personality 51.1%. Anxiety and affective disorders were related with heroin and benzodiacepine use and with being HIV+. Personality disorders were more prevalent in older addicts, those unemployed and patients with court cases pending, and in those with cocaine and benzodiacepine use. Dose of methadone was not related with psychiatric disorders.

Conclusions: Psychiatric disorders (affective, anxiety and personality disorders) were frequent and linked to worse treatment outcomes (drug use, criminal activities). In some patients, there was a HIV-depression-drug use relationship, and these patients clearly need a specific psychosocial intervention. In order for MMT programmes to be more effective greater attention needs to be paid to mental health problems in these patients.