Temperament and Character Dimensions in Opiate Addicts: Comparing Subjects Who Completed Inpatient Treatment in Therapeutic Communities vs. Incompleters

Kann die Symptombelastung einen regulären oder irregulären Behandlungsabschluss bei Substanzkonsumstörungen vorhersagen?

Ziel der Studie Das Ziel der vorliegenden explorativen Studie war zu untersuchen, ob die subjektive Symptombelastung vor und während der Behandlung von PatientInnen mit einer Substanzkonsumstörung einen Einfluss darauf hat, ob die Behandlung regulär (d. h. in gegenseitigem Einverständnis zwischen Therapeut und Patient) oder irregulär (d. h. Therapeut oder Patient bricht ab) beendet wird.

Methodik In der vorliegenden, retrospektiven Untersuchung wurden 54 PatientInnen einer Drogenentzugs- und Entwöhnungsstation untersucht. Die Informationen zur Art des Behandlungsabschlusses wurden der Basisdokumentation und zur Symptombelastung der Brief-Symptom-Checkliste (BSCL) entnommen.

Ergebnisse Die Ergebnisse der binären logistischen Regressionsanalysen zeigten, dass eine allgemeine Reduktion der Symptombelastung während der Behandlung mit einem regulären statt einem irregulären Behandlungsabschluss einherging. Die Analysen der Subskalen der BSCL ergaben signifikante Effekte für eine Abnahme der Ängstlichkeit und des Paranoiden Denkens während der Therapie zugunsten eines regulären Behandlungsabschlusses. Des Weiteren sagten hohe Werte der Zwanghaftigkeit zu Behandlungsbeginn einen regulären Behandlungsabschluss vorher.

Schlussfolgerung Bei der Behandlung von PatientInnen mit Substanzkonsumstörungen erscheint es sinnvoll, die allgemeine subjektive Symptombelastung während der Behandlung zu erfragen, um Therapieabbrüche zu vermeiden. Insbesondere sollten die Ängstlichkeit und das Paranoide Denken in den Fokus der Behandlung rücken, da diese in der vorliegenden Studie einen regulären Behandlungsabschluss vorhersagten.

Temperament and Character Profile and Its Clinical Correlates in Male Patients with Dual Schizophrenia

Personality traits are relevant in understanding substance use disorders (SUD) and schizophrenia (SZ), but few works have also included patients with dual schizophrenia (SZ+) and personality traits. We explored personality profile in a sample of 165 male patients under treatment, using the Temperament and Character Inventory-Revised. The participants were assigned to three groups of 55 patients each, according to previous diagnosis: SUD, SZ- and SZ+ (without/with SUD). We analyzed their clinical characteristics, relating them to personality dimensions. The SUD and SZ+ groups scored higher than SZ- in Novelty/Sensation Seeking. SZ- and SZ+ presented higher Harm Avoidance and lower Persistence than the SUD group. SZ+ patients showed the lowest levels of Self-directedness, while SZ- and SZ+ had higher scores in Self-transcendence than the SUD group. Several clinical characteristics were associated with personality dimensions depending on diagnosis, and remarkably so for psychiatric symptoms in the SZ- and SZ+ groups. The three groups had a maladaptive personality profile compared to general population. Our results point to different profiles for SUD versus SZ, while both profiles appear combined in the SZ+ group, with extreme scores in some traits. Thus, considering personality endophenotypes in SZ+ could help in designing individualized interventions for this group.

Personality Profile and Clinical Correlates of Patients With Substance Use Disorder With and Without Comorbid Depression Under Treatment

Background: Among patients with substance use disorder (SUD), major depressive disorder (MDD) is highly prevalent. Even though, personality plays an important role in treatment outcomes for individuals with SUD and SUD + MDD, few studies have explored personality characteristics in these samples. This study aims to describe personality for patients with SUD taking into account the comorbid MDD, using the Alternative Five Factor Model (AFFM). We also aim to compare SUD + MDD patients with population norms and to elucidate possible personality clinical correlates. Methods: For our study, 116 male patients undergoing for SUD treatment were divided in two groups: SUD only (N = 58) and SUD + MDD (N = 58). To examine personality, we used the Zuckerman-Kuhlman Personality Questionnaire and multiple analyses of covariance were performed to identify differences. In a first analysis, age was introduced as a covariate whereas in a second analysis the continuous variables that showed to have a discriminant value for the groups were added as covariates. Variables predicting the presence of dual diagnosis and personality clinical correlates were analyzed by logistic and linear regression models, respectively. We observed that patients with SUD + MDD show distinctive personality characteristics compared with patients with SUD only and population norms. Results: According to the AFFM, SUD + MDD patients are characterized by higher Neuroticism-Anxiety (positively associated to depressive symptoms) and Impulsivity; and by lower Parties and Friends. Moreover, the probability of having a dual depressive disorder was represented by the amount of medications and substances used. The preference for hard work and the energy self-reported levels (Work Activity trait) are linked to these clinical variables rather than to the presence/absence of a dual depressive disorder. Conclusions: Even when controlling clinical variables related to a higher probability of having a dual depressive disorder, the Neuroticism-Anxiety is a personality trait that strongly differentiates between SUD only and SUD + MDD patients. Further investigation is needed to explore the role of this personality trait as endophenotype in dual depressive men. Our results underline the importance of a dimensional understanding of personality and its clinical correlates among patients with SUD + MDD; this approach could provide us information on specific treatment strategies to improve the prognosis of patients.

Opposed effects of hyperthymic and cyclothymic temperament in substance use disorder (heroin- or alcohol-dependent patients)

INTRODUCTION

In the last decade, the comprehension of affective temperaments has helped us to outline the boundaries of mood disorders, and to expand our knowledge of nosographic areas other than those of affectivity, even if affectivity is closely related to them. In the field of substance use disorders, the temperamental profile of heroin addicts and alcoholics has been discussed elsewhere, but no comparison has yet been made between these two patient populations. Such a comparison would help to shed light on the pathogenetic mechanisms that link temperament with substance abuse.

METHODS

63 Heroin Use Disorder (HUD) and 94 Alcohol Use Disorder (AUD) patients were compared with 130 healthy controls, with the aim of outlining affective temperament quantity and typology according to the formulation of Akiskal and Mallya.

RESULTS

Cyclothymic temperamental quantity differentiated - both at the univariate and multivariate levels - between patients who had various different types of Substance Use Disorder, largely irrespective of the principal substance of abuse (heroin or alcohol); irritable temperament quantity differentiated HUD patients from AUD patients. Hyperthymic temperament typology seemed to be more frequent in healthy controls at both univariate and multivariate levels.

LIMITATION

Cross-sectional study.

CONCLUSIONS

Our analyses suggest that cyclothymic temperament quantity could best correspond to the temperamental profile of Substance Use Disorder patients independently of principal substance of abuse (alcohol or heroin), and that irritable temperament quantity may differentiate HUD from AUD patients. Hyperthymic temperament typology seemed to be highly protective for HUD and, though a bit less, for AUD patients, and was a typical feature of healthy controls.

Temperament and character dimensions in male patients with substance use disorders: Differences relating to psychiatric comorbidity

Previous research has not considered the influence of the Comorbid Mental Disorder (CMD) among Substance Use Disorders (SUD) patients. We explored the possible differences in personality dimensions among SUD patients taking into account their CMD (Schizophrenia, SZ; Bipolar Disorder, BD; Major Depressive Disorder, MDD); and elucidated clinical factors related to personality dimensions according to the CMD. The Temperament and Character Inventory Revised was used to assess a sample of 102 SUD male patients, considered in three groups according to their CMD: SUD+SZ (N=37), SUD+BD (N=30) and SUD+MDD (N=35). SUD+BD patients had the highest levels of Novelty Seeking and Persistence, SUD+SZ patients showed the highest levels of Harm Avoidance, and SUD+MDD patients reported a lower level of Self-transcendence. Novelty Seeking was positively associated with severity of addiction for SUD+BD; Harm Avoidance was positively associated with psychiatric symptoms for SUD+SZ; and the age of SUD onset was positively linked to Cooperativeness for SUD+BD and to Self-transcendence for SUD+MDD. The different personality characteristics associated to the type of CMD among SUD patients are related to several clinical variables. Interventions in these patients should be tailored according the personality traits that could influence treatment outcomes and patients' prognoses.

A systematic review of the methodologies used in research related to adult drug and alcohol rehabilitation in therapeutic communities published 2000-2013

Purpose

– The purpose of this paper is to summarize research conducted in long-term residential rehabilitation centers, including therapeutic communities (TCs), in order to further clarify the effectiveness of this treatment approach and to evaluate the quality of TC research conducted in the period 2000-2013.

Design/methodology/approach

– The composite search engine UQ database Summon were used to find articles with “Therapeutic Community” as title words, and the search was limited to adult participants, peer-reviewed articles, published between January 2000 and June 2013 in the English language. The review was conducted using Cochrane Collaboration methods and reported under the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

Findings

– In total, 25 studies met inclusion criteria for the review and represented data from n=5,923 participants in the USA, Australia, Spain, England, and Belgium. Evidence supports the TC approach for a diverse range of individuals who misuse a range of substances. Several studies reported a relationship between retention and outcomes however dropout from treatment is a widespread issue. A paucity of research using multiple time points precludes any firm conclusions regarding the optimal length of treatment in a TC. There is a lack of research on the interplay between individual and community-level factors on client well-being, retention, and longer term outcomes.

Research limitations/implications

– This review highlights the need for TC research that includes multiple time points and follow-up assessments, and measures of change in theoretically meaningful constructs alongside standard measures of demographics, substance use, and psychiatric symptoms.

Practical implications

– The reporting format of TC research should be better standardized in order to create a better basis for research comparison. More standardized reporting would also allow for effect size analysis, and create a more efficacious evidence base.

Originality/value

– This updates the systematic review body of research.

Personality in male patients with substance use disorder and/or severe mental illness

Dual diagnosis (DD) is the coexistence of a substance use disorder (SUD) and severe mental illness (SMI). The aim of this study is to determine for the first time if a specific personality pattern exists for DD patients compared to those who only have SUD or SMI. The sample was composed of 102 male, 34 patients in each group (DD, SUD and SMI). DD and SMI groups included 20 schizophrenic and 14 depressed patients respectively. Cloninger's TCI-R was administered together with a structured interview of sociodemographic and clinical characteristics. All the temperament dimensions and Self-directedness provided differences among groups. The DD and SUD showed significant higher scores in Novelty Seeking regarding SMI, whereas for Harm Avoidance the SUD subjects scored lower with respect to the DD and SMI group. Persistence was significant lower for the DD and SMI groups compared to the SUD patients. The DD obtained low significant scores in Reward Dependence in relation to the SUD and Self-directedness in relation to the SUD and SMI. Our data highlight the presence of a different personality profiles among DD, SUD and SMI disorders. Taking into account the patients' personality can benefit the clinical course and minimize the DD impact.

Rash impulsiveness and reward sensitivity as predictors of treatment outcome in male substance dependent patients

Recent theories hypothesize that the impulsivity observed in addictive behaviors is a two-factor construct, consisting of Rash Impulsiveness and Reward Sensitivity. There is some evidence for this distinction, but it is unknown what the clinical relevance of this distinction is. The present study examines the predictive value of the two-factor model regarding drop-out from treatment and relapse into substance use in a clinical population of male substance dependent patients. Both behavioral and self-report measures of Rash Impulsiveness and Reward Sensitivity were measured during treatment while substance use relapse was measured after 90days. Results indicate that treatment drop-out could be predicted by a behavioral index of Reward Sensitivity (Card Playing Task); self-reported Rash Impulsiveness only approached significance as predictor drop-out. In contrast, relapse could not be predicted in the present study. These findings might have implications for the early identification and treatment of patients at risk of treatment drop-out.

Impulsivity as a predictor of treatment outcome in substance use disorders: review and synthesis

ISSUES

Impulsivity is a widely studied personality trait and research construct that has been implicated as a risk factor for substance use, including initiating and continuing use. However, relatively few studies have examined impulsivity as a predictor of treatment outcome. Because impulsivity has been operationalised in many different ways, cross-comparisons of empirical studies have been difficult.

APPROACH

The PubMed database was searched in September 2013. Reference lists of papers retrieved from this search were also manually scanned for additional resources. Studies were included if they presented data that assessed impulsivity as a predictor of treatment outcomes.

KEY FINDINGS

The body of literature reviewed in this paper suggests that higher pretreatment impulsivity, regardless of how it is measured, usually is associated with poorer treatment outcomes. Recent data indicate that some psychosocial and pharmacological treatments may directly impact impulsivity and thus represent an interesting avenue for further research.

CONCLUSIONS

Impulsivity appears to be a key predictor of substance use treatment outcomes and warrants more attention in the improvement of treatment outcomes. Suggestions for future research on the role of impulsivity in substance use treatment are provided.

An exploratory study of spiritual orientation and adaptation to therapeutic community treatment

The purpose of this study was to determine the extent to which spiritual orientation was associated with adaptation to therapeutic community treatment. Spiritual orientation was assessed by the Spirituality Self-Rating Scale, a measure consistent with the conceptualization of spirituality typically reflected in Alcoholics Anonymous members' views. Spiritual orientation was positively correlated with acceptance of therapeutic community principles and clinical progress. Further assessment of spirituality related characteristics and their relation to treatment outcomes is important in informing the design of interventions aimed at improving progress in the therapeutic community, particularly those aspects involving the relative value of integrating the 12-Step group approach in therapeutic community programs.