The daily worries and instabilities that plague opioid-dependent patients can make it difficult for providers to deliver effective long-term substance-abuse and medical treatment. Lack of information about patients’ life concerns leaves providers without direction about key issues that may cause patients to leave treatment.
In the first study to classify life concerns in drug users, investigators at Stanley Street Treatment Addiction and Recovery, Inc. (SSTAR), a detoxification facility in Fall River, Massachusetts, tallied the levels of concerns of 529 prescription-opioid or heroin users, 24.2% of whom used prescription opioids. Patients were interviewed as they entered opioid detoxification treatment between February and November 2013.
(Detoxification provides patients with a medically supervised protocol to mitigate drug withdrawal symptoms, begin counseling, and access additional treatment after discharge. Surprisingly, little research exists about the current life concerns of treatment-seeking opioid-dependent patients. This lack of information leaves treatment providers without direction about issues that could influence patients to continue treatment after detoxification and achieve long-term success.)
The study ratings were on a four-point scale, from “no concern” to “serious concern.” The study covered 43 health and welfare items in five categories: physical health, mental health, and concerns centered on economic, community safety, and relationship issues. The study was published online July 11, 2014, in the Journal of Substance Abuse Treatment.
The study sought to:
- Identify and categorize patients’ relevant life concerns
- Compare the life concerns of prescription opioid and heroin users
- Explore the association between life concerns and demographic factors
Previous studies have identified differences in clinical and demographic characteristics of prescription opioid and heroin users, as shown below:
|Type of Study
|Patients receiving methadone maintenance treatment (MMT)
|Prescription opioid (PO) users were more likely than heroin users to report pain, and more likely to receive psychiatric treatment
|Patients seeking office-based buprenorphine treatment
|PO users were more likely to test negative for hepatitis C virus, and to have fewer years of opioid use; they were also less likely to have received treatment for substance abuse
|Patients seeking short-term buprenorphine stabilization, then tapering discontinuation
|PO users were more likely to be white and employed
These underlying differences, the authors noted, may influence the life concerns of the two groups.
SSTAR detox provides only evaluation and inpatient detoxification services for patients who have a substance abuse problem with alcohol, opioids, or benzodiazepines. Average length of stay for opioid detoxification, which accounts for 80 percent of the detoxification facility’s admissions, is about six days. Affiliated SSTAR sites include Lifeline, which became a federally qualified health center (FQHC) in 1990, providing methadone, primary care, and behavioral health care to opioid-dependent patients.
- Male: 69.9%
- Non-Hispanic Caucasian: 87.5%
- Employed full- or part-time: 11.3%
- Average age: 32.2 years
- Average years of education: 11.7
- Injection drug use, past 4 weeks: 75.6%
- Recent cocaine use: 39.7%
- Recent benzodiazepine use: 46.7%
Heroin users were younger and less educated than prescription opioid users. The two groups did not differ significantly in the other characteristics listed above.
Of the 43 topics submitted, patients identified 10 areas of concern. They rated drug problems as the most serious, followed by money problems, relationship problems, mental health, and cigarette smoking. Completing the list were health insurance, alcohol problems, transmitted disease, serious physical illness, and community safety.
Life concerns and opioid type. Heroin users had significantly higher levels of concern about drug problems and transmissible diseases, and significantly less concern about alcohol-related problems. Their levels of concern for the seven other major areas did not differ significantly from those of prescription opioid users.
Life concerns and demographic factors. Age was positively and significantly correlated with concerns about alcohol problems and serious physical illness. Compared to women, men were significantly more concerned about health insurance, but significantly less concerned about mental health. Patients employed full- or part-time were significantly less concerned about money problems than those who were not.
The authors noted that opioid users often lead chaotic lives, “challenged by traumatic events, unemployment, housing and neighborhood problems, mental health disorders, stigma,” and a host of other problems. These issues may synergistically interact to undermine health, and make it difficult to set up long-term treatment.
They also commented that life concerns capture subjective worries that may influence or interact with patients’ drug-use behaviors, treatment decision-making, and the ability to engage in treatment. They suggested that by discussing patients’ health concerns with them, caregivers may be better able to plan effective relapse prevention and ongoing care.
In closing, the authors added: “Relapse prevention efforts that include linking this underserved population with appropriate resources to help them manage their life concerns may be beneficial as they plan for aftercare following discharge from detoxification.” The authors pointed specifically to motivational interventions that include discussion of the patients’ many life issues, and how the patients’ concerns may lead to ambivalence about seeking help with “what might seem to clinicians to be pressing health-related conditions.”
Stein MD, Anderson BJ, Thurmond P, Bailey GL. Comparing the life concerns of prescription opioid and heroin users [Epub July 11, 2014]. J Subst Abuse Treat. doi: 10.1016/j.jsat.2014.07.001