Hege Kornør

Five-factor model personality traits in opioid dependence.

BackgroundPersonality traits may form a part of the aetiology of opioid dependence. For instance, opioid dependence may result from self-medication in emotionally unstable individuals, or from experimenting with drugs in sensation seekers. The five factor model (FFM) has obtained a central position in contemporary personality trait theory. The five factors are: Neuroticism, Extraversion, Openness to Experience, Agreeableness and Conscientiousness. Few studies have examined whether there is a distinct personality pattern associated with opioid dependence.MethodsWe compared FFM personality traits in 65 opioid dependent persons (mean age 27 years, 34% females) in outpatient counselling after a minimum of 5 weeks in buprenorphine replacement therapy, with those in a non-clinical, age- and sex-matched sample selected from a national database. Personality traits were assessed by a Norwegian version of the Revised NEO Personality Inventory (NEO PI-R), a 240-item self-report questionnaire. Cohens d effect sizes were calculated for the differences in personality trait scores.ResultsThe opioid-dependent sample scored higher on Neuroticism, lower on Extraversion and lower on Conscientiousness (d = -1.7, 1.2 and 1.7, respectively) than the controls. Effects sizes were small for the difference between the groups in Openness to experience scores and Agreeableness scores.ConclusionWe found differences of medium and large effect sizes between the opioid dependent group and the matched comparison group, suggesting that the personality traits of people with opioid dependence are in fact different from those of non-clinical peers.

Abstinence‐orientated buprenorphine replacement therapy for young adults in out‐patient counselling

This study assessed treatment retention, compliance and completion of a 9-month buprenorphine replacement programme. In addition, changes in drug use and other relevant variables, as well as predictors of completion, were examined. Seventy-five opioid-dependent out-patients (mean age 26 years; 33% females) who aimed for opioid abstinence were enrolled into the study. Assessments were undertaken prior to buprenorphine induction and again at 3, 6 and 9 months. Forty patients (53%) completed the buprenorphine programme. At 9 months, 67 patients (87%) were still in counselling. Mean attendance rates for buprenorphine dosing and counselling sessions were 0.91 and 0.74, respectively. There were significant and persistent reductions in drug use during treatment with, however, a reversed tendency in the 9th month. Psychiatric problems escalated at 9 months, and three patients died during the detoxification phase. Completion was predicted by fewer previous treatment episodes. Detoxification from buprenorphine is associated with substantial psychological distress and an increased death risk. Buprenorphine replacement therapy should be continued until the patient chooses to leave, and close monitoring during the detoxification phase is essential.

Abstinence-oriented therapies for opiate addicts

Purpose of review Maintenance treatment is increasingly emphasized as the main therapy of opioid dependency. Abstinence-oriented therapy is nevertheless an important alternative and has considerable advantages for those benefiting from this strategy. This review aims to evaluate recent research on abstinence-oriented approaches in the light of earlier findings. Recent findings In the treatment of addiction, assessment has increased in importance. Abstinence-oriented treatment must take psychopathology into consideration and secure adequate treatment for mental problems. Recent research concentrates mainly on opioid maintenance, however this is mostly in the short term. Further, there is a possibility of bias in favour of psychopharmacological interventions. Improved detoxification technology increases compliance but follow-up treatment is found to be crucial in further development. Use of antagonists bears some promise if strengthened by reinforcement and community follow-up. Depot formulations might increase usefulness, but basic research is incomplete. Incentives with vouchers may also increase compliance and to some extent stabilize patients in treatment. Summary There is ample evidence that some opioid addicts do attain long-lasting abstinence. Psychosocial approaches are important and the treatment system should not only emphasize maintenance treatment. Research is important both to clarify which patients are best suited to these treatment traditions and to ascertain what combinations of abstinence and maintenance-oriented programs are optimal. Community reinforcements and antagonist preparations with prolonged effects are particularly important research areas.