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Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance
Journal article   Open access   Peer reviewed

Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance

Kellie M. Jaremko, Robert C. Sterling and Elisabeth J. Van Bockstaele
Journal of substance abuse treatment, v 48(1), pp 117-127
01 Jan 2015
DOI: https://doi.org/10.1016/j.jsat.2014.08.006
PMID: 25239858
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc4250337View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Methadone maintenance treatment Opioid dependence Relapse risk Stress
The present study investigated whether psychological and/or physiological measures of stress would impede induction onto methadone maintenance and predict early (<6months) discontinuation. Compared with controls, opioid-dependent subjects displayed increased distress on the perceived stress scale (PSS) and post-traumatic stress disorder checklist (PCLC); 60% exhibited abnormal cortisol. Addiction severity index (ASI), drug-use, and stress indices explained between 17 and 37% of the variance in engagement including attendance, opioid abstinence, and methadone stabilization. Participants who discontinued treatment displayed poor engagement, abnormal cortisol, elevated withdrawal symptoms, higher distress, and increased ongoing opioid use versus compliant individuals. Discontinuation was initially related to drug-use severity; however, by 6months, retention depended primarily upon cortisol abnormalities, which increased an individual's discontinuation risk by 7.7-fold. These findings support admission screening with the ASI/cortisol for drop out, and stress/drug-use indices for engagement that together may enable clinically-relevant early recognition and interventions for prevention of stress-induced relapse in opioid-dependent populations. •Abnormal cortisol levels, elevated perceived stress and increased post-traumatic stress disorder symptoms are present in opioid-dependent individuals seeking treatment compared with controls or normative values.•Six months after admission, methadone maintenance non-completers exhibit increased withdrawal symptoms, distress, and abnormal cortisol.•Engagement in treatment, including attendance, opioid abstinence, and stabilization, can be predicted by perceived stress and drug severity assessed at admission.•Premature discontinuation from methadone maintenance treatment is negatively influenced by drug severity at 3months and the presence of abnormal cortisol by 6months.

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50 citations in Web of Science
53 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Psychology, Clinical
Substance Abuse
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