Understanding opiate dependence: The influence of personality disorders during detoxification
Bibliographic record
Abstract
Background: Dependence on opiates is a major health issue in North America. The recent increases in both prescription and illicit opiate abuse have exacted enormous tolls in terms of health care, mental illness, quality of life, unemployment, and crime, while the difficulty in treating opioid dependent patients with standard abstinence-based therapies is not well understood. Objectives: The objective of this study was to provide a novel approach to understanding the poor outcomes of opiate dependent patients. Addiction severity, medical, and psychiatric comorbidity among opiate-dependent patients was compared with a sedative-hypnotic control group. In addition, craving, mood, objective and subjective withdrawal symptoms, subjective experiences of pain, and objective measures of hyperalgesia were prospectively monitored during inpatient detoxification. Lastly treatment completion, entry into aftercare, and substance use at three and six months follow-up was examined. Methods: This study was conducted at the Addictions Unit of the McGill University Health Center in Montreal. A total of 106 patients were prospectively monitored during inpatient detoxification for opiate dependence or sedative-hypnotic dependence in terms of craving, mood, withdrawal symptoms, vital signs, subjective experiences of pain, and objective measures of hyperalgesia and allodynia. Patient psychiatric comorbidity (Axis I and Axis II disorders), chronic medical conditions (pain syndromes), and severity of substance dependence were also considered. Results: Opiate patients reported more subjective pain and hyperalgesia during inpatient detoxification. 76.7% reported chronic pain compared to 2.3% of sedative-hypnotic patients, and 39.5% of opiate-dependent patients had both chronic pain and a personality disorder. Cluster B personality disorders were particularly prevalent among both opiate (20.93%) and sedative-hypnotic(16.28%) patients. During treatment patients with cluster B personality disorders reported more negative mood symptoms (anger, anxiety, fatigue, confusion), craving and greater scores on objective measures of withdrawal. Completion rates of detoxification were high (83.5%), although at three months follow-up 51% of patients had slipped or relapsed.Conclusions: Together these findings suggest that hyperalgesic, highly sensitive opiate-dependent patients with cluster B personality disorders and chronic pain experience substantial difficulty tolerating both the physical and emotion symptoms of withdrawal. These particularly sensitive patients may benefit from the development of targeted interventions focusing on pain management and concurrent treatment of personality disorders.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".