The psychodynamics of opiate addiction

Opiate addicts and polydrug, but nonopiate, substance abusers were assessed for depression on the Raskin rating scale for a clinical interview and several self-report measures of depression including the Hamilton, SCL-90, and the recently developed Depressive Experiences Questionnaire (DEQ), which differentially assesses depression focused around neediness from a depression focused around self-criticism (guilt and shame). Opiate addicts were consistently more depressed than polydrug drug abusers on all the measures. On the DEQ, opiate addicts were significantly (p less than .001) more depressed than normals and even somewhat more depressed than psychiatric patients. This depression, however, was focused primarily around issues of self-criticism, guilt, and shame rather than issues of dependency, abandonment, rejection, and neglect. Even further, depression focused around self-criticism, as measured on the DEQ, was significantly correlated (p less than .001) with the extent to which the polydrug, non-opiate-addicted substance abusers had begun to experiment with opiates. These data suggest that intense depression, particularly depression focused around issues of self-criticism, has an important role in opiate addiction.