Prevalence and improvement in psychopathology in opioid dependent patients participating in methadone maintenance

Questions continue in the literature concerning potential cause and effect relationships between opiate dependency and several organically-based psychiatric disorders. For example, does opiate dependency produce secondary anxiety and dysthymic syndromes in otherwise healthy persons? or is narcotics misuse by a patient an attempt to self-medicate pre-existing psychopathology? Does the severity of psychopathologic symptoms decrease with time in treatment? To resolve such questions, we routinely conduct psychiatric evaluations on all opioid dependent patients enrolled into methadone maintenance. In this study, we report upon treatment outcomes for a cohort of 71 patients evaluated for psychopathology upon intake and followed up after being in treatment for a mean time of 24.5 (SD 8.0) months. Based upon objective psychometric testing with confirmatory clinical interview, significant, longitudinal improvements were seen in the symptom severity of anxiety and dysthymia present upon intake evaluation. Personality profiles also improved with treatment. In general, patients presenting with more severe psychopathology required more visits with professional staff in order to stabilize their life situations and personal relationships. No correlation was noted between drug use and severity of psychopathology. Data support the thesis that many opioid dependent patients are self-medicating themselves for preexisting organic psychopathology, most commonly, a combined anxiety-dysthymia syndrome. Improvement seems to occur secondary to the mood stabilizing properties of methadone in disorders thought to be mediated or moderated by endogenous endorphins rather than because of psychotherapeutic interventions.