heroinaA study performed at the Addictions and Dual Pathology section of the Department of Psychiatry at the Vall d’Hebron University Hospital and the Vall d’Hebron Research Institute (VHIR) found that virtually 7 out of 10 of patients treated in Spanish health centers for heroin addiction, suffer at least one associated psychiatric disorder.

The study analyzed data of 621 patients treated for heroin addiction, provided by 74 institutions. This figure makes it a pioneer study in providing a very detailed picture of psychiatric problems arising from the use of heroin, as explained by its coordinator, Carlos Roncero. The study has recently been published in Psychiatry Research.

According with the results, 84% of patients who participated in the study are men, who are mostly under 40 years old. 47% are unemployed and 19% have legal problems. Almost all, 94%, are being treated with methadone. The majority (82%) have other types of addictions (mostly tobacco, alcohol and cannabis), and 59% also suffers at least an infectious disease, such as hepatitis C or HIV infection.

Psychiatric Comorbidity

The study showed that 67% of the analyzed cases presented a dual pathology, i.e. presenting more than one psychiatric disorder at a time. The most common is anxiety, present in 53% of the participants, followed by changes in mood (48%), sleep disturbances (41%) disorders related to substance use (36%) and personality disorders (27%).

Schizophrenia and other psychotic disorder affected 12% of patients, more commonly in those who also abuse cocaine. The proportion of patients with at least one psychiatric comorbidity increased significantly in relation with the methadone dose received, according to the study authors. These problems are “markers of possible relapses,” which must be taken into account.  For this reason, it is necessary to evaluate “all addicted patients, especially those heroin-dependent” to search “if there are other disorders, especially those receiving high doses of methadone,” added Roncero.

Another notable factor is the difference of the detected disorders between men and women. Women have more sexual and gender identity disorders. A “expected” finding, according to Roncero, but warns that when analyzing this data, it is important take into account the low number of women participating in the study.

A Problem of Underdiagnoses

For the expert, the study shows that psychiatric comorbidity in drug abusers is untreated. Acording with the results, 12% does not receive or only partially receive a specific drug treatment for their psychiatric comorbidity. This data does not indicate the “malpractice” of professionals, he says, but it indicates that is important prepare them to detect this conditions, improve the diagnostic process and management.

The problem is that “the symptoms are hidden,” he explained, “by the heroin dependence, which is very serious.” They are “very complicated patients, who need more evaluation time, to find all the problems arising from their dependence,” said the study coordinator.

When dealing with these cases, specialists must consider that patients with associated psychiatric disorders have more severe problems in all the aspects of their life, including health, work, family and legal problems, he said.

This fact, coupled with the differences between men and women, suggest that it is necessary to adopt a gender perspective in treatment.


Source: Agencia SINC