Persistence of heroin use despite methadone treatment: Poor coping self‐efficacy predicts continued heroin use

Abstract

Half of the participants (95/191) reported heroin use in the preceding 14-day period. Heroin use during methadone treatment was associated with financial problems (P = 0.008), spending time with other drug users (P < 0.001), cocaine use (P = 0.002), low mood (P = 0.002) and dissatisfaction with the daily methadone dose (P = 0.014). Compared with 'Heroin-abstinent' patients, the 'Heroin' group reported significantly lower mean coping self-efficacy scores (t = 9.8, d.f. = 182, P < 0.001, effect size 1.17). After correcting for the effects of co-variants in a logistic regression model, the main determinants of persistent heroin use were 'coping self-efficacy' [B -0.05; standard error (SE) 0.008; Wald 36.6; odds ratio (OR) 0.95, 95% confidence interval (CI) 0.94, 0.97; P < 0.001] and 'dissatisfaction with methadone dose' (B 0.93; SE 0.46; Wald 4.1; OR 2.5, 95% CI 1.03, 6.25; P = 0.042). Satisfaction with methadone dose showed no association with self-efficacy. DISCUSSION AND CONCLUSIONS; While heroin use during methadone treatment can partly be explained by inadequate dosing, our data suggest a more complex picture with significant contribution from poor coping self-efficacy. Efforts aimed at enhancing and maintaining the patients' self-efficacy and social skills are likely to improve heroin and other drug use outcomes with added benefits for treatment completion rates and the throughput of methadone programs.

Dosis de metadona y su relación con calidad de vida, satisfacción, psicopatología, rendimiento cognitivo y consumo adicional de sustancias no prescritas

“…El bloqueo químico de los receptores deposita el control sobre el médico y deja de lado intervenciones que persigan la toma de control del propio sujeto sobre su conducta. Cuando la dosis no produce aletargamiento, la persistencia en el consumo o el éxito del tratamiento dependen de variables psicoló-gicas (Senbanjo, Wolff, Marshall y Strang, 2009;Zeldman et al, 2004), la satisfacción del paciente con el tratamiento recibido es el mejor predictor de resultados (Kelly et al, 2011), los resultados dependen más de la provisión de servicios psicosociales como complementos del tratamiento farmacoló-gico (Mino et al, 1998), determinadas intervenciones psicoterapéuticas reducen las dosis necesarias (Preston, Umbricht y Epstein, 2000), las dosis bajas se muestran tan útiles como las altas cuando se combinan con tratamientos psicosociales (Langendam, Van Brussel, Coutinho y Van Ameijden, 2001) y los pacientes son capaces de autogestionar sus dosis por encima de las imposiciones de los programas (Harris y Rhodes, 2013). Este enfoque se corresponde con un estilo de provisión de cuidados orientado a la recuperación, y no al control médico/social (White y Mojer-Torres, 2010).…”

The Effect of Self-Efficacy on Treatment Outcomes of Clients Enrolled in a Methadone Treatment Program in Rural Maryland

“…After adjusting for other factors such as inadequate dose, financial difficulties, and mental health issues, persistent heroin use was linked significantly to a poor sense of self-efficacy (Senbanjo et al, 2009 …”

“…The more confidence an individual has in his or her ability to accomplish a task, the more likely they are to succeed. With regard to use of some illicit substances, higher self-efficacy has been linked to decreased use, better retention in treatment, and lower incidence of relapse (Senbanjo et al, 2009;Ciraulo et al, 2003). Knowing the benefits of higher self-efficacy, treatment providers can incorporate it's enhancement into the treatment plan for individuals with substance use disorders.…”

“…Self-efficacy in drug dependent clients promotes a sense that they can exert some amount of control over their disease, and perform their newly acquired health behaviors over time. Enhancement and maintenance of client's self-efficacy during treatment is likely to decrease their use of illicit substances, and improve retention and completion rates (Bourbeau, 2008;Senbanjo, Wolff, Marshall, & Strang, 2009). A study of 191 heroin users was performed in England, to determine the association between self-efficacy and persistent heroin use.…”

“…A study of 191 heroin users was performed in England, to determine the association between self-efficacy and persistent heroin use. After adjusting for other factors such as inadequate dose, financial difficulties, and mental health issues, persistent heroin use was linked significantly to a poor sense of self-efficacy (Senbanjo et al, 2009). …”