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Heroin Addiction and Related Clinical Problems: 2023, 25, N2 (pages: 37 - 44)

Insight in dual disorder heroin addicts. Are they able to request adequate treatment?

Pacini M., Maremmani A.G.I., Della Rocca F., Miccoli M., and Maremmani I.

Summary: Background. The insight of heroin addicts seeking treatment is poor on average, but little is known about the insight of dual disorder patients. Methods. We examined 105 patients applying for consultation in a private setting. We divided them into two groups according to self-presentation as either single or dual disorder, apart from the actual diagnoses made by clinicians. Results: The presentation was partly consistent with treatment history and the actual diagnostic status, but erroneous attribution of symptoms to addiction rather than dual disorder was much quieter frequent than vice-versa. Patients overrating addiction as the source of their discomfort had a higher rate of cocaine use disorder and administration of antidepressants. Patients whose presentation was discordant from the actual diagnosis had a higher rate of (unrecognised) bipolar disorder and benzodiazepine use disorder. Based on the undermedication of patients presenting themselves as a single diagnosis, there was an inconsistent trend towards antidepressant medication, possibly conceived against the effects of cocaine intoxication. A diagnosis of bipolar disorder increased the likelihood of mistaking their dual disorder for substance-related intoxication. Conclusion. Clinicians should be aware of the reasons for failing self-presentation of dual disorder heroin addicts and be skilled in differential diagnosis from transient substance intoxication or withdrawal.