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Heroin Addiction and Related Clinical Problems: 2013, 15, 2 (pages: 37 - 46)

Psychopathological symptoms of heroin addicts at treatment entry

Maremmani I., Pani P. P., Maremmani A. G. I., Pacini M., Bizzarri I. V., Trogu E., Rovai L., Bacciardi S., Rugani F., Perugi G., Gerra G., and Dell'osso L.

Summary: Patients with substance use disorder (SUD) show a high rate of comorbidity with other mental disorders, particularly those involving mood, anxiety and impulse control. In addition, an equally strong correlation has been shown between psychotic disorders and substance use disorder (SUD). Application of the classic model of psychiatric comorbidity to the field of drug addiction is subject to limitations: the first is that the high frequency of co-occurrence of these two psychopathological events raises doubts as to their independence; the second is the insoluble problem of disentangling psychiatric symptoms from the heart of the psychopathology of drug addiction; lastly, the overlap between the biological substrates and the neurophysiology of addiction and psychiatric disorders cannot be disregarded. With this in mind, we have theorized that symptoms of mood swings, anxiety and impulse dyscontrol should be considered as constituting the psychopathology of addiction. We put forward the hypothesis that the dysregulation of the opioid system, that is determined by the chronic use of heroin, could give rise to a wide range of psychopathological symptoms that are prominent in distinguish heroin addicts, this being true regardless of the co-occurrence of another mental disorder, factors related to gender, education, history of abuse, the modality of abuse and treatment undertaken by patients in their history. We have considered 5 dimensions: 1. feelings of “worthlessness and being trapped”; 2. “somatic symptoms”; 3. “sensitivity-psychoticism”; 4. “panic anxiety”; 5. “violence-suicide”. Although these symptoms do not always reach the threshold that would qualify them as belonging to a psychiatric syndrome, their impact on a patient's life must be recognized; above all, these symptoms should be treated as belonging to the context of the treatment of drug dependence.