Predicting sobriety from the employment status of dually diagnosed clients who are opiate dependent.(Report)

The purpose of this study was to determine the relationship between Minnesota Mulfiphasic Personality Inventory-2 (E. S. Neukrug & R. C. Fawcett, 2006) profiles and employment status for clients who are opiate dependent. A discriminant function analysis indicated that employment was a predictor in maintaining sobriety after 6 months.

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To be effective, substance abuse treatment programs must use all available client and environmental resources (Dzialdowski & London, 1999; Sees et al., 2000; Stevens & Smith, 2001). Given that relapse is a major challenge in the treatment of persons who are drug dependent, intervention necessarily involves a comprehensive approach with sobriety as the primary goal (Llorento del Pozo, Ferandez, Guttirrez, & Vielva Perez, 1998; Whiston, 2005; Witkiewitz & Marlatt, 2004). Unfortunately, for persons who are drug dependent, a comorbid mental illness can interfere with treatment success (Brewer, Catalano, Haggerty, Gainey, & Fleming, 1998; McLellan et al., 1997; Solhkhah & Armentano, 2002). These dual diagnoses, in which clients' emotional problems significantly contribute to their substance abuse (Goeders, 2004; Mitra, 2000; Swartz & Lurigio, 2006), warrant special consideration. Therefore, the purpose of the current study was to determine what personal/emotional and situational variables can be used to predict sobriety among persons who are opiate dependent and dually diagnosed.

Several studies have been dedicated to demonstrating a link between mental illness and substance abuse (Lennings, 1990), a phenomenon known as the self-medication hypothesis of addiction (Goeders, 2004). This hypothesis states that individuals with mental illnesses are more likely to abuse chemicals as a way to medicate their emotional or psychological pain. This hypothesis may help to explain the high rates of dual diagnoses in the population that abuses substances. For example, Mitra (2000) illustrated this linkage in a study that found that levels of depression and social anxiety were significantly higher among individuals who actively used drugs when compared with individuals who did not use drugs or who were rehabilitated. In the same manner, Bums and Teeson (2002) found that their participants with alcohol use disorders were 4 times more likely to have an affective disorder and 3 times more likely to have an anxiety disorder than those who had no chemical dependency problems. Furthermore, Solhkhah and Armentano (2002) found that adolescents with substance use disorders exhibited a high prevalence of psychiatric disorders compared with the general population. These disorders included mood disorders, psychosis, and anxiety and personality disorders.

Further support for understanding the impact of dual diagnoses has been demonstrated by studies (e.g., Young & Weed, 2006) that attempted to identify common personality profiles of persons who were chemically dependent by using the Minnesota Multiphasic Personality Inventory (MMPI; Neukrug & Fawcett, 2006) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Neukrug & Fawcett, 2006). For example, Patalano (1998) analyzed the MMPI profiles of 160 individuals who abused substances (ages 15 to 28 years) who were tested in the 1970s. His analysis showed that 54% were classified as showing signs of characterological disorders, 32% demonstrated thinking disturbances, and 9% showed evidence of emotional disturbances. The relationship between substance abuse and anxiety was supported by Mitchell (2002), who administered the MMPI-2 to clients who were at a residential substance abuse treatment facility. Her results indicated that individuals who used heroin showed elevations on the scales (Hypochondriasis and Hysteria) that measured anxiety. In another study, Ward (1997) administered the MMPI-2 and found that men who abused substances had high levels of anxiety and depression. Similarly, Weybrew (1996) examined the MMPI profiles of U.S. Navy enlisted men who were drug dependent as well as the profiles of their non-drug-using counterparts and found that the individuals who were drug dependent had higher anxiety scores on the MMPI than those with no history of drug abuse. Finally, Patalano (1998) and Wiedemann (1996) found that their samples of dually diagnosed participants all had elevated scores on the clinical scales of the MMPI and the MMPI-2.

In contrast to the aforementioned studies, other studies have stressed that underlying emotional problems do not contribute to drug dependence or predict relapse from treatment programs. These studies have linked drug dependence with factors other than those of a psychological nature. For example, Aaron, McCabe, Gearity, and Hough (2003) demonstrated a connection between adolescents' ethnicity and prevalence rates of drug abuse. In another study of adolescent substance abuse, Kim and Fendrich (2002) found a gender connection, with female participants reporting higher levels of dependence and less need for treatment when compared with male participants. In addition to racial and gender variables, many researchers believe that environmental or situational variables seem to have a larger impact on the recovery rates from substance abuse than the presence or absence of emotional or personality variables (Devine, Brody, & Wright, 1997; Pihl, 1999; Ross, Cutler, & Sklar, 1997). Many authors have noted the importance of one of these situational variables, namely, employment status, and have called for further studies that demonstrate this connection (Blankertz, McKay, & Robinson, 1998; Burtscheidt, Schwarz, Wolwer, & Gaebel, 2001; Bush & Kraft, 2001; Craig, 2004; Drebing et al., 2002; Gunter, Black, Zwick, & Amdt, 2004; McLellan et al., 1997; McLellan et al., 2003; Petry, Tedford, & Martin, 2001; Talpade, 2003).

Research has indicated that employment is a crucial factor in helping persons who are drug dependent maintain sobriety (Cebulla, Smith, & Sutton, 2004; Gold, Meisler, DuRoss, & Bailery, 2004; Leukefeld, McDonald, Staton, & Mateyoke-Scrivner, 2004). For example, Petry et al. (2001), in describing the therapeutic preferences of adults ...