A system for recording individualized behavioral data in a token program

Psychiatric comorbidity: prevalence in methadone maintenance treatment

This study examines prevalence rates for DSM-III-R anxiety and affective disorders in three follow-up samples of opioid addicts who were treated with methadone maintenance. At least one anxiety disorder was diagnosed in 55% of the total sample. Affective disorders were found in 58%. At least one anxiety disorder coexisted with at least one affective disorder in 36% of the sample. The research demonstrates that opiate addiction in this sample is most often associated with other comorbid psychopathology. It suggests a need for thorough assessment for general psychopathology in opioid addicts entering addiction treatment, especially assessment for anxiety and affective disorders. It also suggests the need for treatment that focuses on diagnosed mental disorders in addition to drug counseling for the substance abuse disorder.

Assessing pathological detoxification fear among methadone maintenance patients: the DFSS

This study assessed the reliability, validity, discriminative accuracy, and factor structure of the Detoxification Fear Survey Schedule (DFSS). Prevalence of detoxification fear and its correlates also were assessed. Random samples from three geographically, culturally, and racially disparate populations (N = 271) of treated opioid addicts were used. The DFSS had a test-retest r = .935 and demonstrated several indicants of validity. A briefer version (DFSS-14) showed superior psychometric properties and could identify correctly 81% of the detox fear subjects while it excluded 55% of nonfear subjects. The DFSS-14 had a replicated three-factor structure that accounted for 62.1% of total item variance in the validation sample. Factor two, probably best named dose reduction fear, was replicated in all populations. A cut-off score set at the nonfear mean is recommended for clinical use. A brief clinical interview of positive scorers quickly should eliminate false positives and, thus, efficiently identify most of those with detoxification fear.

Iatrogenic phobic disorders in methadone maintenance treated patients

A detoxification phobia idiosyncratic to methadone maintenance programs is described and several representative cases are presented. Reliability of diagnostic criteria for the phobia are described and their overall reliability was found to be 93% while occurrence reliability was 67%, which investigators conclude is a moderate but clinically useful level. Prevalence data show the phobia occurring in 27% of a random sample of patients treated with methadone maintenance, an estimate the investigators feel is too high to be representative of typical methadone programs. Implications for treatment are discussed.