Opioid dependence latent structure: two classes with differing severity?
- Authors
- Shand, Fiona L; Slade, Tim; Degenhardt, Louisa; Baillie, Andrew; Nelson, Elliot C
- Year
- 2011
- Journal
- Addiction (Abingdon, England)
- PMID
- 21134015
- DOI
- 10.1111/j.1360-0443.2010.03217.x
- PMCID
- PMC3465731
AIMS: To examine the structure of illicit opioid abuse and dependence within an opioid dependent sample and its relationship to other clinical variables. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study of 1511 opioid dependent individuals recruited through opioid pharmacotherapy clinics in the Sydney area, Australia. MEASUREMENTS: A face-to-face structured interview covering substance use and dependence, psychiatric history, child maltreatment, family background, adult violence and criminal history. Dimensional, latent class and factor mixture models were fit to the opioid abuse and dependence data. Classes were then compared on a range of demographic and clinical covariates. FINDINGS: A two-class, one-factor model provided the best fit of all the models tested. The two classes differed with respect to endorsement probabilities on a range of abuse and dependence criteria, and also with respect to the odds of other drug dependence diagnoses, antisocial personality disorder and non-fatal opioid overdose. Within-class severity was associated with similar variables: other drug dependence, borderline personality disorder and opioid overdose. CONCLUSION: In an in-treatment, opioid-dependent sample, there appears to be two classes of individuals exhibiting distinct patterns of abuse and dependence criteria endorsement and to differ on externalizing but not internalizing disorders. This study provides preliminary evidence that the proposed DSM-V opioid use disorder distinction between moderate and severely dependent people is valid. Class one participants were not only more severely dependent, but had greater odds for opioid overdoses, other drug dependence and antisocial personality disorder.
Criteria endorsement probabilities for class 1 (74%) and class 2 (26%), n=1511
| Name | Type |
|---|---|
| abuse and dependence criteria local | phenotype |
| addiction | phenotype |
| age | phenotype |
| alcohol | phenotype |
| alcohol abuse | phenotype |
| alcohol dependence | phenotype |
| antisocial personality disorder | phenotype |
| ASPD | phenotype |
| Australia | cohort |
| axis I disorder | phenotype |
| Axis II disorders | phenotype |
| behavioral disinhibition | phenotype |
| borderline personality disorder | phenotype |
| BPD | phenotype |
| cannabis dependence | phenotype |
| cannabis use | phenotype |
| cannabis use disorder | phenotype |
| Capacity to Comply with Treatment local | phenotype |
| Categorical model local | phenotype |
| childhood trauma | phenotype |
| Christchurch Health and Development Study | cohort |
| class 1 | cohort |
| class 2 | cohort |
| cocaine | phenotype |
| cognition | phenotype |
| Comorbidity and Trauma Study local | cohort |
| Conflict between parents local | phenotype |
| Continue local | phenotype |
| Criminal justice system involvement | phenotype |
| Cut down local | phenotype |
| demographics | phenotype |
| Dependence symptoms | phenotype |
| depression | phenotype |
| Dimensional model | phenotype |
| drug | drug |
| DSM-IV opioid abuse and dependence criteria local | phenotype |
| early substance use | phenotype |
| Externalizing dimensions local | phenotype |
| externalizing disorders | phenotype |
| general population sample | cohort |
| Give up local | phenotype |
| Harmful local | phenotype |
| Hazard local | phenotype |
| heavy drinking | phenotype |
| Heroin treatment history local | phenotype |
| Hybrid model local | phenotype |
| IDU local | cohort |
| internalizing disorders | phenotype |
| Latent severity trait local | phenotype |
| Legal local | phenotype |
| legal criterion | phenotype |
| legal problems | phenotype |
| Longer local | phenotype |
| major depressive disorder | phenotype |
| Moderate Dependence local | phenotype |
| moderate opioid dependence local | phenotype |
| mood disorders | phenotype |
| morphine | drug |
| nicotine | drug |
| nicotine dependence | phenotype |
| Non-fatal Opioid Overdoses local | phenotype |
| non-fatal overdose | phenotype |
| opioid | drug |
| opioid dependence | phenotype |
| Opioid dependence severity local | phenotype |
| Opioid dependent individuals local | phenotype |
| Opioid dependent participants local | cohort |
| opioid dependent sample local | cohort |
| Opioid dependent treatment sample local | cohort |
| opioid overdose | phenotype |
| Opioid pharmacotherapy clinics | cohort |
| Opioid replacement therapy (ORT) local | drug |
| Opioid users local | phenotype |
| Opioid use (times per day during heaviest period) local | phenotype |
| ORT clinics local | cohort |
| other drug use | phenotype |
| Other externalizing disorders local | phenotype |
| other substances | phenotype |
| overdose | phenotype |
| panic disorder | phenotype |
| Performance and Image Enhancing Drugs local | drug |
| personality disorders | phenotype |
| physical abuse | phenotype |
| Polydrug dependence local | phenotype |
| Polydrug Dependence local | phenotype |
| polysubstance abuse | phenotype |
| Poorer Functioning local | phenotype |
| Post-Traumatic Stress Disorder | phenotype |
| Problem solving | phenotype |
| psychosis | phenotype |
| Role local | phenotype |
| sedative dependence | phenotype |
| sedatives | drug |
| severe alcohol use disorder | phenotype |
| Severe dependence group local | cohort |
| severe opioid dependence local | phenotype |
| sex | phenotype |
| stimulant | drug |
| stimulant dependence | phenotype |
| stimulants | drug |
| study cohort | cohort |
| substance abuse | phenotype |
| substance use | phenotype |
| suicide | phenotype |
| time | phenotype |
| tobacco use | phenotype |
| tolerance | phenotype |
| treatment | phenotype |
| treatment samples | cohort |
| withdrawal | phenotype |
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