Posttraumatic stress disorder and one-year outcome in methadone maintenance treatment.
BACKGROUND
Although opiate use may be associated with posttraumatic stress disorder (PTSD), it is not clear whether PTSD is associated with retention in methadone maintenance.


OBJECTIVE
To evaluate among those receiving methadone maintenance at an urban methadone maintenance clinic the frequency of life-time traumatic experiences, the predictors and prevalence of current PTSD, and whether PTSD affects retention at 1 year.


METHODS
Eighty-nine people participated in the study. The Post Traumatic Diagnostic Scale was used to determine the prevalence of PTSD. The Life Stressor Checklist Revised was used to evaluate trauma history. Logistic regression analyses examined associations between demographic characteristics, substance use, trauma-related variables, and PTSD. Similar logistic regression analyses were used to examine retention in methadone maintenance at 1 year.


RESULTS
The mean number of reported lifetime stressful events was 8.0 (SD = 3.7). Twenty-seven percent were diagnosed with PTSD. Nearly 92% of those with PTSD had co-occurring depressive symptoms. Female gender (adjusted odds ratio [AOR][95% CI]; 3.89 [1.07-14.01]), number of traumatic events (AOR [95% CI]; 1.34 [1.13-1.61]), and less education (AOR [95% CI]; 4.13 [1.14-14.98]) were significantly associated with PTSD. Those with a toxicology positive screen were 80% less likely to remaine in methadone maintenance at 1 year (OR [95% CI]; 0.20 [0.07-0.52]). PTSD diagnosis was not significantly associated with treatment retention at 1 year (OR [95% CI]; 0.61 [0.23-1.64]).


CONCLUSIONS
Future studies are needed to determine if treatment of PTSD that is integrated into methadone maintenance programs may impact continued substance abuse use and thereby improve retention in care.
Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. shimelho@psych.umaryland.edu
Seth
S
Himelhoch
Elyssa
E
Weber
Deborah
D
Medoff
Melanie
M
Charlotte
Sara
S
Clayton
Camille
C
Wilson
Racquel
R
Ware
Jewell
J
Benford
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003863:Depression / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000453:epidemiology; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D016896:Treatment Outcome; D016903:Drug Monitoring
D000701:Analgesics, Opioid; D008691:Methadone