title: Impact of lifetime psychiatric diagnosis on long-term retention and survival of former opiate addicts in methadone maintenance treatment.
abstract: OBJECTIVE
  To characterize lifetime psychiatric diagnosis groups among methadone maintenance treatment (MMT) patients and associations of diagnosis to long-term (up to 20 years) retention and survival either during treatment or post discontinuation.
  
  
  METHODS
  A total of 758 patients with available psychiatric diagnosis (98% of those ever admitted between June 1993 and June 2012) were followed-up until June 2013. Lifetime psychiatric diagnosis was assessed according to DSM-IV-TR (Axis I, II, I & II, or none). Observed urine samples at 1 and 13 months were positive for drugs if at least one was positive. Survival data were based on the Israel National Population Registry. Survival and retention in MMT were compared (Kaplan Meier) between groups.
  
  
  RESULTS
  The Axis II (personality disorders) group had the worst mean long-term retention (5.8 years, 95% Confidence Interval (CI) 5.0-6.5) compared with the Axis I, Axis I & II or no psychiatric diagnosis groups (9.6 years, 95% CI 8.8-10.4) (P < 0.0005). Mean survival since admission (16.4 years, 95% CI 15.9-16.9) was similar for all groups. Axis II patients included more males, more drug injectors, were younger at initial opiate use and more likely left treatment before 1 year.
  
  
  CONCLUSIONS
  Personality and coping mechanisms (Axis II) could be significant obstacles to the success of MMT, warranting special interventions to overcome them.
authors.affiliation: Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research , Tel Aviv , Israel.
authors.forename: Einat
authors.initials: E
authors.lastname: Peles
authors.forename: Shaul
authors.initials: S
authors.lastname: Schreiber
authors.forename: Yoav
authors.initials: Y
authors.lastname: Domany
authors.forename: Miriam
authors.initials: M
authors.lastname: Adelson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D001523:Mental Disorders / Q000150:complications* / Q000401:mortality / Q000523:psychology; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000401:mortality / Q000523:psychology / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D010554:Personality Disorders / Q000150:complications / Q000401:mortality / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: methadone maintenance treatment; opioids; personality disorders; retention; survival