This study assesses patients currently in treatment (baseline visit) for their opioid and potentially other substance use disorder(s) who are not presently clinically stable, which we defined a priori as early (first 6 months) in treatment or in treatment longer but self-report having used opioids during the past month. As this programmatic research is thematically focused on BZD/opioid polysubstance use, we attempted to recruit a sample enriched with individuals with a history of BZD misuse in addition to their opioid misuse; however, we did not explicitly require a history of, or current, use of BZDs to be enrolled in this study.
First, we defined BZD misuse history based on two lifetime factors, either: (1) any BZD misuse based on a “yes” response to the question, “Have you ever used sedatives/hypnotics not as prescribed intending to get high,” on the Drug History and Use Questionnaire DHUQ (described in Section “2.3.4. Substance use”), or (2) diagnosis of sedative use disorder involving a BZD based on the SCID diagnostic interview (described in Section “2.3.5. Psychopathology and affective dysregulation”). Any participant meeting at least one of these two criteria was classified as a lifetime BZD misuser, and any participant not meeting either criterion was classified as a BZD never-misuser. Importantly, any participant who reported using BZDs as exactly prescribed for them throughout their lifetime, and denied misuse, was classified as a never-misuser. Second, to account for possible temporal variation in the effects of BZD misuse or abstinence, we defined differences in recency of BZD misuse as either (1) more than 1 year ago, or (2) within the past year, relative to the date of the initial screening visit. Participants who reported BZD misuse more than 1 year prior, or met DSM-5 criteria for partially remitted or past sedative use disorder were classified as misusers more than a year ago. Participants who reported BZD misuse within the past year, or met DSM-5 criteria for current (past-year) sedative use disorder involving a BZD, were classified as past-year misusers. Thus, we formed three distinct groups for analyses: (1) never misuse, (2) misuse > 1 year ago, and (3) past-year misuse of BZDs.
All participants are adults, ages 18–70 years old enrolled in a substance use disorder treatment program (outpatient or residential) in the Detroit metropolitan region. Exclusion criteria were estimated IQ < 80, expired breath alcohol > 0.02% breath alcohol concentration, neurological disorders that affect cognition, and current psychosis or suicidality. This study is also approved to re-contact participants (in-person or remotely) for 3-month follow-up assessment; these follow-up data will be reported elsewhere.
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Greenwald M.K., Moses T.E., Lundahl L.H, & Roehrs T.A. (2023). Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder. Frontiers in Psychiatry, 14, 1103739.