Evaluation of the suicide risk factors among methadone maintenance treatment of opiate dependent individuals: A six month assessment

Naghmeh Mokhber, Reza Afshari, Fatemeh Farhoodi

Addiction Research Centre, University of Medical Sciences, Mashhad, Iran.
Psychiatry and Behavioral Sciences Research Center of MUMS, Mashhad, Iran.

DOI: 10.4236/ojpsych.2012.22013                

Abstract

Background: Opiate abuse is a universal socio-medical problem and one of the most important risk factors for suicide, especially in accordance with other psychological disorders. This study designed to evaluate four important suicide risk factors in methadone maintenance therapy clinics within six months treatment. Method: In this cross-sectional study, a psychologist performed interviews with 82 patients who attended in methadone maintenance therapy (MMT) center of Hejazi and Ebnesina hospitals’ clinics, Mashhad, Iran. Five questionnaires including demographic characteristics, Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory (BDI) were completed at first visit and after six months treatment. Results: Eighty two individuals (68 male and 14 female) ranged between 20 to 44 years old (31.68 ± 4.93) abused mostly crystal (crystal heroein) (79.3%), opium (15.9%) then Shishe (methamphetamine) (4.9%). All studied characteristics of the patients decreased significantly after six month follow up (P < 0.01). As BAI, BHS and BSS and BDI were 33.06 ± 14.47, 6.64 ± 5.47, 3.37 ± 3.14 and 8.45 ± 6.17 respectively, before the study and 17.62 ± 8.5, 2.69 ± 2.65, 1.02 ± 1.17 and 5.81 ± 3.41 after the study period, respectively. Most of studied characteristics of the patients attempted suicide (BDI, BHS and BAI) weren’t significantly different between gender before and after the study period (P > 0.05), while BHS after MMT period decreased significantly in men (P = 0.028). Conclusion: The positive effect of methadone maintenance therapy on reduction of four important risk factors for suicide imply on another benefits of this treatment method and it is useful for reduction of suicide risk, among substance abusers.

Keywords

Methadone Maintenance Therapy; Substance Abuse; Suicide; Suicide Risk Factors

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Farrell, M., Ward, J., Mattick, R., Hall, W., Stimson, G.V., Des Jarlais, D., Gossop, M. and Strang, J. (1994) Methadone maintenance treatment in opiate dependence: A review. British Medical Journal, 309, 997-1001. doi:10.1136/bmj.309.6960.997
[2]	Cushman, P. (1981) Detoxification after methadone treatment. In: Lowinson, J.H. and Ruiz P., Eds., Substance Abuse: Clinical Problems and Perspectives, Williams and Wilkins, Baltimore, 1981.
[3]	McGlothlin, W.H. and Anglin, M.D. (1981) Long-term follow-up of clients of high- and low-dose methadone programs. Archives of General Psychiatry, 38, 1055-1063. doi:10.1001/archpsyc.1981.01780340107013
[4]	Bell, J., Hall, W. and Byth, K. (1992) Changes in criminal activity after entering methadone maintenance. British Journal of Addiction, 87, 251-258. doi:10.1111/j.1360-0443.1992.tb02699.x
[5]	Chen, V.C., Lin, T.Y., Lee, C.T., Lai, T.J., Chen, H., Ferri, C.P. and Gossop, M. (2010) Suicide attempts prior to starting methadone maintenance treatment in Taiwan. Drug and Alcohol Dependence, 109, 139-143. doi:10.1016/j.drugalcdep.2009.12.023
[6]	Maloney, E., Degenhardt, L., Darke, S. and Nelson, E.C. (2010) Investigating the co-occurrence of self-mutilation and suicide attempts among opioid-dependent individuals. Suicide and Life-Threatening Behavior, 40, 50-62. doi:10.1521/suli.2010.40.1.50
[7]	Maloney, E., Degenhardt, L., Darke, S. and Nelson, E.C. (2009) Impulsivity and borderline personality as risk factors for suicide attempts among opioid-dependent individuals. Psychiatry Research, 169, 16-21. doi:10.1016/j.psychres.2008.06.026
[8]	Darke, S. and Ross, J. (2002) Suicide among heroin users: Rates, risk factors and methods. Addiction, 97, 1383-1394. doi:10.1046/j.1360-0443.2002.00214.x
[9]	Wilcox, H.C., Conner, K.R. and Caine, E.D. (2004) Association of alcohol and drug use disorders and com- pleted suicide: Anempirical review of cohort studies. Drug and Alcohol Dependence, 76, S11-S19. doi:10.1016/j.drugalcdep.2004.08.003
[10]	Darke, S. and Ross, J. (2001) The relationship between suicide and heroin overdose among methadone maintenance patients in Sydney, Australia. Addiction, 96, 1443-1453. doi:10.1046/j.1360-0443.2001.961014438.x
[11]	Roy, A. (2002) Characteristics of opiate dependent patients who attempt suicide. Journal of Clinical Psychiatry, 63, 403-407. doi:10.4088/JCP.v63n0505
[12]	Conner, K.R., Britton, P.C., Sworts, L.M., Jr. Joiner, T.E. (2007) Suicide attempts among individuals with opiate dependence: The critical role of belonging. Addictive Behaviors, 32, 1395-1404. doi:10.1016/j.addbeh.2006.09.012
[13]	El-Bassel, N., Schilling, R.F., Turnbull, J.E. and Su, K.H. (1993) Correlates of alcohol use among methadone patients. Alcoholism: Clinical and Empirical Research, 17, 681-686. doi:10.1111/j.1530-0277.1993.tb00819.x
[14]	Darke, S., Ross, J., Lynskey, M. and Teesson, M. (2004) Attempted suicide among entrants to three treatment modalities for heroin dependence in the Australian Treatment Outcome Study (ATOS): Prevalence and risk factors. Drug and Alcohol Dependence, 7, 1-10. doi:10.1016/j.drugalcdep.2003.08.008
[15]	Phillips, J., Carpenter, K.M. and Nunes, E.V. (2004) Suicide risk in depressed methadone-maintained patients: Associations with clinical and demographic characteristics. American Journal on Addictions, 13, 327-332. doi:10.1080/10550490490482973
[16]	Chatham, L.R., Knight, K., Joe, G.W. and Simpson, D.D. (1995) Suicidality in a sample of methadone maintenance clients. American Journal of Drug and Alcohol Abuse, 21, 345-361. doi:10.3109/00952999509002702
[17]	Dolan, K., Salimi, S., Nassirimanesh, B., Mohsenifar, S., Allsop, D. and Mokri, A. (2011) Characteristics of Iranian women seeking drug treatment. Journal of Women’s Health, 20, 1687-1691. doi:10.1089/jwh.2010.2694
[18]	Dolan, K., Salimi, S., Nassirimanesh, B., Mohsenifar, S. and Mokri, A. (2011) The establishment of a methadone treatment clinic for women in Tehran. Iraian Journal of Public Health, 32, 219-330.
[19]	Beck, A.T., Ward, C., Mendelson, M., Mock, J. and Erbaugh J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571. doi:10.1001/archpsyc.1961.01710120031004
[20]	Beck, A.T., Ward, C. and Mendelson, M. (1961). Beck Depression Inventory (BDI). Archives of General Ps chiatry, 4, 561-571. doi:10.1001/archpsyc.1961.01710120031004
[21]	Beck, A.T. (1988) Beck hopelessness scale. The Psychological Corporation, San Antonio.
[22]	Beck Institute for Cognitive Therapy and Research (2007) Beck scales for adults and children.
[23]	Joseph, H., Stancliff, S., Langrod, J. (2000) Methadone Maintenance Treatment (MMT): A review of historical and clinical issues. The Mount Sinai Journal of Medicine, 67, 347-364.
[24]	Peles, E., Schreiber, S., Naumovsky, Y. and Adelson, M. (2007) Depression in methadone maintenance treatment patients: Rate and risk factors. Journal of Affective Disorders, 99, 213-220. doi:10.1016/j.jad.2006.09.017
[25]	Britton, P.C. and Conner, K.R. (2010) Suicide attempts within 12 months of treatment for substance use disorders. Suicide and Life-Threatening Behavior, 40, 14-21. doi:10.1521/suli.2010.40.1.14
[26]	Maxwell, J.C., Pullum, T.W. and Tannert, K. (2005) Deaths of clients in methadone treatment in Texas: 1994-2002. Drug and Alcohol Dependence, 78, 73-81. doi:10.1016/j.drugalcdep.2004.09.006