A prospective study of psychopathology stability and changes after 3-month residential treatment in italian substance use disorder patients

Background: Using the SCL-90 checklist, we previously showed that a cluster of five psychopathological symptoms could be found in Heroin Use Disorder patients. This aggregation demonstrated a high specificity for Substance Use Disorder (SUD) patients. In this prospective study, we have explored the consistency across time of these dimensions by considering psychopathological stability and changes after 3-month residential treatment (TC: therapeutic community) in Italian SUD patients. Methods: 636 subjects with SUD according to DSM-IV diagnostic criteria, 558 (87.7%) male and 78 (12.3%) females, mean age 36.23 ± 8.8 years, were evaluated at treatment entry and after three months during their stay in a TC. All patients recruited for this study had been detoxified elsewhere. Results: After a 3-month period in a TC, the severity of all psychopathological dimensions decreased significantly over time. This development was especially frequent in subjects characterized by predominant Worthlessness-Being Trapped (W/BT), Somatic Symptoms (SS) and Sensitivity-Psychoticism (S/P) symptomatology, whereas a majority of Panic Anxiety (PA) and Violence-Suicide (V/S) subjects remained unchanged or showed a worsening of their symptoms. The baseline PA subjects appeared to be the most stable over time, followed by S/P, then by V/S, then by SS, and, lastly, by W/BT subjects. Stable W/BT patients showed greater severity in their baseline symptomatology, while stable PA patients showed lower severity. The only prediction of psychopathological stability arose from the 3-month PA score for severity. By contrast, V/S baseline severity, W/BT and S/P baseline typology all indicated psychopathological instability. Conclusions: After continuing for three months in a TC, a general reduction of SCL-90 severity is accompanied by a reduction in the frequency of the dimensions most closely linked with the intoxication/withdrawal state and with active substance abuse-related behaviour (SS and W/BT). The less frequent change regards patients allocated to the dimensions most involved in addiction processes (PA and V/S).