The Psychodynamics of Opiate Addiction

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Opiate addicts and polydrug, but nonopiate, substance abusers were assessed for depression on the Raskin rating scale for a clinical interview and several self-report measures of depression including the Hamilton, SCL-90, and the recently developed Depressive Experiences Questionnaire (DEQ), which differentially assesses depression focused around neediness from a depression focused around self-criticism (guilt and shame). Opiate addicts were consistently more depressed than polydrug drug abusers on all the measures. On the DEQ, opiate addicts were significantly (p < .001) more depressed than normals and even somewhat more depressed than psychiatric patients. This depression, however, was focused primarily around issues of self-criticism, guilt, and shame rather than issues of dependency, abandonment, rejection, and neglect. Even further, depression focused around self-criticism, as measured on the DEQ, was significantly correlated (p < .001) with the extent to which the polydrug, non-opiate-addicted substance abusers had begun to experiment with opiates. These data suggest that intense depression, particularly depression focused around issues of self-criticism, has an important role in opiate addiction.

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