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Digital archive of theses discussed at the University of Pisa


Thesis etd-10252022-124605

Thesis type
Tesi di specializzazione (4 anni)
Thesis title
From harm reduction to patient-tailored therapy in Opioid Agonist Treatment (OAT): The role of psychopathology, craving behavioural covariates, and stress response in monitoring patients under OAT
Course of study
relatore Prof. Perugi, Giulio
correlatore Prof. Maremmani, Icro
  • quality of life
  • opioid agonist treatment
  • craving
  • stress sensitivity
  • psychopathology
  • Heroin Use Disorder
  • Heroin addiction
Graduation session start date
Release date
Background: A patient-tailored therapeutic approach in the field of Heroin Use Disorder (HUD) appears to be still in its early stages. The study of patients' specific psychopathology, craving behavior and stress sensitivity may provide novel information for monitoring patients under Opioid Agonists Treatment (OAT). HUD patients, during long-term treatment, tend to show an impaired capacity to experience pleasure, anhedonia, and a more severe stress reaction to life events, that may interfer with the rehabilitative program. Aims: We explored the correlations among heroin addiction-related clinical aspects (severity of addictive behavior and subjective wellness), the severity of the psychopathological symptoms and the stress-reactivity indexes (PTSD-Spectrum) in a naturalistic, observational, cross-sectional, and non-interventional cohort exploratory study. Methods: Subjects were recruited from the Drug Addiction Service (SerD) of Pisa among adult individuals who had required OAT and remained in treatment for more than one month. Individuals were interviewed during the maintenance phase of the OAT program. Results: Significant correlations were found between length of current treatment and time items and severity of heroin addictive behaviors; stress sensitivity was correlated with mental status at treatment entry, substance concurrent use, lifetime different treatment load, severity of psychopathological syndromes, and subjective wellness. HUD patients with PTSD-Spectrum (H/PTSD-S) were females with a low income. Their heroin addiction history was characterized by more severe mental status at treatment entry, more difficulties in working adaptation and legal problems during treatment, high level of psychopathology, more difficulties in wellness and more risk behaviors during treatment. Conclusions: H/PTSD-Spectrum has to be considered as an outcome of HUD, which becomes a major risk factor for the H/PTSD-S itself. Therefore, in such perspective, social and behavioral impairment in HUD patients could be considered the clinical expression of the H/PTSD-Spectrum. The very long-term outcome of HUD is actually not represented by taking drugs behaviors, rather the inability to cope with the contingent environmental conditions is the key feature of such a disorder. The H/PTSD-Spectrum, therefore, should be viewed as a syndrome caused by an acquired inability (increased salience) with respect to normal (daily) life events.