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Experiences of Codeine Use, Misuse and Dependence: Application of Liese and Franz's Cognitive Developmental Model of Substance Abuse

Published online by Cambridge University Press:  10 February 2017

Marie Claire Van Hout ,
Ian Norman ,
Eileen Rich  and
Michael Bergin
Marie Claire Van Hout*
Affiliation:
School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
Ian Norman
Affiliation:
Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
Eileen Rich
Affiliation:
Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
Michael Bergin
Affiliation:
School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
*
*Correspondence to Marie Claire Van Hout, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland. E-mail: [email protected]
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Abstract

Background: Misuse of codeine-containing medicines is an emerging public health issue. Aims: We present the application of Liese and Franz's (1996) cognitive developmental model of substance abuse to the trajectory from legitimate codeine use for pain, towards that of therapeutic and other forms of misuse, and physical and psychological dependence. It illustrates a cognitive behavioural analysis of the experiences of codeine misusers – which ‘surfaces’ the specific beliefs, thoughts, emotions and behaviours of this group of hidden codeine dependent individuals, who are distinct and unique from other opioid-dependent cohorts. Method: In-depth one-to-one interviews with codeine misusers and dependent individuals in Ireland (n = 21) and South Africa (n = 25) are analysed and applied to Liese and Franz's (1996) cognitive developmental model of substance abuse. Results: Misuse and dependence pathways are maintained by the interplay between physiological determinants relating to pain, withdrawal and tolerance, and psychological influences such as therapeutic need, pre-empting of anticipated physical pain, pleasure from the dreamy sedative opiate effect of codeine and relief of emotional distress. Progression towards habitual use and misuse for therapeutic and intoxication purposes appears to be mediated by external environmental triggers pertaining to availability, internal meta-cognitions around physical pain and emotional distress, and increasing importance of codeine in the life of the user. Conclusion: The concept mapping of codeine misuse and dependence presented here could provide psychological therapists working with individuals experiencing problems with codeine, misusing codeine and those with iatrogenic dependence, with an enhanced understanding of the key concepts involved in misuse and recovery pathways.

Keywords

codeinepainaddictioncognitive behavioural therapyopioid
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 45 , Issue 3 , May 2017 , pp. 238 - 252
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Alford, E. A. and Nocross, J. C. (1991). Cognitive therapy as integrative therapy. Journal of Psychotherapy Integrations, 1, 175–190.CrossRefGoogle Scholar
Agyapong, V. I. O., Singh, K., Savage, M., Thekiso, B. T., Finn, M., Farren, C. K. and McLoughlin, D. M. (2013). Use of codeine containing medicines by Irish psychiatric in-patients before and after regulatory limitations on their supply. Irish Journal of Psychological Medicine, 30, 7–12.Google Scholar
Babalonis, S., Lofwall, M. R., Nuzzo, P. A., Siegel, A. J. and Walsh, S. L. (2013). Abuse liability and reinforcing efficacy of oral tramadol in humans. Drug and Alcohol Dependence, 129, 116–124. doi: 10.1016/j.drugalcdep.2012.09.018 Google Scholar
Beck, A. T., Wright, F. D., Newman, C. F. and Liese, B. S. (1993). Cognitive Therapy of Substance Abuse. New York: The Guilford Press.Google Scholar
Beck, A. T. and Alford, B. A. (2000). O poder integrador da terapia cognitiva. (Tradução organizada por M. C. Monteiro). Porto Alegre: Artes Médicas (original publicado em 1996).Google Scholar
Borland, R. (2014). Understanding Hard to Maintain Behaviour Change: A Dual Process Approach. Chichester, UK: John Wiley and Sons.Google Scholar
Casati, A., Sedefov, R. and Pfeiffer-Gerschel, T. (2012). Misuse of medicines in the European Union: a systematic review of the literature. European Addiction Research, 18, 228–245.Google Scholar
Collins, G. B. and McAllister, M. S. (2006). Combating abuse and diversion of prescription opiate medications. Psychiatric Annals, 36, 410–416.Google Scholar
Cooper, R. J. (2011). Respectable Addiction – a qualitative study of over the counter medicine abuse in the UK. Sheffield, UK: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.Google Scholar
Cooper, R. J. (2013a). Over-the-counter medicine abuse: a review of the literature. Journal of Substance Use, 18, 82–107.Google Scholar
Cooper, R. J. (2013b). ‘I can't be an addict. I am.’ Over-the-counter medicine abuse: a qualitative study. British Medical Journal Open, 3, 1–9. e002913. doi: 10.1136/bmjopen-2013-002913 Google Scholar
Derry, S., Karlin, S. M. and Moore, R. A. (2013). Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database of Systematic Reviews, 14, 4: CD008099. doi: 10.1002/14651858.CD010107.pub3 Google Scholar
Frei, M. Y., Nielsen, S., Dobbin, M. and Tobin, C. L. (2010). Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. The Medical Journal of Australia, 193, 294–296.CrossRefGoogle ScholarPubMed
Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W. and Strang, J. (1995). The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction, 90, 607–614.Google Scholar
Hard, B. (2014). Management of opioid painkiller dependence in primary care: ongoing recovery with buprenorphine/naloxone. British Medical Journal Case Reports, pii: bcr2014207308. doi:10.1136/bcr-2014-207308 Google Scholar
Karlsson, G. (1995). Psychological Qualitative Research from a Phenomenological Perspective (2nd edn). Göteborg, Sweden: Almqvist and Wiksell International.Google Scholar
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.CrossRefGoogle ScholarPubMed
Kean, J. (2015). Illicit and over-the-counter codeine dependence after acute back pain-successful treatment and ongoing recovery after buprenorphine/naloxone taper. Heroin Addiction and Related Clinical Problems, 5–8.Google Scholar
Liese, B. S. and Franz, R. A. (1996). Treating substance use disorders with cognitive therapy: Lessons learned and implications for the future. In Salkovskis, P. (ed), Frontiers of Cognitive Therapy (pp. 470–508). New York: Guilford Press.Google Scholar
Liese, B. S., Beck, A. T. and Seaton, K. (1999). The cognitive therapy addictions group. In Brook, D. W. and Spitz, H. I. (eds), Group Psychotherapy of Substance Abuse. Washington, DC: American Psychiatric Press.Google Scholar
Liese, B. S. (2014). Cognitive behavioral therapy for addictions. In Straussner, S. L. A. (ed), Clinical Work with Substance Abusing Clients (3rd edn, pp. 225–250). New York: Guilford Press.Google Scholar
Liese, B. S. and Esterline, K. M. (2015). Concept mapping: a supervision strategy for introducing case conceptualization skills to novice therapists. Psychotherapy, 52, 190–194.CrossRefGoogle ScholarPubMed
Lincoln, Y. S. and Guba, E. G. (1985). Naturalistic Inquiry. Beverly Hills, California: Sage Publications.Google Scholar
Marr, E. and Hill, D. (2015). Optimising service provision for prescribed opioid analgesic dependence. Heroin Addiction and Related Clinical Problems,17, 13–18.Google Scholar
McAvoy, B. R., Dobbin, M. D. H. and Tobin, C. L. (2011). Over-the-counter (OTC) ibuprofen/codeine analgesics: misuse and harm: characteristics of cases in Australia and New Zealand. New Zealand Medical Journal, 124, 29–33.Google Scholar
Myers, B., Siegfried, N. and Parry, C. D. H. (2003). Over-the-counter and prescription medicine misuse in Cape Town -findings from specialist treatment centres. South African Medical Journal, 93, 367–370.Google Scholar
Nielsen, S., Bruno, R., Carruthers, S., Fischer, J., Lintzeris, N. and Stoove, M. (2008). Investigation of Pharmaceutical Misuse Amongst Drug Treatment Clients. Melbourne, Australia: Turning Point Alcohol and Drug Centre.Google Scholar
Nielsen, S., Cameron, J. and Pahoki, S. (2010). Over-the-Counter Codeine Dependence. Melbourne, Australia: The Turning Point Alcohol and Drugs Centre.Google Scholar
Nielsen, S., Cameron, J. and Lee, N. (2011). Characteristics of a nontreatment-seeking sample of over-the-counter codeine users: implications for intervention and prevention. Journal of Opioid Management, 7, 363–370.Google Scholar
Nielsen, S., Cameron, J. and Pahoki, S. (2013). Opportunities and challenges: over-the-counter codeine supply from the codeine consumer's perspective. The International Journal of Pharmacy Practice, 21, 161–168. doi: 10,1111/j.2042-7174.2012.00247.x Google Scholar
Nielsen, S., Bruno, R., Murnion, B., Dunlop, A., Degenhardt, L., Demirkol, A. et al. (2015a). Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug and Alcohol Review. Early online. doi: 10.1111/dar.12315 Google Scholar
Nielsen, S., Murnion, B., Dunlop, A., Degenhardt, L., Demirkol, A., Muhleisen, P. et al. (2015b). Comparing treatment-seeking codeine users and strong opioid users: findings from a novel case series. Drug and Alcohol Review, 34, 304–311. doi: 10.1111/dar.12315 CrossRefGoogle ScholarPubMed
Nielsen, S., Roxburgh, A., Bruno, R., Lintzeris, N., Jefferson, A. and Degenhardt, L. (2015c). Changes in non-opioid substitution treatment episodes for pharmaceutical opioids and heroin from 2002 to 2011. Drug and Alcohol Dependence, 149, 212–219.Google Scholar
Otto, C., Crackau, B., Lӧhrmann, I., Zahradnik, A., Bischof, G., John, U. and Rumpf, H. J. (2009). Brief intervention in general hospital for problematic prescription drug use: 12-month outcome. Drug and Alcohol Dependence, 105, 221–226. doi: 10.1016/j.drugalcdep.2009.07.010 Google Scholar
Pates, R., McBride, A. J., Li, S. and Ramadan, R. (2002). Misuse of over-the-counter medicines: a survey of community pharmacies in the South Wales health authority. Pharmaceutical Journal, 268, 179–182.Google Scholar
Robinson, G. M., Robinson, S., McCarthy, P. and Cameron, C. (2010). Misuse of over-the-counter codeine containing analgesics: dependence and other adverse effects. New Zealand Medical Journal, 123, 59–64.Google Scholar
Romach, M. K., Sproule, B. A., Sellers, E. M., Somer, G. and Busto, U. E. (1999). Long-term codeine use is associated with depressive symptoms. Journal of Clinical Psychopharmacology, 19, 373–376.CrossRefGoogle ScholarPubMed
Roussin, A., Bouyssi, A., Pouche, L., Pourcel, L. and Lapeyre-Mestre, M. (2013). Misuse and dependence on non-prescription codeine analgesics or sedative h1 antihistamines by adults: a cross-sectional investigation in France. Public Library of Science One, 8, 1–10; e76499.Google Scholar
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N. and Stanton, M. V. (2004). Toward a syndrome model of addiction: multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367–374. doi:10.1080/10673220490905705 Google Scholar
Shaffer, H. J., LaPlante, D. A. and Nelson, S. E. (eds). (2012). The APA Addiction Syndrome Handbook (vol. 1. Foundations, Influences, and Expressions of Addiction). Washington, DC: American Psychological Association Press.Google Scholar
Sproule, B. A., Busto, U. E., Somer, G., Romach, M. K. and Sellers, E. M. (1999). Characteristics of dependent and nondependent regular users of codeine. Journal of Clinical Psychopharmacology, 19, 367–372.Google Scholar
Stannard, C. (2013). Opioids in the UK: what's the problem? British Medical Journal, 347, f5108. doi: 10.1136/bmj.f5108 Google Scholar
Thekiso, B. and Farren, C. (2010). ‘Over the counter’ (OTC) opiate abuse treatment. Irish Journal of Psychological Medicine, 27, 189–191.Google Scholar
Tobin, C., Dobbin, M. and McAvoy, B. (2013). Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom. Australian and New Zealand Journal of Public Health, 37, 483–488.Google Scholar
Tremlett, M., Anderson, B. J. and Wolf, A. (2010). Pro-con debate: is codeine a drug that still has a useful role in pediatric practice? Pediatric Anesthesia, 20, 183–94. doi: 10.1111/j.1460-9592.2009.03234.x CrossRefGoogle Scholar
Van Hout, M. C., Bergin, M., Foley, M., Rich, E., Rapca, A. I., Harris, R. and Norman, I. (2014). A scoping review of codeine use, misuse and dependence, final report. CODEMISUSED Project European Commission 7th Framework Programme, EU. Brussels.Google Scholar
Van Hout, M. C., Delargy, I., Ryan, G., Flanagan, S. and Gallagher, H. (2015a). Dependence on over the counter (OTC) codeine containing analgesics: treatment and recovery with buprenorphine naloxone. International Journal of Addiction and Mental Health. Early online.Google Scholar
Van Hout, M. C., Horan, A., Santlal, K., Rich, E. and Bergin, M. (2015b). ‘Codeine is my companion’: misuse and dependence on codeine containing medicines in Ireland. Irish Journal of Psychological Medicine. Early online. doi:10.1017/ipm.2015.60 Google Scholar
Van Hout, M. C. and Norman, I. (2015c). Misuse of non-prescription codeine containing products: Recommendations for detection and reduction of risk in community pharmacies. International Journal of Drug Policy, Early online. doi: 10.1016/j.drugpo.2015.09.007 Google Scholar
Van Hout, M. C., Rich, E., Dada, S. and Bergin, M. (2015d). Codeine is my helper: a qualitative study of pharmacy access and codeine misuse in South Africa. Qualitative Health Research. Early online. doi: 10.1177/1049732315613764 Google Scholar
West, R. (2005). Theory of Addiction. Oxford, UK. Blackwell Publishing. ISBN: 101-4051-1359-1366.Google Scholar
West, R. (2013). Models of Addiction. Portugal, Lisbon: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).Google Scholar
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