Investigation of mental disorders in 377 patients who met ICD-10 criteria for opioid dependence.

Clinical observation and psychological examination.

It was shown that mental disorders of opioid addicts consist of three types of psychopathological categories: pro-addictive phenomena (personality features and co-morbid disorders predisposing to drug abuse), meta-addictive disorders (psychopathological states gained due to drug abuse) and addictive disorders proper (craving and drug-seeking behavior). Anxiety and other neurotic symptoms are predominant types of mental disorders in opioid addicts. The core disorder of neurosis spectrum disturbances is fear of abstinence or withdrawal phobia. Withdrawal phobia determines largely negative reinforcement of drug. This phenomenon results in anticipating intake of drug and augmentation of daily drug dose. Opioid abuse leads to addictive personality deformation which including such features as constant and hypertrophied demand for positive emotional states, intolerance to frustration and other discomfort, low threshold of stress susceptibility and increased stress vulnerability, permanent urge to modulate the psychic and physical condition by dint of drug use, marked egocentricity and motivational collapse. Distorted motivational hierarchy can be illustrated by phenomenon of attractive taxis: opioid addicts show preference for the activities which lead to afford pleasure only. “Illegal exploitation” of reward system by means of drug abuse results in crucial extinction of non-rewarding routine activities (such as work or studies).

It appears that a stability of neurotic spectrum disorders and addictive personality deformation is the principal reason of low efficiency of opioid dependence treatment.