Date of Award

2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Psychology

Department

Psychology

First Advisor

Robert G. Laforge

Abstract

Objective: To identify risk and protective factors for return to opioid use post inpatient detoxification in a sample of persons with opioid use disorder (OUD).

Design and Methods: This study used data from a larger randomized controlled study following 206 eligible individuals who entered in-patient detoxification for OUD. Participants entered the study as part of the observation arm and were assessed for six months following in-patient detoxification. Timeline follow-back assessment was used to identify if and when participants returned to opioid use post-detoxification. A series of bivariate and multivariate logistic regressions were used to identify risk and protective factors associated with any opioid use over the course of the study, including interactions of variables. Then, survival analyses were used to investigate covariates in relation to return to opioid use.

Results: Multivariate logistic regression analyses identified childhood sexual assault, the interaction of sex ´ injection drug use, and the interaction of post-detox plan x health insurance as risk factors for post-detox opioid use. Expectation of treatment success was identified as a protective factor of use. Through systematic model reduction, a parsimonious Cox regression analysis model of significant predictors of time to first post-detox drug use was developed consisting of expectation of success and the interaction of gender x injection drug use was identified. Expectation of treatment success was negatively associated with time to first opioid use post-detoxification. The interaction of gender x injection drug use was positively associated with time to first opioid use post-detoxification. Specifically, individuals who did not inject had a slower return to opioid use. This effect was especially salient in women.

Discussion and Conclusion: Participants who realistically expect treatment success and individuals who do not inject drugs have a significantly slower return to opioid use. These findings are novel and have implications for harm reduction interventions on people with OUD who are in in-patient detoxification.

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