Outpatient Detoxification Completion and One-Month Outcomes for Opioid Dependence: A Preliminary Study of a Neuropsychoanalytic Treatment in Pain Patients and Addicted Patients

The current practice in the United States is to maintain patients with opioid dependence on opioids. A case series approach was used to investigate the results of outpatient detoxification/opioid-free treatment using a neuropsychoanalytic paradigm. Detoxification involved a single dose of buprenorphine, adjunctive medications, and intensive neuropsychoanalytic psychotherapy. Depression, attention deficit hyperactivity disorder (ADHD), and nicotine dependence were treated with bupropion. Low-dose naltrexone was used to remedy hypothesized low endogenous opioid tone. In the study, 92% of subjects completed one week of detoxification. By selfreport, 60% were still sober one month into treatment. When divided into a group who met the DSM–IV criteria for opioid dependence because of withdrawal, tolerance, and inability to cut down or stop opioid medications only (the “Pain Group”) and a group who met more than these three criteria (the “Addicted Group”), there were significant differences in maintaining abstinence. In addition, the Addicted Group were much more likely to be depressed and to have borderline personality disorder. All cases of ADHD and all drug dream reports were in the Addicted Group. The conclusion of the study was that neuropsychoanalytic treatment of addiction (including complete abstinence from opioids and neuropsychoanalytic interventions) may be a viable approach to opioid-use disorder. Current DSM criteria for diagnosis of addiction to opioids may incorrectly include a subgroup who are unable to stop the drug only because of inability to endure the withdrawal syndrome. With the neuropsychoanalytic approach, they appear to tolerate withdrawal and stay off opioids. Further investigation is required to compare this neuropsychoanalytic paradigm to other treatments.