Cognitive and Psychological Status of Methadone Maintenance Treatment Patients in Yunnan Province and Its Influencing Factors

doi:10.21203/rs.3.rs-3937078/v1

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Research Article

Cognitive and Psychological Status of Methadone Maintenance Treatment Patients in Yunnan Province and Its Influencing Factors

https://doi.org/10.21203/rs.3.rs-3937078/v1

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Background: Cognitive and psychological impairments are commonly found among heroin-dependent individuals receiving methadone maintenance treatment (MMT). This study investigates the screening methods and influencing factors of cognitive and psychological impairments in this population, aiming to improve treatment adherence and social functioning in MMT patients.

Methods: In a cross-sectional study conducted from December 2022 to December 2023, a total of 293 valid questionnaires were collected and included in the study. A questionnaire survey was conducted in Yunnan Province MMT outpatient clinic, including general sociological data, SCL-90(90-item Self-rating Scale for Symptoms) questionnaire to investigate the psychological status, MMSE (Mini-Mental State Examination) scale to assess the cognitive function, and analysis of the factors affecting the psychological cognition of the patients. The analyses were based in part on conventional statistical testing (t-test, χ²-test,and Binary logistic regression）.

Results: (1)In our sample, the prevalence of cognitive impairment was 52.2%, with a prevalence of depressive symptoms at 64.8% and anxiety symptoms at 54.3%;（2）Influencing factors of cognitive impairment in MMT subjects with different characteristics: age level differences was statistically significant. (P < 0.05); (3) The SCL-90 scale of MMT subjects showed a statistically significant difference in the nine factors of mental symptoms compared with the Chinese positive normal mode (P < 0.001);（4）The factors affecting depression of MMT subjects with different characteristics were statistically different: whether they lived alone (P < 0.05).

Conclusion: A significant proportion of Chinese patients undergoing MMT experience depression, anxiety, and cognitive impairments during the course of treatment. It is necessary to provide timely and effective psychological interventions for this high-risk population and control the influencing factors.

Cognitive impairment

Anxiety

Depression

Drug user

Methadone maintenance treatment

According to the World Health Organization (WHO), alcohol, tobacco, and heroin are probably the most toxic substances that cause the highest burden of disease and drug-related deaths worldwide. As of the end of 2022, there were 1.124 million drug users in China, among whom 416,000 abused heroin and 588,000 abused methamphetamine(1). The "Golden Triangle" region is still China's main drug source. Yunnan, because of its unique geographical location, is still a major area of traditional drug abuse in China. According to the research, the relapse rate of heroin abusers within one month after quitting drug use is 54.57%. The relapse rate from the first to the third month accounts for 31.76%, while within the first six months it reaches 93.31%. Within the first year, the relapse rate amounts to 96.68%(2). Drug users often fall into a vicious cycle of "drug use-detoxification-relapse-struggle-abstinence," which will cause more obvious harm to the body, which will lead to nervous system damage, neuropsychiatric diseases, serious damage to the physical and mental health of patients, and increase the social burden. Substance use disorders can lead to cognitive and behavioral disorders, anxiety, depression, and social isolation. Currently, MMT is the most widely used method for opioid addiction dependence(3). Methadone is a long-acting synthetic opioid agonist that prevents opioid-related withdrawal and euphoria. According to current research, long-term use of methadone in patients has been found to be associated with cognitive and psychiatric disorders, which can significantly affect their social functioning and quality of life. Cognitive dysfunction in patients with MMT is associated with depression and anxiety(4). Most patients with MMT will continue to participate in unhealthy lifestyles, resulting in significant physical and mental health morbidity(5).

Depression is common, costly, debilitating, and associated with increased risk of suicide. It is one of the leading global public health problems(6). Anxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors.Anxiety disorders are associated with increased health care utilization and reduced quality of life and functioning(7).There is a high prevalence of mental disorders in drug abuse patients, especially mood disorders.

There is a bidirectional relationship between mood disorders such as depression or anxiety and drug abuse(8, 9). In addition, anxiety and depression were the most significant psychological factors associated with withdrawal

symptoms and cravings among drug users and patients with comorbidity of mood disorder and drug use had a higher risk of suicide(10). According to previous studies. It has been found in many studies that there is a significant prevalence of depression, anxiety, or Post-Traumatic Stress Disorder (PTSD) in individuals who use heroin or other addictive disorders which is also associated with worse treatment outcome and prognosis(11). According to these findings, it is important to identify and treat psychiatric problems among heroin users, since the effective treatment of co-morbid mental illness may improve heroin use disorders prognosis. The cognitive decline in people with substance use disorders is well known and can be found during both the dependence and drug abstinence phases. At the clinical level, cognitive decline impairs the response to addiction treatment and increases dropout rates. It can be irreversible, even after the end of drug abuse consumption(12). The development of cognitive changes directly or indirectly increases the burden on individuals, families, society, and health.Relevant studies have shown that patients undergoing MMT commonly experience cognitive and psychological problems, such as cognitive impairment, anxiety and depression. These issues can affect patients' compliance with MMT. There have been more recent studies that show that chronic heroin users, including those enrolled in MMT and those who are abstinent formerly dependent, have impaired visual memory, working memory, impulsivity, and compulsivity(4, 13–15).In addition, it has been found that MMT is one of the main contributing factors to the occurrence of depression(16). A considerable proportion of methadone maintenance treatment clients in China have experienced depression and anxiety during treatment(17).

Cognitive impairments, anxiety, and depression are commonly observed mental symptoms among individuals undergoing MMT for heroin dependence. The risk factors for MMT patients leading to the aforementioned symptoms have not been well studied and characterized in the literature. In this paper, a self-designed questionnaire was used to investigate the status quo and influencing factors of cognition, anxiety, and depression in patients with MMT. Therefore, the aim of this study is to investigate the prevalence of cognitive impairment, depression, and anxiety in MMT outpatient patients in Yunnan, China, and their related influencing factors. It is important for us to survey the psychological and cognitive status of MMT patients and help them improve their quality of life through psychological and cognitive interventions, which can alleviate the burden on individuals, families, and society.

Study participants

A total of 293 methadone maintenance patients were randomly selected from methadone clinics in Yunnan Province. The inclusion criteria were :(a) meeting the DSM-5(The diagnostic and statistical manual of mental disorders,DSM) diagnostic classification criteria for substance abuse, (b) first-time participation in the Psychiatric Cognitive Scale survey, (c) age 18–70 years, (d) consent to participate in the program and signed informed consent. The exclusion criteria are :(a) serious physical illness; (b) presence of a psycho-neurological disorder prior to exposure to heroin.

Questionnaire and measurement instruments

Investigation contents: Trained professional investigators (including sociology professionals and psychiatrists) will conduct a self-prepared structured questionnaire for subjects. The survey included subjects' general personal data, disease history and drug use history, personal life history, drug abuse, drug craving, psychological status, and cognitive status.

Survey Tools: SCL-90 (90-item Self-rating Scale for Symptoms), MMSE (Mini-Mental State Examination), and SCL-90 scale were fully explained by the investigator and then filled in by the subjects themselves. For example, the subjects with low education levels or illiteracy were asked item by item by the investigator. The subjects were told the meaning of the question in a neutral way without any hint or bias. The MMSE is evaluated by investigators.

SCL-90 is a self-report instrument widely used to assess clinical psychiatric symptoms and mental health status(18).In the SCL-90, healthy people are distinguished from mentally ill patients(19).SCL-90 includes 90 items for 9 factors (somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, psychosis, and others), Each item on the scale was measured on a five-point Likert scale, with 1–5 representing the severity of the symptoms as follows: “1 = from no”, “2 = light”, “3 = moderate”, “4 = quite heavy”, and “5 = severe”. Thus, a higher score reflected a higher frequency and intensity of symptoms. If the total score is more than 160, or the number of positive items is more than 43, or the score of any factor is more than 2 points, positive screening should be considered. After evaluating the results of the SCL-90 questionnaire, we further analyze the levels of depression and anxiety. Based on the scores obtained from the depression and anxiety subscales of the SCL-90.

The MMSE is a widely used assessment tool in clinical and research settings for evaluating cognitive impairment(20). The total score of MMSE was 30 points, including seven cognitive domains (time orientation, place orientation, immediate memory, attention and computation,delayed memory, language, and visual space). There are 30 questions in total, with 1 point for each correct answer and 0 points for each wrong answer or unknown answer. The total score ranges from 0 to 30 points, and less than 27 points indicates cognitive dysfunction. The severity of cognitive impairment is classified as follows: 0–9 points: severe dementia; 10–20 points: moderate dementia; Score 21–26: Mild cognitive impairment.

Statistical analysis

Statistical Analysis All data were input by two people to ensure the correct input of the results, and then imported into SPSS26.0 statistical analysis software for data analysis.Participant characteristics were described as number and percent for categorical variables and mean and standard deviation for continuous variables. Comparisons of the incidence rates of different characteristics among MMT patients were conducted using the chi-square test. Binary logistic regression analysis was performed using a stepwise variable selection method to identify the factors influencing cognitive and psychological disorders in MMT patients, with a significance level of α = 0.05.

Patient characteristics

Basic Characteristics and drug use characteristi survey subjects 293 cases signed informed consent and completed valid questionnaires before the survey. Table 1

Cognitive and psychological characteristics

Cognitive Status of the subjects In the test, there were 153 cases (52.2%) of cognitive impairment, among which 137 cases were mild (46.8%), 16 cases were moderate (5.5%), and 0 cases were severe.Table 2 The age factor is an Influencing factor leading to cognitive impairment in MMT patients(P<0.05).Table 3 Investigation on Psychological Status of Subjects In the subjects, SCL-90 was compared with the norm of the normal population in China, and the 9 factors of mental state showed significant statistical differences compared with the normal population(P<0.001).Table 4 There were 190 cases (64.8%) of depressive symptoms and 159 cases (54.3%) of anxiety symptoms.Table 5 Living alone is an influencing factor leading to depressive disorders in MMT patients(P<0.05).Table 6

Table 1 Participants’ (N = 293) background and substance abuse information

	M	SD	n	%
Age (years)	51.9	7.9
Height(cm)	165.0	7.2
Body weight(kg)	60.7	11.8
Gender
Male			132	45.1
Female			161	54.9
Residential Patterns
Living alone			99	33.8
Group living			194	66.2
Education
Primary school education or below			61	20.8
Junior high school			131	44.7
Senior high school or above			101	34.5
Marital status
Married			115	39.2
Unmarried			67	22.9
Divorced			18	6.1
Widowed			89	30.4
Other			4	1.4
Employment status
Employed			70	29.3
Not employed			223	76.1
Physical exercise
No			163	55.6
Yes			130	44.4

Auration of drug abuse	19.1	8.2
Time of drug abstinence	9.1	6.7
Positive in urine tests			11	3.8
Number of withdrawal episodes*	4.9	4.3
Number of relapses*	4.6	4.3
Type of drug use*
Single-substance use			231	78.8
Poly-substance use			45	15.4
Reasons for initial drug use
Curiosity			179	61.1
Affected by others			65	22.2
Others			49	16.7
Location of initial drug use
Friends' homes			203	69.3
Own homes			54	18.4
Other place			36	12.3
HIV infection
HIV transmission route			65	22.2
HCV infection			146	49.8
Complicated by other diseases
Hypertension			75	25.6
Diabetes			8	2.7
Smoking			275	93.5
Alcohol			101	34.5

Note*：Some patients are unable to accurately recall the content, resulting in missing dat

Table 2 Cognitive analysis of MMT subjects with different characteristics

Variable	Total cases (composition ratio %)	Cognitive impairment (%)	χ2value	P value
Age group/year			9.031	0.003
≤50	108（36.9）	44（40.7）
＞50	185（63.1）	109（58.9）
Gender			0.237	0.626
Male	132（45.1）	71（53.8）
Female	161（59.4）	82（50.9）
Residential Patterns			1.133	0.287
Living alone	99（33.8）	56（56.6）
Group living	194（66.2）	97（50.0）
Degree of education			7.477	0.024
Primary school and below	61（20.8）	41（67.2）
Junior high school	131（44.7）	66（50.4）
Senior high school or above	101（34.5）	46（45.5）
Marital status			2.301	0.512
Unmarried	67（22.9）	33（49.3）
Married	115（39.2）	56（48.7）
Divorced	89（30.4）	51（57.3）

Employment status			0.490	0.484
Employed	70（23.9）	34（48.6）

Not employed	223（76.1）	119（53.4）
Income level			1.449	0.485
High	10（3.4）	7（70.0）
Middle	96（32.8）	51（53.1）
Low	187（63.8）	95（50.8）
Infected with HIV			0.686	0.408
No	228（77.8）	122（53.5）
Yes	65（22.2）	31（47.7）
Infected with hepatitis C			1.816	0.178
No	147（50.2）	71（48.3）
Yes	146（49.8）	82（56.2）
Drink alcohol			0.888	0.346
No	192（65.5）	93（48.4）
Yes	101（34.5）	60（59.4）
Smoking			0.608	0.436
No	18（6.1）	11（61.1）
Yes	275（93.6）	142（51.6）
Physical exercise			0.939	0.333
No	163（55.6）	81（49.7）
Yes	130（44.4）	72（55.4）

Table 4 Comparison between SCL-90 of MMT subjects and Chinese crowd norm

Factor	MMT subject（n=293）	Chinese crowd norm（n=1388）	t value	P value
Somatization	2.00±0.75	1.37±0.48	14.433	＜0.001
Compulsion	2.09±0.75	1.62±0.58	10.616	＜0.001
Interpersonal relationship	1.84±0.76	1.65±0.51	4.249	＜0.001
Depression	1.96±0.79	1.50±0.59	10.008	＜0.001
Anxiety	1.78±0.76	1.39±0.43	8.776	＜0.001
Antagonism	1.88±0.82	1.48±0.56	8.256	＜0.001
Terror	1.59±0.74	1.23±0.41	8.454	＜0.001
Paranoid	1.77±0.74	1.43±0.57	7.799	＜0.001
Psychosis	1.75±0.72	1.29±0.42	10.965	＜0.001
Total equalization	1.89±0.70	1.44±0.43	10.862	＜0.001

Table 5 Symptoms of depression and anxiety in MMT subjects with different characteristics analyze

Variable	Total cases (composition ratio %)	Depression (%)	χ2 value	P value	Anxiety (%)	χ2value	P value
Age group/year			0.793	0.069		0.402	0.526
≤50	108（36.9）	69（63.9）			56（51.9）
＞50	185（63.1）	121（65.4）			103（55.7）
Gender			0.154	0.694		0.008	0.931
Male	132（45.1）	84（63.3）			72（54.5）
Female	161（59.4）	106（65.8）			87（54）
Residential Patterns			4.074	0.044		3.255	0.071
Living alone	99（33.8）	72（72.7）			61（61.6）
Group living	194（66.2）	118（60.8）			98（50.5）
Degree of education			0.425	0.808		0.094	0.954
Primary school and below	61（20.8）	40（65.6）			33（54.1）
Junior high school	131（44.7）	87（66.4）			70（53.4）
Senior high school or above	101（34.5）	63（62.4）			56（55.4）
Marital status			3.247	0.355		0.406	0.939
Unmarried	67（22.9）	49（73.1）			38（56.7）
Married	115（39.2）	69（60）			60（52.2）
Divorced	89（30.4）	57（64）			47（52.8）
Widowed	18（6.1）	12（66.7）			10（55.6）
Employment status			0.471	0.492		1.202	0.273
Employed	70（23.9）	43（61.4）			34（48.6）
Not employed	223（76.1）	147（65.9）			125（56.1）
Income level			5.161	0.076		0.311	0.856
High	10（3.4）	5（50）			5（50）
Middle	96（32.8）	55（57.3）			55（57.3）
Low	187（63.8）	130（69.5）			102（54.5）
Infected with HIV			0.002	0.965		2.215	0.137
No	228（77.8）	148（64.9）			129（56.6）
Yes	65（22.2）	42（64.6）			30（46.2）
Infected with hepatitis C			0.324	0.570		0.033	0.856
No	147（50.2）	93（63.3）			79（53.7）
Yes	146（49.8）	97（66.4）			80（54.8）
Drink alcohol			0.910	0.368		3.712	0.054
No	192（65.5）	128（66.7）			112（58.3）
Yes	101（34.5）	62（31.7）			47（46.5）
Smoking			0.028	0.867		0.745	0.388
No	18（6.1）	12（66.7）			8（44.4）
Yes	275（93.6）	178（64.7）			151（54.9）
Physical exercise			0.661	0.416		2.387	0.122
No	163（55.6）	109（66.9）			95（58.3）
Yes	130（44.4）	81（62.3）			64（49.2）

Our research findings indicate that cognitive impairments, depression, and anxiety are common health issues among MMT patients. Although MMT has shown significant therapeutic effects as a heroin substitution therapy, the cognitive and mental health of patients remain important areas of concern. Our survey of MMT clinics revealed that patients face significant social functioning impairments, with 76.1% of patients being unemployed. Further investigation into their sources of income revealed that the majority rely on government assistance or support from family members to sustain their livelihoods. This highlights the need to consider strategies for improving social functioning in these patients, identifying and intervening in risk factors that contribute to impaired social functioning, and promoting their reintegration into society. From the history of heroin use among MMT patients, there is evidence of recurrent cycles of relapse and withdrawal. Despite the use of MMT as a substitution treatment, 11 cases of patients tested positive for heroin in urine screenings. An investigation into the reasons for their initial heroin use revealed that 66.1% of patients did so out of curiosity, while 22.2% were influenced by others. This suggests that individual characteristics, psychological factors, and environmental influences play significant roles in substance dependency. Therefore, it is necessary to further analyze the personality traits, personal developmental backgrounds, and cultural factors associated with these patients.Furthermore, MMT patients have higher rates of HIV (22.2%) and HCV (49.8%) infections. This may be related to the association between injection drug use and the acquisition and transmission of HIV and HCV(21). Cross-sectional surveys provide insights into the comorbidity of other diseases among MMT patients, with 25.6% having hypertension and 2.7% having diabetes. The detection rates for other diseases are relatively low, suggesting insufficient awareness of their own health conditions and a lack of routine health check-ups among MMT patients. This highlights the need for comprehensive health management for MMT patients, including regular medical examinations and education and treatment regarding infectious diseases.

Cognitive dysfunction, characterized by progressive deterioration of intelligence including memory loss and/or impaired judgment, calculation, language, orientation, skills, and behavior, has been a leading cause of disability in patients(22). Substance abuse not only alters and promotes normal learning and memory processes, but also inhibits the ability to control use(23). Heroin abusers often show impairments in cognitive function, including attention, inhibition, and working memory, which can negatively affect their behavior(24, 25).Chronic heroin use results in deficits in verbal fluency, verbal working memory, inhibitory control, planning, risk, and rewards-based decision-making(26). Cognitive impairment will lead to the insufficiency of patients' cognitive ability and treatment compliance, which seriously affects the therapeutic effect of patients. At present, there are relatively few cognitive studies on patients with MMT. Literature study: Patients who have been dependent on methadone will have cognitive dysfunction such as visuospatial memory impairment and chronic working memory impairment(27). The MoCA(Montreal Cognitive Assessment) scale was used to assess methadone treatment in patients with significant cognitive impairment(28). Patients with MMT show impairments in cognitive prospective memory sustained attention, and response inhibition(29).In this study, through the MMSE assessment of the cognitive function of 293 subjects in the MMT clinic, about 52.2% of the subjects had cognitive dysfunction, and it was found that age was risk factors for cognitive dysfunction, which was consistent with a study that found that age was one of the influencing factors among the factors affecting cognitive function. Based on the fact that cognitive dysfunction can lead to the impaired social function of patients, the cognitive function should be assessed early for patients with older age, and appropriate intervention measures should be taken to prevent and delay further impairment of cognitive function, improve patients' treatment compliance, and restore their social function and living standard.

Methadone therapy is a well-known method used to treat opioid addiction(30). Despite its widespread use, there are still some challenges, such as severe dependency, depression, and anxiety(31). Many patients with MMT suffer from mental health problems, including depression and anxiety(32, 33). Depression and anxiety disorders: An estimated 5% of adults suffer from depression in 2023, according to the WHO. Depression can lead to serious consequences such as suicide. Substance-dependent patients are prone to depressive disorder, and the occurrence of depressive disorder will further aggravate substance dependence, seriously damage the patient's social function, harm the patient's physical and mental health, and increase the social and economic burden. Anxiety is a common and persistent primary symptom in patients with MMT, and co-anxiety increases the risk of injecting behavior, HIV infection, and criminal behavior in patients with MMT(34). High suicide rates in patients with MMT are associated with anxiety(35). Several surveys on anxiety of MMT patients from China showed that the incidence of anxiety was 23.0%, 30.5%, and 33.6%, respectively.(34, 36).In the SCL-90 questionnaire survey of MMT patients, there is a significant difference between their psychological status and that of normal individuals, and the presence of psychological disorders is not optimistic. The incidence rates of depression and anxiety were 64.8% and 54.3%, respectively. Analysis of risk factors: It was found that living alone, was risk factors for depression. Living alone is a common form of social isolation. Social isolation is the worst thing that can lead to substance dependence and impaired mental health. It is a catalyst for negative outcomes, including re-use of drugs, increased drug use, fatal and non-fatal overdoses, and worsening mental health symptoms. Recovery of substance-dependent patients relies on social connections, face-to-face services and groups, and access to resources for maintenance to restore their mental health(37). People living in counties with lower levels of social isolation and residential stability have a higher risk of substance dependence(38). The rat model found that depression and anxiety increased during MMT, and a rich living environment could reduce the occurrence of MMT depression and anxiety(39). Positive life experiences and anti-stress effects may prevent the release of drug addiction from developing(40). Peer-facilitated activities can improve the mental health of patients with MMT and prevent anxiety and depression(41). Therefore, for heroin and drug-dependent patients, to avoid the occurrence of depression and anxiety disorders, to avoid further substance dependence caused by depression and anxiety and a series of problems harmful to physical and mental health, We can promote the social interpersonal communication of patients, strengthen social contact, provide the rich living environment, community and volunteers and medical rehabilitation personnel to provide their social activities resources.

In addition, our research has found that MMT patients have very high rates of smoking and drinking. MMT patients have alcohol dependence, with a survey of MMT patients in Shanghai, China indicating a 30.9% prevalence of alcohol use disorder(42).MMT patients who use alcohol often face adverse consequences and health-related risks, such as drug overdose, liver issues (particularly hepatitis C and cirrhosis), and problems associated with the use of methadone (respiratory depression) (43), which can lead to impaired cognitive function(44).The combined use of alcohol by MMT patients predicts poorer clinical outcomes (such as relapse and lower survival rates) and significantly impairs their quality of life, including social functioning(45). Research has found that more than three-quarters of individuals with opioid use disorder smoke cigarettes(46). Smoking is a comorbid health risk that is common among those undergoing addiction treatment, with smoking rates much higher than other populations, with as many as 85%-98% of individuals participating in MMT treatment being smokers. Smokers receiving MMT treatment are at high risk for tobacco-related diseases, with a mortality rate four times higher than smokers not undergoing MMT treatment(47, 48). Alcohol and smoking are also forms of substance dependence. Our survey found that the smoking rate of MMT patients is as high as 93.5%, and the drinking rate is 34.5%. Previous clinical studies have found that smoking and drinking increase the incidence of mental illness. The occurrence of anxiety and depression may also be accompanied by substance dependence problems, which exacerbate the damage to physical and mental health and lead to poor treatment outcomes. Therefore, MMT patients may have higher substance dependence-related problems. When treating and following up on these patients in clinical community hospitals, attention should be paid to the severity of this problem and timely interventions should be taken, such as providing health education, smoking and drinking cessation clinics, social support, mutual aid groups, and alternative exercise measures.

Patients with MMT generally have cognitive disorders and psychological abnormalities, among which depression and anxiety are mental disorders that significantly affect patients' social functions and aggravate their social burden. Therefore, patients with MMT should be screened for cognitive and mental diseases, and early intervention should be given to risk factors leading to diseases, which is helpful to prevent the occurrence of diseases. For older and less educated MMT patients, cognitive therapy should be given to delay and prevent the progression of their cognitive impairment. For patients living alone, social support should be given to promote their interpersonal communication and social group activities, and work integration into society should be encouraged. For smoking and drinking patients, patients should be encouraged to quit smoking and drinking alcohol, such as disease health education and management; Use drug intervention to stop smoking and drinking; Participate in smoking cessation, alcohol withdrawal groups and other aspects of intervention, reduce their substance dependence, reduce the incidence of depression and anxiety from the aspect of risk factors, restore the social function of their patients, promote their physical and mental health.

MMT:Methadone Maintenance Treatment

SCL-90:90-item Self-rating Scale for Symptoms

MMSE:Mini-Mental State Examination

DSM:The diagnostic and statistical manual of mental disorders

WHO:World Health Organization

PTSD:Post-Traumatic Stress Disorder

HIV:Human Immunodeficiency Virus

HCV:Hepatitis C Virus

MoCA:Montreal Cognitive Assessment

Acknowledgements

Not applicable.

Authors’contributions

Yang Wen participated in collecting the data, designed and performed the analyses. wrote the paper. Both authors read and approved the final manuscript.

Luo Xiao, Bi Ke, Li Yuansen, Fan Xuan, Liu Xingyu and Hu Hongwei participated in the data collection and statistical analysis for this study.

Luo Huayou, Zhu Mei, and Xu Yu participated in research guidance and quality control.

Authors’information

1.Yunnan University，Kunming City，Yunnan Province

2.Yunnan Drug Dependence Treatment Innovation Center，Kunming City，Yunnan Province

3.The First People's Hospital of Yunnan Province，Kunming City，Yunnan Province

4.Kunming Medical University，Kunming City，Yunnan Province

5.Yunnan Provincial Maternal and Child Health Care Hospital，Kunming City，Yunnan Province

Funding

The design, data collection, and analysis of the study were supported by the following funding:

Yunnan Drug Dependence Treatment Technology Innovation Center (202305AK340001)

Yunnan Province "High-level Talents Training Support Plan" Training Program-Youth Top-notch Talents Special Project (NO.YNWR-QNBJ-2019-243)

Yunnan Huang Changming Expert Workstation (NO. 202105AF150040)

Yunnan Province High-level Talents Training Support Plan-"Famous Doctor" Special Project (NO.RLMY20200019)

Yunnan Province Basic Research Program Key Project (202202AS070077)

Yunnan Provincial Health Commission Medical Reserve Talents (H-2019004)

Availability of data and materials

Data sets used and/or analyzed during the current study are available from corresponding authors upon reasonable request.

Ethics approval and consent to participate

The entire protocol and recruitment process of this study have been approved by the Research Committee of the First

Affiliated Hospital (2021-1-2). All participants provided written informed consent before enrollment.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Author details

Yunnan Drug Dependence Treatment Innovation Center, Yunnan University, South Outer Ring Road, Chenggong District, Kunming City, Yunnan Province, 650500

Commission OoNN. China Drug Situation Report 2022. Beijing Weekly. 2023;35:5-8.
Oviedo-Joekes E, Guh D, Brissette S, Marchand K, Marsh D, Chettiar J, et al. Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women. Drug and Alcohol Dependence. 2010;111(1-2):50-7.
Li CL, Hsu HC. Cognitive function and associated factors among older people in Taiwan: age and sex differences. Arch Gerontol Geriatr. 2015;60(1):196-200.
Tolomeo S, Davey F, Steele JD, Baldacchino AM. Effects of Opioid Dependence on Visuospatial Memory and Its Associations With Depression and Anxiety. Frontiers in Psychiatry. 2019;10.
Rosen D, Hunsaker A, Albert SM, Cornelius JR, Reynolds CF, 3rd. Characteristics and consequences of heroin use among older adults in the United States: a review of the literature, treatment implications, and recommendations for further research. Addict Behav. 2011;36(4):279-85.
Marwaha S, Palmer E, Suppes T, Cons E, Young AH, Upthegrove R. Novel and emerging treatments for major depression. The Lancet. 2023;401(10371):141-53.
Szuhany KL, Simon NM. Anxiety Disorders. Jama. 2022;328(24).
Bridget F. Grant FSS, Deborah A. Dawson, S. Patricia Chou, Mary C. Dufour， Wilson Compton,D; Roger P. Pickering, Kenneth Kaplan, . Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders. Arch Gen Psychiatry. 2004;61:807-16.
Helen M. Pettinati CPOB, William D. Dundon,. Current Status of Co-Occurring Mood and Substance Use Disorders: A New Therapeutic Target. Am J Psychiatry 2013;170:23-30.
Zorick T, Nestor L, Miotto K, Sugar C, Hellemann G, Scanlon G, et al. Withdrawal symptoms in abstinent methamphetamine-dependent subjects. Addiction. 2010;105(10):1809-18.
Hassan AN, Howe AS, Samokhvalov AV, Le Foll B, George TP. Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis. The American Journal on Addictions. 2017;26(6):551-63.
Gasparyan A, Maldonado Sanchez D, Navarrete F, Sion A, Navarro D, García-Gutiérrez MS, et al. Cognitive Alterations in Addictive Disorders: A Translational Approach. Biomedicines. 2023;11(7).
Baldacchino A, Balfour DJK, Matthews K. Impulsivity and opioid drugs: differential effects of heroin, methadone and prescribed analgesic medication. Psychological Medicine. 2014;45(6):1167-79.
Tolomeo S, Matthews K, Steele D, Baldacchino A. Compulsivity in opioid dependence. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018;81:333-9.
Tolomeo S, Gray S, Matthews K, Steele JD, Baldacchino A. Multifaceted impairments in impulsivity and brain structural abnormalities in opioid dependence and abstinence. Psychological Medicine. 2016;46(13):2841-53.
Peles E, Schreiber S, Naumovsky Y, Adelson M. Depression in methadone maintenance treatment patients: Rate and risk factors. Journal of Affective Disorders. 2007;99(1-3):213-20.
Yin W, Pang L, Cao X, McGoogan JM, Liu M, Zhang C, et al. Factors associated with depression and anxiety among patients attending community‐based methadone maintenance treatment in China. Addiction. 2014;110(S1):51-60.
Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale--preliminary report. Psychopharmacology bulletin. 1973;9(1):13-28.
Hardt J, Gerbershagen HU, Franke P. The symptom check-list, SCL-90-R: its use and characteristics in chronic pain patients. European Journal of Pain. 2000;4(2):137-48.
M F Folstein SEF, P R McHugh. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-98.
T. Jake Liang MD, and John W. Ward, M.D. Hepatitis C in Injection-Drug Users — A Hidden Danger of the Opioid Epidemic. The NEW ENGLAND JOURNAL of MEDICINE. 2018:1169-71.
Navarro D, Gasparyan A, Marti Martinez S, Diaz Marin C, Navarrete F, Garcia Gutierrez MS, et al. Methods to Identify Cognitive Alterations from Animals to Humans: A Translational Approach. Int J Mol Sci. 2023;24(8).
Torregrossa MM, Corlett PR, Taylor JR. Aberrant learning and memory in addiction. Neurobiol Learn Mem. 2011;96(4):609-23.
Schippers MC, Binnekade R, Schoffelmeer AN, Pattij T, De Vries TJ. Unidirectional relationship between heroin self-administration and impulsive decision-making in rats. Psychopharmacology (Berl). 2012;219(2):443-52.
Gruber SA, Silveri MM, Yurgelun-Todd DA. Neuropsychological consequences of opiate use. Neuropsychol Rev. 2007;17(3):299-315.
Baldacchino A, Balfour DJ, Passetti F, Humphris G, Matthews K. Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neurosci Biobehav Rev. 2012;36(9):2056-68.
Tolomeo S, Davey F, Steele JD, Baldacchino AM. Effects of Opioid Dependence on Visuospatial Memory and Its Associations With Depression and Anxiety. Front Psychiatry. 2019;10:743.
Zeng T, Li S, Wu L, Feng Z, Fan X, Yuan J, et al. A Comparison Study of Impulsiveness, Cognitive Function, and P300 Components Between Gamma-Hydroxybutyrate and Heroin-Addicted Patients: Preliminary Findings. Front Hum Neurosci. 2022;16:835922.
Redžepagić Š, Ladas AI. Prospective Memory, Sustained Attention and Response Inhibition in Poly-Substance Users Stable on Methadone Maintenance Treatment. Substance Use & Misuse. 2023;58(3):397-405.
Saxon AJ, Hser YI, Woody G, Ling W. Medication-assisted treatment for opioid addiction: methadone and buprenorphine. J Food Drug Anal. 2013;21(4):S69-S72.
Alizadeh M, Zahedi-Khorasani M, Miladi-Gorji H. Treadmill exercise attenuates the severity of physical dependence, anxiety, depressive-like behavior and voluntary morphine consumption in morphine withdrawn rats receiving methadone maintenance treatment. Neurosci Lett. 2018;681:73-7.
Zhang X, Xu H, Gu J, Lau JT, Hao C, Zhao Y, et al. Depression, suicidal ideation, and related factors of methadone maintenance treatment users in Guangzhou, China. AIDS Care. 2016;28(7):851-6.
Jiao M, Gu J, Xu H, Hao C, Lau JT, Mo P, et al. Resilience associated with mental health problems among methadone maintenance treatment patients in Guangzhou, China. AIDS Care. 2017;29(5):660-5.
C. J. Stam WdH, 2 A. Daffertshofer,3 B. F. Jones,4 I. Manshanden,1 A. M. van Cappellen van Walsum,5,6 T. Montez,7 J. P. A. Verbunt,1,8 J. C. de Munck,8 B. W. van Dijk,1,8 H. W. Berendse2 and P. Scheltens2. Graph theoretical analysis of magnetoencephalographic functional connectivity in Alzheimer’s disease. Brain 2009;132:213-4.
van den Heuvel MP, Hulshoff Pol HE. Exploring the brain network: a review on resting-state fMRI functional connectivity. Eur Neuropsychopharmacol. 2010;20(8):519-34.
Cao P, Zhang Z, Zhong J, Xu S, Huang Q, Fan N. Effects of treatment status and life quality on anxiety in MMT patients. Subst Abuse Treat Prev Policy. 2021;16(1):9.
Jeffers A, Meehan AA, Barker J, Asher A, Montgomery MP, Bautista G, et al. Impact of Social Isolation during the COVID-19 Pandemic on Mental Health, Substance Use, and Homelessness: Qualitative Interviews with Behavioral Health Providers. Int J Environ Res Public Health. 2022;19(19).
Yang TC, Shoff C, Shaw BA, Strully K. Neighborhood characteristics and opioid use disorder among older Medicare beneficiaries: An examination of the role of the COVID-19 pandemic. Health Place. 2023;79:102941.
Lari M, Miladi-Gorji H, Najafi M, Rezaei AM. Environmental Enrichment Ameliorates Psychological Dependence Symptoms and Voluntary Morphine Consumption in Morphine Withdrawn Rats Under Methadone Maintenance Treatment. Basic Clin Neurosci. 2021;12(5):607-16.
Solinas M, Thiriet N, Chauvet C, Jaber M. Prevention and treatment of drug addiction by environmental enrichment. Prog Neurobiol. 2010;92(4):572-92.
Abrantes AM, Van Noppen D, Bailey G, Uebelacker LA, Buman M, Stein MD. A Feasibility Study of a Peer-Facilitated Physical Activity Intervention in Methadone Maintenance. Ment Health Phys Act. 2021;21.
Gong Y, Zhang L, Long J, Wu Q, Zhang J, Bao J, et al. Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial. Journal of Addiction Medicine. 2023;17(3):294-9.
Staiger PK, Richardson B, Long CM, Carr V, Marlatt GA. Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence. Addiction. 2012;108(7):1188-93.
Kleykamp BA, Vandrey RG, Bigelow GE, Strain EC, Mintzer MZ. Effects of methadone plus alcohol on cognitive performance in methadone-maintained volunteers. The American Journal of Drug and Alcohol Abuse. 2015;41(3):251-6.
Senbanjo R, Wolff K, Marshall J. Excessive alcohol consumption is associated with reduced quality of life among methadone patients. Addiction. 2006;102(2):257-63.
Guydish J, Passalacqua E, Tajima B, Chan M, Chun J, Bostrom A. Smoking Prevalence in Addiction Treatment: A Review. Nicotine & Tobacco Research. 2011;13(6):401-11.
Jennifer G . Clarke MD, Michael D. Stein, M.D., Kelly A. McGarry, M.D., Aruna Gogineni, Ph.D. Interest in Smoking Cessation Among Injection Drug Users. The American Journal on Addictions 2001;10:159-66.
de Dios MA, Anderson BJ, Caviness CM, Stein MD. Early Quit Days Among Methadone-Maintained Smokers in a Smoking Cessation Trial. Nicotine & Tobacco Research. 2014;16(11):1463-9.

No competing interests reported.

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Cognitive and Psychological Status of Methadone Maintenance Treatment Patients in Yunnan Province and Its Influencing Factors

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Abstract

Background

METHODS

Study participants

Questionnaire and measurement instruments

Statistical analysis

Results

Patient characteristics

Cognitive and psychological characteristics

Discussion

Conclusions

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References

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