Examining Relationships between Gender, Opioid Dependence, and Distress Tolerance among Patients in Substance Use Disorder Treatment

Abstract

Background: Opioid abuse/dependence is associated with multiple negative outcomes relative to other forms of substance abuse/dependence, including relapse. Research identifying modifiable characteristics associated with opioid dependence and associated negative outcomes may inform the development of targeted interventions for this high-risk population. One factor warranting investigation is low distress tolerance (DT). Purpose/Objectives: In a sample of patients in substance use disorder (SUD) treatment, the present study examined DT levels among patients with current opioid dependence versus no history of opioid dependence, as well as the moderating role of gender. We predicted that patients with opioid dependence would exhibit lower DT than those without a history of opioid dependence, and that women with opioid dependence would exhibit lower levels of DT than men with opioid dependence. Methods: A sample of 203 patients in residential SUD treatment were administered a series of diagnostic interviews and a behavioral measure of DT. Results: DT did not differ significantly as a function of opioid dependence. However, there was a significant opioid dependence by gender interaction, such that men with current opioid dependence exhibited significantly lower levels of DT than women with opioid dependence and men without a history of opioid dependence. Conclusions/Importance: Findings highlight a modifiable characteristic associated with opioid dependence among men that may be targeted in interventions.

Keywords:

• Emotion regulation
• opioid misuse
• risk factor
• substance use disorder

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Notes

1 Hyperalgesia has also been found to occur in the context of alcohol withdrawal (Jochum et al., 2010).

2 Given that conditions (i.e. hyperalgesia) may occur in the context of alcohol abuse/dependence that contribute to low DT and thus could provide an alternative explanation for our findings, we conducted a 2 (alcohol dependence vs. no alcohol dependence) × 2 (men vs. women) ANOVA with latency to terminate the PASAT-C serving as the dependent variable. No significant main effects or interaction were found, Fs (1,199) < 2.21, ps > .138, fs < .08.

In addition, given our hypothesis that prolonged opioid misuse would contribute to the development of low DT, we also examined the effect of lifetime opioid dependence on DT with our full sample of participants with complete PASAT-C data (n = 222). Specifically, we conducted a 2 (lifetime opioid dependence vs. no lifetime opioid dependence) × 2 (men vs. women) ANOVA with latency to terminate the PASAT-C serving as the dependent variable. No significant main effects or interaction emerged. However, the interaction between lifetime opioid dependence and gender was associated with a significance level of .052, F (1, 218) = 3.81, p = .052, f = 0.11. The nature of this interaction was consistent with results obtained in our primary analyses. The non-significance of this finding could be attributed to our lack of data on when participants without current opioid dependence last met criteria for opioid dependence. If opioid dependence had not been present for some time, it would be expected to have less of an influence on DT levels.

Additional information

Funding

This

study was supported in part by R21 DA022383 awarded to the first author (MTT) from the National Institute on Drug Abuse of the National Institutes of Health. NIDA had no role in the study design, collection, analysis, or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication.