Does Dual Diagnosis Affect Violence and Moderate/Superficial Self-harm in Heroin Addiction at Treatment Entry?

Objectives: The presence of aggressive and self-harm behaviors is common in heroin-addicted patients, but these frequent cooccurrences have been poorly investigated. Given the fact that selfharm may be seen as both a clear addictive behavior, with its opiate theory, and as part of psychiatric illness, such as psychosis and bipolar spectrum disorders, in this study, we intend to investigate which of the 2 models is more consistent., Methods: We compared dual diagnosis with the clinical features of 30 moderate/superficial self-harmed and 162 violent heroin-addicted patients who reported aggressive behavior in the month preceding their request to be treated. As control group, we selected 808 lifetime nonviolent heroin-addicted patients., Results: The presence of a bipolar spectrum diagnosis proved to be the highest risk factor (B = 4.33; exp(B) = 76.52; 95% confidence interval for exp(B) = 35.69-164.04; P < 0.001) for the presence of aggressive behavior (X2= 433.05; df = 5; P < 0.001). The highest risk factor for the presence of moderate/superficial self-harm ( X2 = 24.83; df = 2; P < 0.001) was a dual diagnosis for chronic psychosis (β = 1.46; exp(B) = 4.34); 95% confidence interval for exp(B) = 1.11-16.98; P < 0.001). The relationships between aggressive and/or self-harm behaviors and the natural history of addiction in heroin-addicted patients seemed to be less consistent., Conclusions: Our data show a frequent co-occurrence of aggression and bipolar spectrum disorder in heroin-addicted patients, which is manifested as aggression directed toward others (violence). On the contrary, self-injurious behavior seems to be strongly correlated with psychotic disorders. Thus, aggressive behavior seems to be corre-lated, in heroin-addicted patients before entering treatment, with dual diagnosis rather than with a natural history of heroin addiction. © 2014 American Society of Addiction Medicine.