Assessing subjective wellness in heroin use disorder. Part II. Sensitivity to clinical change and temporal responsiveness of the DM-SWS in opioid-dependent patients

Background: The Deltito-Maremmani Subjective Wellness Scale (DM-SWS) was developed to assess subjective well-being among individuals recovering from heroin addiction. Building on prior work that established its reliability and structural validity, the present study investigates the sensitivity to clinical change and temporal responsiveness of the DM-SWS in patients undergoing opioid agonist treatment (OAT). Methods: A total of 63 individuals diagnosed with Heroin Use Disorder (HUD) were recruited from outpatient addiction treatment centres in Tuscany, Italy. Participants completed the DM-SWS in relation to three distinct time points: the current week, the worst week during treatment, and the best week outside of treatment. The scale comprises ten items assessing emotional, social, and existential wellness dimensions. Non-parametric tests (Friedman and Wilcoxon signed-rank) were used to analyse changes in wellness scores across time points, with Bonferroni correction applied. Results: Significant improvements were observed between the current and worst treatment weeks in multiple domains, including the ability to manage daily responsibilities (p < 0.001), tolerate everyday irritations (p < 0.001), and maintain hope for the future (p = 0.001). These changes were also reflected in the global severity index (p = 0.033) and two DM-SWS factors: Resilient Stability (p < 0.001) and Proactive Social Engagement (p = 0.002). However, Existential/Intimate Fulfilment scores declined in the current week compared to the worst (p = 0.020). Comparisons with the best week outside treatment revealed fewer significant differences, with Resilient Stability scoring higher in the current week (p = 0.030), while other domains remained stable or declined modestly. Conclusions: The DM-SWS demonstrates strong sensitivity to change and captures meaningful fluctuations in subjective wellness over time. Its multidimensional structure allows for a nuanced assessment of recovery, supporting its utility as a patient-centred outcome measure in addiction treatment settings. These findings underscore the need to incorporate broader wellness indicators into treatment evaluation and highlight specific domains, such as existential fulfilment, that may require targeted clinical attention.