Heroin Addiction and Related Clinical Problems 2007; 9(1):5-24
Mintzer M. Z.
Address for reprints: Miriam Z. Mintzer, Department of Psychiatry and Behavioral Sciences, Behavioral Biology Research Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, Maryland 21224. phone (410) 550-0529 fax (410) 550-0030, mmintzer@jhmi.edu
Summary: Opioid pharmacotherapy can provide the stability necessary to initiate lifestyle changes, obtain steady employment and function in society. Thus, a critical question is the extent to which pharmacotherapy is associated with impairment in psychomotor and cognitive performance that might affect functioning. In this article, I review human laboratory studies of the effects of the most common opioid pharmacotherapies, methadone and buprenorphine, on psychomotor and cognitive performance (both observational group comparison and experimental drug administration studies) and the effects of withdrawal from opioid pharmacotherapy on performance. I then outline some recommendations for further study in this area.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(1):25-34
Curet E., Beeder A. B., Joseph H., Alexander K., Schamisso C., Rodriguez H.
Address for reprints: Eugenia Curet, Ph.D. The Vincent P. Dole Research and Treatment Institute, Department of Public Health, Weill Cornell Medical College, 445 East 68th St. #3P, New York, New York 10021, Tel. 212 746-1252, Email: euc2004@med.cornell.edu
Summary: This paper will provide an overview of an integrated biopsychosocial treatment model utilized at the Vincent P. Dole Research and Treatment Institute for Opiate Disorders of the Weill Cornell Medical College, Department of Public Health, and the New York Presbyterian Hospital, to provide treatment services to a population of multi-diagnosed opiate addicted patients. The Institute consists of two methadone clinics that employs a multidisciplinary staff and provides treatment services to young adults (Adolescent Development Program) and to older adults (Adult Services Clinic) who are multi-diagnosed with substance abuse and chronic psychiatric and medical illnesses.
Publication Type: Policy Initiatives
Heroin Addiction and Related Clinical Problems 2007; 9(1):35-44
Opioid Substitution with Methadone and Buprenorphine: Sexual Dysfunction as a Side Effect of Therapy
Brown R. T., Zueldorff M.
Address for reprints: Brown Randall T., MD, University of Wisconsin, Department of Family Medicine, 777 S. Mills St. Madison, WI 53715, Usa, e-mail: Randy.Brown@fammed.wisc.edu
Summary: Opioid substitution is the most widespread and well-researched treatment modality for opioid dependence. Methadone and buprenorphine are currently the most commonly used pharmacotherapeutic agents. Sexual dysfunction has been reported as an adverse effect of opioids including methadone and buprenorphine. The current article describes proposed mechanisms for sexual dysfunction as an adverse effect of methadone and buprenorphine, summarizes research conducted on subjects on these agents, and explores appropriate evaluation and intervention in the management of the types of sexual dysfunction most commonly encountered during opioid substitution treatment (libido, erectile, and orgasm dysfunction).
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(1):45-54
Paxil (Paroxetine) in Complex Therapy in Heroin Addicts
Rokhlina M., Kitkina T., Gubanov G.
Address for reprints: Maya Rokhlina, Prof. MD, Leading Researcher, National Research Center on Addictions, Ministry of Public Health. Russia, 119002, Moscow, Maly Mogiltsevski per. 3. Tel. 7 (495)358 44 38, Fax 7 (495) 241 09 81
Summary: The efficiency of Paroxetine was studied in 27 males with heroin addiction (average age: 26.2 years, average disease duration: 3.4 years) undergoing detoxification. After 3-4 days of paroxetine (initial dose 20 mg/day, maximum dose 40 mg/day) the first improvement of affective symptoms were noticed. By the 14th day of treatment, affective discomfort had been arrested in most cases. On the whole paroxetine can be considered an effective medicine for contrasting affective discomfort of heroin addicts in the post-withdrawal stage, as long as agonist compounds are not available.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2007; 9(1):55-76
Use of Sodium Gamma-Hydroxybutyrate (GHB) in Alcoholic Heroin Addicts and Polydrug-Abusers
Maremmani I., Pacini M.
Address for reprints: Icro Maremmani, MD; Santa Chiara University Hospital, Department of Psychiatry, University of Pisa, Via Roma, 67, 56100 PISA, Italy, EU. Phone +39 0584 790073 Fax +39 0584 72081 E-Mail: maremman@med.unipi.it
Summary: Sodium gamma-hydroxybutyrate (GHB) in one of the most effective options available for the treatment of hard-core alcoholism in maintenance programmes that aim to achieve relapse prevention and rehabilitation. Polysubstance abuse and multiple addiction have become quite common in alcoholic youths and former heroin addicts receiving inadequate or no specific treatment. In approaching these categories, GHB is usually neglected, on the basis of the idea that its abuse potential must be amplified in abuse-prone individuals. However, the normalizing effects of anticraving treatment on the behaviour of heroin addicts may make GHB a suitable remedy for the heroin-alcohol polyabuse picture. The same cannot be said of cocaine abusers, due to the lack of anticraving treatments possessing major, reliable effectiveness. After reviewing the data in the literature on the use of GHB in alcoholics and other kinds of abusers, we describe 13 cases of alcohol-abusing heroin addicts, in which GHB proved to possess some effectiveness, even if there were major limitations regarding compliance and completeness of response.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(2):5-10
Can Heroin Maintenance Treatment Be Called a Therapy?
Guelfi G. P., Cibin M., Pani P. P., Maremmani I., For the Board of Directors of Italian Society of Addiction Medicine
Icro Maremmani, M.D., Vincent P. Dole Dual Diagnosis Group, Santa Chiara University Hospital, Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy, EU Phone +39 050 993045, E-mail: maremman@med.unipi.it
Summary: Heroin administration may be reasonably accounted for in order to handle the cases of patients who proved refractory to methadone, despite repeated attempts and the employment of enhancement techniques to favour retention and rehabilitative processes. In most countries this is not the case, since standard effective treatments are often neglected or applied with unjustified limitations resulting in hampered effectiveness. As a consequence, effective treatment is far from being actually available to all those who apply for it, let alone those who may benefit from it. The first step to empower the addiction care system is to spread and enhance resources to grant patients with correct and powerful application of effective techniques, methadone/buprenorphine maintenance being regarded as the gold and first-line standard for the average addict. If that will ever be the case, as we hope, we would need to provide patients identified as refractory with a salvage option, along the concept of harm reduction. In any other context, the introduction of heroin administration programs would rather reduce the benefit than the harm
Publication Type: Positional paper
Heroin Addiction and Related Clinical Problems 2007; 9(2):11-16
Buprenorphine for Dual Dependency: Cocaine, Alcohol and Opiates
Gardner T., Kosten T.
Tracie Gardner PhD, Michael E. DeBakey VA Medical Center, Research 151 - BLDG 110, Room 225 - 2002 Holcombe Boulevard, Houston, TX 77030, USA Email: tgardner@bcm.edu - Phone: 713 794 7170 - FAX: 713 794 7240
Summary: Dual-drug dependency is common in Europe and America and represents a complex management and treatment challenge. Most heroin addicts abuse stimulants or alcohol in addition to opiates. Cocaine pharmacotherapy remains a challenge, but there has been some success with Buprenorphine, Disulfiram, Modafinil and GABA agonists. A promising cocaine vaccine is also under development. Triple-dependency with alcohol or benzodiazepines is also common and can lead to serious dependence requiring detoxification. In addition to regular monitoring following alcohol detoxification, relapse prevention pharmacotherapy is essential. The following review will briefly describe concurrent-drug abuse with cocaine and opiates as well as describe current pharmacotherapies for multi-drug dependence. In addition, we will briefly discuss the implications for combining behavioral therapies with medications to improve treatment efficacy.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(2):17-26
Polunina A. G., Davydov D. M., Kozlov A.
Dr. Anna Polunina, 156-368 Leninsky pr-t Moscow 119571 Russia, e-mail: anpolunina@mail.ru, Tel./Fax: +7-495-438-7624
Summary: The present review aims to clear up the issue of the neurological processes underlying the personality changes induced by chronic opioid use. The effects of methadone treatment on brain functions have been analyzed, too. Brain disintegration becomes evident very soon after an onset of chronic heroin abuse and continues throughout the period of drug consumption. A considerable proportion of opioid addicts are characterized by conspicuous neuropsychological deficits, which preclude the maintenance of complete opioid abstinence in this patient subgroup. At present, there are no data to testify that the effects of methadone maintenance on brain functions exceed the adverse neurological effects of chronic heroin use.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(2):27-38
Voucher-Based Reinforcement Therapy for Drug-Dependent Pregnant Women
Heil S. H., Linares Scott T. J.
Sarah Heil, PhD - Substance Abuse Treatment Center -Department of Psychiatry, Room 1415 University Health Center, 1 South Prospect Street, Burlington, VT 05401, USA - ph: 802-656-8714 fax: 802-656-5793
Summary: Opioid and other drug abuse during pregnancy is a leading preventable cause of fetal and neonatal morbidity and mortality. Given the limited availability of safe and effective pharmacotherapies for this population, additional interventions that address drug use and other behaviors are sorely needed. One of the most robust interventions for increasing drug abstinence is voucher-based reinforcement therapy (VBRT). The present report reviews the growing literature on VBRT interventions to promote opioid and other drug abstinence in pregnant substance abusers. Overall, results suggest that VBRT interventions can foster drug abstinence and other therapeutic behaviors in this special population.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(2):39-46
Pharmacokinetic and Pharmacogenetic Factors Influencing Methadone Plasma Levels
Crettol S., Eap C. B.
Dr Chin B. Eap, Hôpital de Cery, CH-1008 Prilly-Lausanne, Switzerland Tel: +41 21 643 64 38; Fax: +41 21 643 64 44; E-mail: Chin.Eap@chuv.ch
Summary: Methadone is widely used as a maintenance treatment for opiate addiction. Methadone plasma levels vary widely for a given dose, so contributing to interindividual variability in response to methadone maintenance treatment. Until recently, the relative in vivo involvement of various cytochrome P450 (CYP) isoforms in methadone pharmacokinetics had been unclear. A recent large-scale pharmacogenetic study with patients in methadone maintenance treatment has now demonstrated that CYP3A4 and CYP2B6 are the major cytochrome P450 isoforms with a major involvement in methadone metabolism, while CYP2D6 only contributes to a minor extent. In addition, P-glycoprotein, a transmembrane efflux protein, is also involved in methadone kinetics.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(2):47-54
Marion I. J., Burke D.
Ira J. marion, MA, Executive Director, Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences, Albert Einstain College of Medicine, 1500 Waters Place, Bronx, NY, USA
Summary: Not Available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2007; 9(2):55-64
Dihydrocodeine Treatment of Alcohol Addicts with Previous Opiate Addiction — Case Reports
Ulmer A., Mueller M., Frietsch B.
Albrecht Ulmer, MD, HIV-and Addiction-Disease- Practice, Schwabstr. 26 - D-70197 Stuttgart, Germany, EU Tel. +49-711-626308; Fax +49-711-610074; E-mail: albrecht.ulmer@gmx.de
Summary: Objective: In papers already presented at conferences we were able to report that a successful maintenance therapy for alcohol addicts is possible with Dihydrocodeine (DHC). Here we report the case histories of 9 serious alcohol addicts; eight of these were former opiate addicts and the ninth a former non-addicted heroin user. Methods: We describe here all nine of our former heroin users who have more recently been treated with DHC because of a serious alcohol addiction. They had all distanced themselves for several years from their earlier phases of heroin addiction. All these patients had received professional counselling and, with one exception, had experienced professional addiction treatment. We prescribed DHC very cautiously and normally avoided exceeding the dosage of 320 mg daily, a much lower dosage than would have been needed for opiate substitution; higher dosages were prescribed to only two patients in this group. Results: All these patients substantially reduced their alcohol consumption; this led to a clear general improvement. Two patients stopped drinking altogether, the first over a period of 1.5 years at the time of writing, and the second over a period of nearly 3 years; both report an unrestricted feeling of well-being. One has, meanwhile, also completed his DHC-intake treatment. A third patient showing a similar improvement, who now drinks only very occasionally, does not seem to need absolute alcohol abstinence. In most of the patients the improvement was not sustained or absolutely irreproachable. One patient with a severe phasic depression committed suicide after years of clear improvement. Other patients showed an only transient improvement in their GGT, despite having reported nearly complete alcohol reduction and a drastic improvement in their anxiety and panic attacks, or they experienced a gradual relapse back to their original level of alcohol consumption. Two patients refused to undergo a regular DHC therapy as prescribed by us, and switched back to heroin or alcohol consumption. Conclusions: In 7 out of 9 patients a clear improvement in the situation was achieved by prescribing DHC. These seven patients substantially reduced their alcohol intake; in two cases drinking was completely eliminated. But one suicide, one heroin relapse and two apparently definitive alcohol relapses, in addition to other problems, show that we are unable to present DHC as offering all patients an easily won treatment success
Publication Type: Case Report
Heroin Addiction and Related Clinical Problems 2007; 9(3):5-8
Addiction Treatment: When Will Medical Principles Matter?
Pacini M., Maremmani I.
Address for reprints: Matteo Pacini, MD, "G. De Lisio" Institute of Behavioural Sciences, Via di Pratale, 3 - 56127-Pisa, Italy, EU
E-mail; paciland@virgilio.it
Summary: Not available
Publication Type: Editorial
Heroin Addiction and Related Clinical Problems 2007; 9(3):9-20
New Approaches in the Treatment of Opioid Dependency During Pregnancy
Kaltenbach K., Jones H., Fischer G., Selby P.
Address for reprints: Karol Kaltenbach, PhD, Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University - 1201 Chestnut St. Suite 900, Philadelphia, PA 19107
Phone: 215-955-4068, Fax; 215-568-6414, E-mail: Karol.Kaltenbach@jefferson.edu
Summary: Although the treatment of opioid dependence during pregnancy has received considerable attention over the past 40 years, most approaches have been based on retrospective, observational and/or clinical studies rather than well controlled clinical trials. An exciting new period appears to be emerging in which rigorous empirical data will provide recommendations for optimal treatment approaches for both the opioid dependent pregnant woman and her child.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2007; 9(3):21-30
Clinical Features of Heroin Dependence Onset in Young Women
Blagov L. N.
Address for reprints: Lev N. Blagov, MD, PhD, Associate Professor, Chair of Drug Dependence, Russian State Medical University, Moscow, Russia
E-mail: lblagov@rambler.ru
Summary: Important clinical mechanisms leading to opiate (heroin) addiction in young female patients have been investigated using a clinical-psychopathological method. The aim of this study is a better understanding of how integration takes place between the main factors involved in the onset and initial dynamics of general syndromes involving chemical dependence: pattern of intoxication, withdrawal syndrome, craving, personality degradation. Our clinical definitions have focused on describing the symptomatology and analysing which factors count the most in determining dependence. Distinctions have been drawn between the main onset mechanisms of heroin dependence in young females. They have been divided into: inductive, hedonistic, neurotic and mixed inductive-neurotic. Each mechanism is characterized by intrinsic clinical traits and symptoms, which comprise both premorbid personality and environmental factors. Comments are provided on the clinical dynamics of opioid dependence in its early stages, as these emerge in young female patients.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2007; 9(3):31-40
Supporting GP’s in Improving Substitute Prescribing for Opiate Users in UK General Practice
Ford C.
Address for reprints: Dr Chris Ford MBChB MRCP FRCGP, Clinical Lead SMMGP & GP, Lonsdale Medical Centre, 24 Lonsdale Road, London NW6 6SY, UK
Phone: 020 7328 6164 - Email: chrishelen.ford@virgin.net
Summary: UK General Practice is now undertaking an increasing role in drug treatment but it hasn’t always been that way. Over the previous 20-30 years, much of the drug treatment in the UK has been poor with little involvement of General Practice. From the mid 90s there was the beginning of government support for general practice to be involved in this area of work. Many developments have occurred which have try to address the barriers and provide support such as 1) A network of support and training; 2) An annual conference, a newsletter and web site; 3) The RCGP Certificate course and 4) Writing of guidance’s specifically for care in general practice. All these measures have begun to change the face of drug treatment in the UK from general practice undertaking less than 5% to now about 30% and still rising.
Publication Type: Policy Initiatives
Heroin Addiction and Related Clinical Problems 2007; 9(3):41-50
Mortality Among Opiate Abusers in Stockholm: A Longitudinal Study
Stenbacka M., Leifman A., Romelsjö A.
Address for reprints: Marlene Stenbacka Ph.D. Associate Professor. Stockholm Dependency Centre, Magnus Huss, M 4:04, 171 76 Stockholm, Sweden, EU
E-mail address: marlene.stenbacka@sll.se
Summary: Background. Earlier studies have shown that opiate abuse is associated with an increased risk of developing a negative lifestyle, and also with high mortality and morbidity in young people. Many studies on mortality among drug users are based on clinical samples with short follow-up periods. In this study we were able to follow a more general cohort of opiate abusers with reference to mortality and morbidity during a 37-year follow-up period. The aims were to analyse mortality in a large cohort of opiate abusers during a follow-up period as long as 37 years. Material and methods: The study is based on a cohort of opiate abusers selected in Stockholm in 1967. They were recruited by using a case finding method, with data based on reports from authorities, hospitals, prisons, schools, and so on. A total of 817 people (647 men and 170 women) reported opiate abuse alone (Op) or in combination, either with central stimulants (Op+Cs) or alcohol (Op+Alc). The cohort was followed up in the Cause of Death and Inpatient-care Registers, until 2003 and 2004, respectively. Results. A total of 477 (58.4%) opiate abusers (392 men and 85 women) died during the follow-up period. The average age of death was higher for the men in the cohort (48.1 years) than for the women (42.9 years). The average age at death in Stockholm County was 71.7 for men and 76.3 for women in 1967 and 77.8 and 82.3 in 2003. Irrespective of drug use (Op, Op + Cs and Op+Alcohol use), a common cause of death among the youngest (15-34 years) was accidents (41%, 35%, and 11%) followed by suicide. After adjusting to take account of age and gender in the general population in Stockholm County, the standard mortality ratio (SMR) among the whole group was 4.38 (95% CI 4.0-4.78); it was 5.79 (95%CI 4.56-7.02) for the women and 3.45(95% CI 3.11-3.79) for the men. Conclusion. The female addicts were at a considerably higher mortality risk than the men and at death they were younger. Accidents and suicide, especially among young people, are two causes of death which might have been prevented. This is crucial in supplying information useful to preventive efforts.
Publication Type: Research Article
Heroin Addiction and Related Clinical Problems 2007; 9(3):51-56
Methadone Treatment in the Criminal Mental Hospital of Montelupo Fiorentino, Tuscany, Italy
Lamanna F.
Address for reprints: Francesco Lamanna, M.D., PISA-SIA Group, "G. De Lisio" Institute of Behavioural Sciences, Via di Pratale, 3 - 56127 Pisa, Italy, EU.
E-mail: francesco.lamanna0@aliceposta.it
Summary: Not Available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2007; 9(4):5-8
The Need For Scientifically Based Ethical Principles In Dealing With Drug-addicted Persons
Pacini M., Maremmani I.
Address for reprints: Matteo Pacini, MD, "G. De Lisio" Institute of Behavioural Sciences, Via di Pratale, 3 - 56127-Pisa, Italy, EU
E-mail; paciland@virgilio.it
Summary: Not available
Publication Type: Editorial
Heroin Addiction and Related Clinical Problems 2007; 9(4):9-20
Maintenance: How Long ? Experiences from a German Practice
Ulmer A., Muller M., Frietsch B.
Address for reprints: Albrecht Ulmer, MD, HIV- and Addiction-Disease-Practice, Schwabstr. 26, D-70197 Stuttgart, Germany, EU
E-mail: albrecht.ulmer@gmx.de
Summary: Objective: Classical addiction treatments comprise detoxification therapies and in, some cases, inpatient therapies in special clinics. This kind of treatment is so firmly established that society, many professionals and even many addicts think it should be possible to cure addiction diseases within a few months. This is why, maintenance therapies are believed to be disease-prolonging. The prescribers are often asked how long they plan to treat their patients. Methods: For 17 years now, we have been observing the evolution of > 350 addicted patients in our practice with the help of diagrams, leading to an overview of what we have seen, rather than to statistical analyses. Results: The impression is absolutely clear: addiction diseases are chronic, life-accompanying diseases. Patients who are able to overcome the symptomatic phase of this kind of disease forever, within months or only a few years, are rare and, in most cases, are among those less seriously affected. Even our 'best', and most presentable patients need ten and more years of treatment for a lasting stabilization even when they are already stable. Other patients who have not been stable over a long period of time, usually need much longer. Conclusions: When treating addicted patients, we must have plenty of patience. The overwhelming majority need therapy for many years, often for the rest of their lives. We should always look forward, and never give up. The prognosis for most of the patients is hopeful. Lasting improvement has been seen in at least a majority of our patients.
Publication Type: Short Communication
Heroin Addiction and Related Clinical Problems 2007; 9(4):21-30
Agonist Opioid Treatment in Prisons
Kastelic A., Kostnapfel-Rihtar T.
Address for reprints: Andrej Kastelic, M.D., Head, Center for Treatment of Drug Addiction Ljubljana, Zaloska 29, SI-1000 Ljubljana, Slovenia, EU
E-mail: andrej.kastelic@guest.arnes.si
Summary: It is estimated that approximately one third of prison inmates can be considered opiate-dependent, and that many more are experienced drug users. In several prisons, this includes up to three quarters of the inmate population. Prisons are extremely high-risk environments for HIV transmission because of overcrowding, poor nutrition, limited access, continued illicit drug use (“unhygienic relapses”) and unprotected sex. As to recidivism among substance abusing prisoners, between 70 and 98 % of those who have been imprisoned for drug-related crimes, but did not receive treatment during their imprisonment, undergo a relapse during the twelve months following their release. The recently published position paper WHO, UNODC and UNAIDS (2004) on agonist opioid maintenance therapy concludes that providing agonist opioid maintenance therapy in treating opioid dependence is an effective strategy for preventing HIV/AIDS, and that it should be considered for implementation as soon as possible in communities at risk from HIV infection. IDUs who do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment. The death rate of people with opioid dependence in methadone maintenance treatment is between one third and one quarter the rate for those not in treatment. The health services for individuals in prisons or correction houses should have standards as high as those provided outside the correctional system.
Publication Type: Policy Initiatives
Heroin Addiction and Related Clinical Problems 2007; 9(4):31-50
Quilici C., Pacini M., Maremmani I.
Address for reprints: Matteo Pacini, MD, "G. De Lisio" Institute of Behavioural Sciences, Via di Pratale, 3 - 56127-Pisa, Italy, EU
E-mail; paciland@virgilio.it
Summary: Objective: that of making clear the level of neuroscientific knowledge and the cultural prejudices that call for targeted psychoeducational interventions in treating heroin dependence. Methods: after a time-interval of 10 years, and within the same socio-cultural environment, standardized methods have been used to map out the attitudes of groups of drug-addicted subjects undergoing treatment at local addiction treatment units (“SerT”) or in Therapeutic Communities (n=60), of young people at risk (n=30) and of subjects drawn from the general population (n=20). Results: our results show a poor, little-changed level of scientific knowledge and of the frequency of misconceptions about heroin-addiction in the recent past (1995-2005), along with a significant deterioration in the general population. The areas that most clearly reveal a need for psychoeducational interventions prove to be those linked with knowledge about the disease, with the attitudes of drug-addicts towards the onset of their addiction, with knowledge about the available therapeutic resources, with risks to health associated with drug-taking and with the choice of the most appropriate person to be in charge of therapeutic programs. Conclusions: nowadays, more than ever before, there is a need in Italy for an intensive psychoeducational program to be planned, to cover all the environments involved (social and health care structures, schools, therapeutic communities, and so on), and for this program to be clear and precisely targeted in its contents. Practical implications: major effort should be addressed towards the improvement of patients’ insight and professionals’ cultural attitudes, which appear to be stay in spite of rational awareness of therapeutic results or the understanding of scientific knowledge.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2007; 9(4):51-54
Motivational Interviewing: Linking Systems and Dancing with Clients
Bes R.
Address for reprints: Rik Bes, Center for Motivation and Change, Koningshof 59, 1211 MJ Hilversum, the Netherlands, EU,
E-mail: r.bes@hetnet.nl - www.motivationalinterview.nl
Summary: Not Available
Publication Type: Letter to the Editor