Heroin Addiction and Related
Clinical Problems 2008; 10(2):5-10
Uchtenhagen
A., Stevens A., Berto D., Frick U., Hunt N., Kerschl V., Mcsweeney T., Puppo
I., Santamaria A., Schaaf S., Steffan E., Gegenhuber B., Turnbull P., Werdenich
W.
Correspondence: Prof. Ambros
Uchtenhagen, MD, PhD - Kirchgasse 30 - CH-8001 Zurich, Switzerland. Tel.
+41-44-252 71 02, E-mail: uchtenhagen@isgf.uzh.ch
Summary: A multi-country, multi-site comparative research study has
documented the feasibility of recruiting drug-dependent individuals receiving
treatment as an alternative to imprisonment (‘quasi-compulsory’ treatment, in
the setting of an experimental group), while comparing them with those receiving
treatment in the same therapeutic institutions, on a voluntary basis (control
group). The study combined qualitative and quantitative methods in describing
the evolution and outcome of each case after 6, 12 and 18 months in treatment.
845 probands were recruited from 9 sites in 5 countries (Austria, Germany,
Italy, UK, Switzerland), 429 in the experimental and 416 in the comparison
group. Data were collected using a standardized instrument set and following a
joint protocol that allowed for the testing of a number of pre-established
hypotheses. Significant reductions in drug use and delinquent behaviour,
together with improvements in social integration and health, were found in both
groups. Higher rates of perceived external pressure to stay in treatment in the
experimental group did not affect motivation of these patients as regards
improvement and retention in the study. It can be concluded that the
availability of treatment alternatives to imprisonment for drug dependence are
a valuable policy option, under various different conditions, but that this
option is open to further improvement.
Publication Type: Regular Article
Heroin Addiction and Related
Clinical Problems 2008; 10(2):11-20
Motivational
interventions for Methadone-Treated patients
Kantchelov
A.
Correspondence: Alexander
Kantchelov, MD, The Kantchelov Clinic, 102 - B, D.Hadjikocev Str., Office N.6,
1421 Sofia Bulgaria, EU- E-mail: al.kantchelov@gmail.com
Summary: Implementing a motivational approach in MMT acts as a powerful
resource in influencing in a positive way the dominant programme atmosphere,
staff-client interactions, quality of services and programme functioning as a
whole. There are various ways in which motivational interventions can be
successfully applied in MMT. The evidence to date is very encouraging in
suggesting that even brief interventions can enhance client motivation and
trigger significant improvement and change. The use of these promising methods
in the future will depend on the creativity of clinicians and researchers in
adopting, adapting and evaluating motivational interventions to make them more
widely and effectively implemented in MMT clinical practice for the good of our
clients.
Publication Type: Review
Heroin Addiction and Related
Clinical Problems 2008; 10(2):21-26
Health care utilization and
morbidity associated with Methadone and Buprenorphine
Treatment
Bell J.,
Butler B.
Correspondence: Dr. James Bell,
The Langton Centre, 591 South Dowling St., Surry Hills NSW 2010, Australia -
E-mail: James.bell@sesiahs.health.nsw.gov.au
Summary: Background: Methadone and buprenorphine treatment reduce the high
mortality associated with heroin addiction, but even in-treatment, Standardised
Mortality Rates are high. Aim: This study investigates the nature of morbidity
associated with methadone and buprenorphine treatment, and investigates
predictors of health care utilization among people in a variety of treatment
settings. Methods: Collation of data from earlier studies, and from published
reports. Findings: In a recent study of an entry cohort, the SMR was 5.52
[4.62, 5.65]; suicide and overdose accounted for 2/3 of the mortality, but
allowing for this, mortality rates remain elevated. Cancer, heart disease and
respiratory disease were the three major contributors to mortality. Taken in
conjunction with a recent study of medical co-morbidity, this suggests that
alcohol, tobacco and other drug use represent the major factors contributing to
serious illness in treated opioid addicts. In addition, side-effects of
treatment may themselves contribute to some morbidity. Lack of access to health
care does not appear to be a contributing factor, as opioid users consult
doctors (other than their methadone doctors) at rates far higher than the
general population. Predictors of doctor attendance “outside” doctors were
psychological distress, and benzodiazepine use. Adjusting for these factors, we
found evidence that quality of methadone treatment was a significant predictor
of doctor attendance, with better clinical care being associated with less
outside doctor attendance. Conclusion: There is a paradox; heroin users have
significant physical illness, but their attendance for health care tends to be
driven by psychological distress, and can be improved by good care within
treatment programs. The priority in addressing health problems of stabilised
heroin users is dealing with alcohol and tobacco problems.
Publication Type: Review
Heroin Addiction and Related
Clinical Problems 2008; 10(2):27-38
Michelazzi
A., Vecchiet F., Leprini R., Popovic D., Deltito J., Maremmani I.
Correspondence: Icro Maremmani,
MD, “Vincent P. Dole” Dual Diagnosis Unit. “Santa Chiara” University Hospital,
Department of Psychiatry, University of Pisa, Via Roma, 67 56100 PISA. Phone:
+39 0584 790073; Fax: +39 0584 72081; E-Mail: maremman@med.unipi.it
Summary: Objective: To evaluate the effectiveness of methadone treatment
carried out by General Practitioners (GPs) and to identify response treatment
factors. Methods: 33 subjects with heroin addiction according to the DSM-IV-R
criteria , 25 males and 8 females with an average age of 26 ± 6 years, were
placed in an observational protocol with average duration of 429 ± 273 days.
Retention rate, substance use, overall clinical improvement, social adaptation,
quality of life and psychopathologic symptoms were used as outcome measures. In
order to assess predictors of treatment response dropout and non-dropout
subjects were compared at baseline. Results: At the end of the observational
period, 6 patients (18.2%) had a positive outcome, 8 (24.2%) negative outcome,
while 19 (57.6%) were still in treatment with a cumulative retention of 60% at
the end of the third year of observation. In 25 non-dropout patients
baseline-endpoint improvement results were statistically significant for
substance use, global clinical evaluation, psychological, social and
occupational functioning, and craving. They also showed improvement in all of
investigated psychopathological and quality of life dimensions. There were no
significant side effects associated with their treatment. Patients with higher
severity of illness, with problematic relationships with spouse/partner, difficulty
with socialization and organization of leisure, with an altered mental state at
beginning of treatment, subjects with dual diagnosis (especially bipolar
disorder), with greater severity of obsessive-compulsive symptoms,
interpersonal sensitivity, depression, violence, with greater severity of
psychopathological symptoms, with the largest number of problematic areas as
regarding the quality of life, patients with a low dose of methadone given for
treatment were considered most at risk for abandoning treatment. Conclusions:
Methadone treatment carried out by General Practitioners appears safe and
effective, especially in less severe patients treated with adequate doses,
without severe psychopathology, without dual diagnoses (particularly bipolar
disorder) and with quality of life impairment only in limited areas.
Publication Type: Regular article
Heroin Addiction and Related
Clinical Problems 2008; 10(2):39-40
Use of Sertraline in
depressed methadone maintenance patients
Trajanovska
A. S., Popovska O. S.
Summary: Not Available
Publication Type: Letter to the Editor