NCJ Number
198933
Journal
Journal of Maintenance in the Addictions Volume: 2 Issue: 1/2 Dated: 2003 Pages: 19-36
Date Published
2003
Length
18 pages
Annotation
This cross-sectional study explored various clusters of substance use and abuse in 77 heroin addicts during methadone or naltrexone maintenance.
Abstract
This was a cross-sectional observational study of all patients who had been treated at the Addiction Unit of the Italian Public Health System (SerT) in Pisa. In addition to other drug treatment programs, SerT provides methadone and naltrexone maintenance programs for persons diagnosed with heroin dependence. Urine analysis is performed randomly once a month in stabilized patients, and more frequent urinalyses are administered during the induction phase or according to clinical conditions. The study focused on patients who had been treated for a period of time that ranged between 12 and 18 months during the spring of 1995. A total of 77 patients (50 males and 27 females, mean age 29) were included in the study. Data were obtained on addiction history, urinalyses testing, and psychosocial adjustment. For outcome criteria, a "positive" outcome referred to complete compliance with program rules, improvement in social adjustment, having a score of 70-100 on the Global Assessment of Functioning (GAF) Scale of the DSM, and having no more than one episode of "dirty" urine toxicology in the previous 30 days. A "negative" outcome was determined when the patient refused to increase the methadone dosage, if he/she used heroin, when there were more than two absences from the clinic within a month, when there was a difficult relationship with the staff, and when there was a relapse into addictive behavior. The study found that 20 patients (26 percent) used heroin, and 49 (63.6 percent) used or abused at least 1 substance. Nineteen patients (25.3 percent) were taking up to 60 mg/day of methadone. Patients with good compliance were those whose overall use of heroin and other substances was lowest. The craving for heroin in this group was probably absent or minimized under methadone treatment, and the abuse of other substances was not needed. Naltrexone-treatment patients showed no tendency toward polydrug abuse. Methadone patients with poor compliance differed from the other two groups in their higher use of heroin and other substances, with a tendency toward polydrug abuse. The correlation between polydrug abuse and social functioning attested to the uselessness of limiting dosages of methadone. This study concluded that the search for an appropriate methadone dosage is crucial, because it bears upon the patient's retention rate within the treatment group, thus providing an opportunity for an improvement in social rehabilitation and reducing the risk of polydrug abuse. 4 tables and 18 references