Search

Background: Naltrexone has considerable potential in helping to prevent relapse in heroin dependency. A longer-lasting formulation for naltrexone treatment is desirable to further reduce non-adherence and relapse during treatment of opiate dependence.Aims: To evaluate the safety and effectiveness of a 6-month naltrexone implant in reducing opioid use after in-patient treatment.Method: A group of 56 abstinence-oriented patients who completed in-patient treatment for opioid dependence were randomly and openly assigned to receive either a 6-month naltrexone implant or their usual aftercare. Drug use and other outcomes were assessed at 6-month follow-up.Results: Patients receiving naltrexone had on average 45 days less heroin use and 60 days less opioid use than controls in the 180-day period (both P<0.05). Blood tests showed naltrexone levels above 1 ng/ml for the duration of 6 months. Two patients died, neither of whom had received an implant.Conclusions: Naltrexone implant treatment safely and significantly reduces opioid use in a motivated population of patients. [ABSTRACT FROM AUTHOR]

A study of 50 opiate addicts attending a London service for treatment of drug dependence found that 47 subjects had previously made at least one attempt at self-detoxification. These subjects reported 212 previous attempts. Although 30 subjects reported having managed to complete at least one attempt, the success rate per episode was low (24%). One of the most commonly reported methods, used by 28 subjects, involved an abrupt cessation of opiates ('cold turkey'). Of the drugs used in their attempts at self-detoxification, benzodiazepines were reported by 24 subjects and opiates by 20. Practical strategies such as distraction and avoidance were also used. Self-help detoxification materials for opiate addicts might be useful. [ABSTRACT FROM AUTHOR]

This paper presents data from the first British prospective study to investigate relapse among opiate addicts after treatment. Eighty subjects were followed up over the six-month period immediately after discharge from treatment and were interviewed on several occasions. Large numbers of subjects used opiates within a very short time after discharge; 71% used them within the first six weeks. However, this first lapse to opiate use did not herald a full-blown relapse to dependent use. There was a gradual increase in the number of abstinent subjects, with 45% abstinent and living in the community at the six-month point. The practical and theoretical implications may be regarded as broadly encouraging. [ABSTRACT FROM AUTHOR]

This study investigates and compares the responses of 132 opiate addicts to a 10-day or a 21-day in-patient oral methadone withdrawal regime. For both groups, symptom severity (on the Opiate Withdrawal Scale) steadily increased through the methadone withdrawal phase, and peaked near the point of completion of the prescribed drug, declining slowly thereafter. Patients on the 10-day programme reported significantly higher peak withdrawal scores than those on the 21-day programme. Although the proportions who completed detoxification were similar, there was a significantly higher drop-out rate immediately after detoxification for the 10-day group. The possible benefits and handicaps of the two withdrawal schedules are considered and recommendations are proposed for further refinement of the present widely adopted approach. [ABSTRACT FROM AUTHOR]

Seventy-eight opiate abusers were followed up after successful in-patient detoxification in order to examine renewed opiate use. The greatest number of initial lapses occurred within a week of subjects leaving in-patient treatment. Eleven categories of lapse precipitant were identified: cognitive, mood, external, withdrawal, interpersonal, leaving a protected environment, drug availability, drug-related cues, craving, priming, and social pressure. Cognitions, negative moods and external events emerged as the most commonly mentioned factors; these often occurred together, either in clusters or in a sequence. Implications of these results for models of relapse and for treatment approaches are discussed. [ABSTRACT FROM AUTHOR]

A group of 24 opiate addicts admitted to an in-patient drug dependence unit received either electrostimulation or graduated oral methadone withdrawal. Addicts treated with electrostimulation showed high levels of withdrawal symptoms during the first week of treatment: these reached a peak on Day 3. In this respect electrostimulation was markedly inferior to methadone withdrawal treatment. However, although progressive methadone withdrawal quickly reduced symptoms to a moderate or low level, there was no reduction in symptomatology as late as one month after admission (i.e. after ten days without methadone). The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Addicts who use illicit drugs despite receiving a maintenance prescription present a difficult management problem for drug dependence clinics. This study looks at a small group of such addicts and at their response to the provision of a temporary increase in their prescribed opiates. The results indicate that this increase led to a reduction in illicit drug use and to improvements in social functioning. These and other findings are discussed. It is suggested that clinics should be more prepared to consider such temporary increases, but the need for careful monitoring and for the involvement of more than one member of the treatment team is stressed. [ABSTRACT FROM AUTHOR]

In a study of male addicts attending a London drug dependence unit, it was found that convicted addicts tended to score more highly on measures of hostility than non-convicted subjects. The differences in hostility between the convicted and non-convicted groups were most clearly seen on the violent crimes variable, although addicts convicted of drug-possession and of non-drug crimes were also more hostile than non-convicted subjects. It is suggested that hostility acts as a personality factor which predisposes the individual towards criminal behaviour, and that the more hostile subjects may also be more likely to be apprehended and convicted. [ABSTRACT FROM AUTHOR]

Although a number of studies have suggested that hostility and drug dependence may be related, there are few systematic studies of this issue. Using the Hostility and Direction of Hostility Questionnaire, the present study compares several drug-dependent groups of patients. Results showed that the intravenous in-patient group was more hostile on several variables than their out-patient counterparts, and also more hostile than an oral in-patient group. Barbiturate abusers were found to have high levels of hostility; amphetamine abusers were the least hostile group, and narcotic dependent patients were intermediate between the two. Correlations between scales of the HDHQ were all positive, and most were both high and statistically significant, suggesting that hostility represents a relatively generalized trait in drug-dependent subjects. The results are discussed both in terms of patient selection factors--the differential pressures on different types of patients, and in terms of direct drug effects. It is suggested that the hostility of drug-dependent patients may represent an important problem of personal functioning and may require special attention in treatment programmes. [ABSTRACT FROM AUTHOR]

The article discusses developments in the government's response to drug abuse problems in Great Britain. The author notes the Maudsley Relapse Project is a study about the return to opiate use of a group of addicts who have been successfully withdrawn from opiates. He adds one particular interest of the project is a previously unreported tendency for substantial numbers of subjects to move towards abstinence during the first six months after leaving treatment. He stresses the treatment program maximizes the chances of success and treatment needs to be extended after discharge from hospital.

A response by John Strang and Michael Gossop to a letter to the editor about their article on methadone withdrawal in the May 1991 issue is presented.