Retention and outcome in a narcotic antagonist treatment program.

Investigations of outpatient narcotic antagonist programs have found high attribution rates when compared to such modalities as methadone. Moreover, outcome studies generally are lacking. The present study followed 50 patients through their course of treatment at an outpatient clinic of the Nassau County Department of Drug and Alcohol Addiction. Retention was found to average 69.22 days. This was slightly higher than the average found by other investigators. Patients in the present study who remained longer were similar demographically to those who dropped out early, but were found to enter treatment with more stable employment records and less recent opiate use. They also appeared more successful at termination, with better vocational stability, less extraneous drug use, and greater acceptance of referrals to other treatment. Identification of the needs of individuals at greater risk for premature termination can serve as a basis for refining treatment efforts.

Naltrexone treatment in a jail work-release program.

Inmates with a history of opiate addiction have traditionally been excluded from jail work-release programs because of their high likelihood of returning to drug use. In 1972, a new jail work-release program was begun in the Nassau County (New York) Jail, to which addicted inmates, who had formerly been excluded automatically, could request admission if they took the opiate blocking agent naltrexone. Inmates received naltrexone twice a week and had routine urine checks for drugs of abuse and an alcohol breath test when indicated. Psychological and vocational testing and weekly psychotherapy sessions were provided. For those no longer incarcerated, the adjacent hospital outpatient clinic was available for naltrexone treatment. Naltrexone has proved to be a completely effective opiate blocking agent with no major side effects in 691 patients over a 10-year period.