Executive summary: Consensus document of GEHEP of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), along with SOCIDROGALCOHOL, SEPD and SOMAPA on hepatitis C virus infection management in drug users / Resumen ejecutivo: Documento de consenso de GEHEP, perteneciente a la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), junto a SOCIDROGALCOHOL, SEPD y SOMAPA, sobre el manejo de la infección por virus de la hepatitis C en usuarios de drogas

The micro-elimination of HCV infection in drug users (DU) in our area is a priority in order to achieve the overall elimination of this disease. Coordinated action between specialists in addiction treatment, microbiologists and physicians who treat HCV infection is required to implement infection screening, to achieve universal access to treatment and to prevent new infections and reinfections. The objective of this document was to come to a consensus on the screening, hospital referral, treatment, follow-up and prevention of HCV infection in DU by an expert panel from GEHEP/SEIMC and three scientific societies of addiction treating physicians: SEPD, SOCIDROGALCOHOL and SOMAPA

La microeliminación de la infección por VHC en pacientes usuarios de drogas (UD) es una prioridad para lograr la eliminación global de esta enfermedad. Se requiere una acción coordinada de especialistas en el tratamiento de adicciones, microbiólogos y médicos que tratan la infección por VHC para realizar el cribado de los pacientes, garantizar el acceso al tratamiento y prevenir nuevas infecciones y reinfecciones. El objetivo de este documento fue consensuar las medidas de cribado, envío a unidades hospitalarias, tratamiento, seguimiento y prevención de la infección por VHC en UD, por parte de un panel de expertos de GEHEP/SEIMC y 3 sociedades científicas implicadas en el tratamiento de las adicciones: SEPD, SOCIDROGALCOHOL y SOMAPA

Executive summary: Consensus document of GEHEP of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), along with SOCIDROGALCOHOL, SEPD and SOMAPA on hepatitis C virus infection management in drug users.

The micro-elimination of HCV infection in drug users (DU) in our area is a priority in order to achieve the overall elimination of this disease. Coordinated action between specialists in addiction treatment, microbiologists and physicians who treat HCV infection is required to implement infection screening, to achieve universal access to treatment and to prevent new infections and reinfections. The objective of this document was to come to a consensus on the screening, hospital referral, treatment, follow-up and prevention of HCV infection in DU by an expert panel from GEHEP/SEIMC and three scientific societies of addiction treating physicians: SEPD, SOCIDROGALCOHOL and SOMAPA.

Abuso o dependencia a la cocaína y otros trastornos psiquiátricos. Estudio Madrid sobre la prevalencia de la patología dual / Cocaine abuse or dependency and other psychiatric disorders. Madrid study on dual pathology

Objetivos: El objetivo de este estudio es analizar el subgrupo de adictos (criterios de abuso o dependencia) a la cocaína procedentes del estudio Madrid sobre prevalencia de diagnóstico dual en varios dispositivos asistenciales. Material y métodos: La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 488 tenían un diagnóstico de abuso o dependencia de cocaína a lo largo de la vida y 222 tenían otros trastornos por uso de sustancias distintos de la cocaína. Se usó la entrevista Mini Internacional Neuropsychiatric Interview (MINI), para el diagnóstico de los trastornos mentales del eje i y el cuestionario Personality Disorder Questionnaire (PDQ), para la valoración de los trastornos de personalidad. Resultados: Se consideró que un 73,4% de los adictos a la cocaína tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del estado de ánimo y de ansiedad. El 49,6% de los adictos a la cocaína tenían un diagnóstico de trastorno de la personalidad. Un 94,9% de estos adictos a la cocaína tenían otros diagnósticos asociados de trastornos por uso de sustancias. El subgrupo de adictos a la cocaína no tenía mayor prevalencia de diagnóstico dual que el resto de los adictos. El subgrupo de adictos con abuso o dependencia de la cocaína tenían mayor prevalencia de trastorno antisocial de la personalidad, agorafobia y trastorno por estrés postraumático, que los adictos no consumidores de cocaína, y habían iniciado de forma más precoz el consumo de alcohol y cannabis. Conclusiones: La presencia de diagnóstico dual no es más elevada en adictos a la cocaína en tratamiento, que en otros adictos, aunque han iniciado más precozmente otros consumos y se asocia más que el resto de adictos a ciertos trastornos mentales específicos(AU)

Objectives: The main objective of this study was to analyse the cocaine addict subgroup from the Madrid study of prevalence of dual disorders in community mental health and substance misuse services. Material and methods: The sample consisted of 837 outpatients from Madrid, Spain. We compared 488 subjects who had a lifetime diagnosis of cocaine abuse or dependence, and 222 subjects who did not have a cocaine substance use disorder. We used the Mini International Neuropsychiatric Interview to evaluate axis I mental disorders, and the Personality Disorder Questionnaire to evaluate personality disorders. Results: Almost three-quarters (73.4%) of cocaine addicts had a current dual disorder. Most prevalent were mood and anxiety disorders. Almost half (49.6%) had a personality disorder. Most of them (94.9%) had other substance use disorders. Cocaine addicts did not have higher prevalence rates of dual pathology than addicts with no cocaine abuse or dependence. Cocaine addicts were associated to a diagnosis of antisocial personality disorder, agoraphobia, and posttraumatic stress disorder, and they had an early age of onset of alcohol and cannabis use. Conclusions: Dual pathology is no higher in cocaine addicts in treatment than in addicts who do not use cocaine, however cocaine addicts started other drugs earlier, and were associated with specific mental disorders(AU)

[Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services]. / Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente.

The objective was to quantify the prevalence of dual diagnosis and to evaluate the characteristics of these patients from community mental health and substance misuse services in Madrid. The sample consisted of 837 outpatients from Madrid, 208 from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate disorders from axis I and II. It was considered that 517 (61.8%) patients had dual pathology (current diagnoses of axis I or II disorders and an addictive disorder): 36,1% in mental health services and 70,3% in substance misuse services. There were fewer males amongst the dual patients and it was also found that they had a worse employment situation, along with higher figures of alcohol and cannabis dependence than addicts without dual diagnoses (n=194). When comparing them with patients with mental disorder diagnoses only, excluding substance use disorder (n=126), there were differences in all socio-demographic characteristics analyzed, and dual patients were associated with diagnoses of bipolar disorder, agoraphobia, generalized anxiety disorder, post-traumatic stress disorder, and had more suicide risk and different personality disorders. Thus, dual pathology is higher in patients who are in treatment and have differential characteristics (higher suicide risk, worse employment situation) that suggest greater severity that could be of help in the planning of care resource policies for these patients.

Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente / Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services

Se valora la prevalencia y características de los pacientes de patología dual (diagnóstico actual de un trastorno mental y de un trastorno por uso de sustancias (TUS)): en las redes asistenciales de Salud Mental y Drogodependencias de la Comunidad de Madrid. Se consigue una muestra de 837 sujetos (208 de la red de Salud Mental y 629 de la red de Drogodependencias). Se usó la entrevista MINI (Mini International Neuropsychiatric Interview) y el cuestionario PDQ4+ (Personality Disorder Questionnaire) para la valoración de los trastornos del eje I y II. Se hallaron 517 (61,8%) pacientes con patología dual (un 36,1% en la red de salud mental y un 70,3% en la red de drogas). Al compararlos con el grupo de sujetos con TUS sin patología dual (n=194), había entre los duales menos varones y peor situación laboral, siendo las drogas más consumidas el alcohol y cannabis. Al compararlos con el grupo de trastornos mentales sin uso de sustancias (n=126), encontramos diferencias en todas las características sociodemográficas analizadas y los casos de patología dual son diagnosticados más frecuentemente como trastorno bipolar, agorafobia, trastorno por ansiedad generalizada, trastorno por estrés postraumático, mayor riesgo de suicidio y distintos trastornos de personalidad. Por lo tanto, la presencia de patología dual es elevada en sujetos en tratamiento y presentan unas características diferenciales, tales como mayor riesgo de suicidio y situación laboral precaria que hacen pensar en un peor pronóstico, cuestión a considerar para el desarrollo de recursos asistenciales adecuados (AU)

The objective was to quantify the prevalence of dual diagnosis and to evaluate the characteristics of these patients from community mental health and substance misuse services in Madrid. The sample consisted of 837 outpatients from Madrid, 208 from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate disorders from axis I and II. It was considered that 517 (61.8%) patients had dual pathology (current diagnoses of axis I or II disorders and an addictive disorder): 36,1% in mental health services and 70,3% in substance misuse services. There were fewer males amongst the dual patients and it was also found that they had a worse employment situation, along with higher figures of alcohol and cannabis dependence than addicts without dual diagnoses (n=194). When comparing them with patients with mental disorder diagnoses only, excluding substance use disorder (n=126), there were differences in all socio-demographic characteristics analyzed, and dual patients were associated with diagnoses of bipolar disorder, agoraphobia, generalized anxiety disorder, post-traumatic stress disorder, and had more suicide risk and different personality disorders. Thus, dual pathology is higher in patients who are in treatment and have differential characteristics (higher suicide risk, worse employment situation) that suggest greater severity that could be of help in the planning of care resource policies for these patients (AU)

Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence.

OBJECTIVES: Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. CONCLUSIONS: Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a polysubstance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders.

Abuso o dependencia al cannabis y otros trastornos psiquiátricos. Estudio Madrid sobre prevalencia de patología dual / Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence

Objetivos. El consumo de cannabis se ha asociado con una amplia variedad de trastornos mentales, destacando el posible papel causal de dicho consumo en la etiología de trastornos mentales graves como la esquizofrenia o el trastorno bipolar. Además el sistema cannabinoide está implicado en la regulación emocional, por lo que el consumo de cannabis también puede alterar dicha regulación y asociarse con trastornos de ansiedad y depresivos. El objetivo de este estudio es analizar el subgrupo de adictos a cannabis procedentes del estudio Madrid sobre prevalencia de patología dual en varios dispositivos asistenciales. Material y métodos. La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 353 tenían un diagnóstico de abuso o dependencia de cannabis a lo largo de la vida y 357 tenían otros trastornos por uso desustancias pero no cannabis. Se uso la entrevista MINI (Mini Internacional Neuropsychiatric Interview) para el diagnóstico de los trastornos mentales del eje I y el cuestionario PDQ (Personality Disorder Questionnaire) para la valoración de los trastornos de personalidad. Resultados. Se consideró que un 76,5% de los adictos al cannabis tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del humor y de ansiedad. El 51% de los adictos a cannabis tenían un diagnóstico de trastorno de la personalidad. La mayoría tenían varios diagnósticos de trastornos por uso de sustancias. Los sujetos con abuso o dependencia de cannabis tenían un inicio más precoz en el consumo de otras drogas como el alcohol, la cocaína y el tabaco que el resto de los adictos. Igualmente este subgrupo se diferenció del resto de los adictos por su asociación con el trastorno antisocial de la personalidad, el trastorno bipolar, la psicosis y la agorafobia. La presencia de estos trastornos mentales se asoció de forma significativa con una edad de inicio más precoz en el consumo de cannabis. Conclusiones. La presencia de patología dual es muy elevada en adictos en tratamiento que tienen dependencia de cannabis y dicho consumo, posiblemente en el contexto de un patrón de poli consumo, se asocia con trastornos mentales graves como la psicosis y el trastorno bipolar. Una edad de inicio más precoz en el consumo de cannabis se asocia con más riesgo de presentar dichos trastornos mentales (AU)

Objectives. Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. Material and methods. The sample consisted of 837outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. Results. It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. Conclusions. Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a poly substance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders (AU)

Cocaine abuse or dependency and other pyschiatric disorders. Madrid study on dual pathology.

OBJECTIVES: The main objective of this study was to analyse the cocaine addict subgroup from the Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients from Madrid, Spain. We compared 488 subjects who had a lifetime diagnosis of cocaine abuse or dependence, and 222 subjects who did not have a cocaine substance use disorder. We used the Mini International Neuropsychiatric Interview to evaluate axis I mental disorders, and the Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: Almost three-quarters (73.4%) of cocaine addicts had a current dual disorder. Most prevalent were mood and anxiety disorders. Almost half (49.6%) had a personality disorder. Most of them (94.9%) had other substance use disorders. Cocaine addicts did not have higher prevalence rates of dual pathology than addicts with no cocaine abuse or dependence. Cocaine addicts were associated to a diagnosis of antisocial personality disorder, agoraphobia, and post-traumatic stress disorder, and they had an early age of onset of alcohol and cannabis use. CONCLUSIONS: Dual pathology is no higher in cocaine addicts in treatment than in addicts who do not use cocaine, however cocaine addicts started other drugs earlier, and were associated with specific mental disorders.

[Psychometric performance of the 6th version of the Addiction Severity Index in Spanish (ASI-6)]. / Rendimiento psicométrico de la sexta versión del Addiction Severity Index en español (ASI-6).

This work analysed the psychometric properties of the 6th version of the Addiction Severity Index (ASI-6) translated and adapted to the Spanish language. A multicentre, observational and prospective design was used. A total of 258 participants were included, 217 were patients (35 stable patients and 182 unstable patients), and 41 were controls. The results show satisfactory psychometric performance of the ASI-6. The degree of the internal consistency of the standardized objective scores ranged between .47 and .95. As for test-retest reliability, the values were acceptable, varying from .36 to 1. The study of the internal structure revealed a good fit to a unidimensional solution for all scales taken independently. Regarding convergent-discriminant validity, the correlations between the primary and secondary scales of the ASI-6 and the Clinic Global Impression score were low, with values from .01 to .26. Likewise, 8 of the 15 scales differentiated between controls and unstable patients. The psychometric properties of the ASI-6 Spanish version seem to be acceptable, though it is necessary to carry out new studies to test metric quality with independent samples of patients.

Rendimiento psicométrico de la sexta versión del Addiction Severity Indez en español (ASI-6) / Psychometric performance of the 6th version of the Addiction Severity Index in Spanish (ASI-6)

El presente estudio examinó las propiedades psicométricas del Addiction Severity Index-6 (ASI-6) en su versión traducida y adaptada al español. Se realizó un estudio multicéntrico, observacional y prospectivo donde participaron un total de 258 sujetos, siendo 217 pacientes (35 estables y 182 inestables) y 41 controles. Los resultados muestran que el ASI-6 presentó un buen comportamiento psicométrico. Los niveles de consistencia interna de las puntuaciones objetivas estandarizadas de las escalas del ASI-6 oscilaron entre 0,47 y 0,95. Por su parte, los valores de fiabilidad test-retest fueron aceptables, oscilando entre 0,36 y 1. El estudio de la estructura interna del ASI-6 informó que todas las escalas, considerándolas de forma independiente, se ajustaron a una solución esencialmente unidimensional. En cuanto a la obtención de evidencias de validez convergente-discriminante, las correlaciones entre las escalas primarias y secundarias del ASI-6 y las puntuaciones en la Impresión Clínica Global de Gravedad fueron bajas, oscilando entre 0,01 y 0,26. Asimismo, ocho de las quince escalas del ASI-6 lograron diferenciar entre controles y pacientes inestables. La versión española del ASI-6 presenta propiedades psicométricas que pueden ser consideradas aceptables, aunque sería necesario llevar a cabo nuevos estudios que continúen examinando su calidad métrica en muestras independientes de pacientes(AU)

This work analysed the psychometric properties of the 6th version of the Addiction Severity Index (ASI-6) translated and adapted to the Spanish language. A multicentre, observational and prospective design was used. A total of 258 participants were included, 217 were patients (35 stable patients and 182 unstable patients), and 41 were controls. The results show satisfactory psychometric performance of the ASI-6. The degree of the internal consistency of the standardized objective scores ranged between .47 and .95. As for test-retest reliability, the values were acceptable, varying from .36 to 1. The study of the internal structure revealed a good fit to a unidimensional solution for all scales taken independently. Regarding convergent-discriminant validity, the correlations between the primary and secondary scales of the ASI-6 and the Clinic Global Impression score were low, with values from .01 to .26. Likewise, 8 of the 15 scales differentiated between controls and unstable patients. The psychometric properties of the ASI-6 Spanish version seem to be acceptable, though it is necessary to carry out new studies to test metric quality with independent samples of patients(AU)

[High-dose methadone detoxification in a hospital unit. Clinical experience]. / Desintoxicacion de dosis elevadas de metadona en una Unidad de Desintoxicacion Hospitalaria (UDH). Experiencia clinica.

The increase in opiate addicts in treatment with methadone, coupled with improved survival of HIV patients, has meant an increase in the demand for detoxification from this substance in our environment. It is common practice in hospital detoxification units to request a maximum dose of methadone (around 40 mg) on beginning detoxification treatment. However this is not always possible, due to the time needed for a gradual decrease for outpatients making daily visits to the methadone dispensing centres, due to the appearance of withdrawal symptoms, or because the patient starts out from very high doses of methadone. Reported here is an experience with 22 inpatients who over the last two years underwent detoxification from methadone without requesting from their treatment centres a maximum-limit dose at the start of their treatment. During the detoxification they are given treatment with clonidine and benzodiazepines (dosage being adjusted according to concomitant use of alcohol, benzodiazepines and cocaine) and non-opiate-based painkillers. On the seventh day they are given 50 mg of naltrexone. Of these addicts, 21 completed the detoxification adequately.

Desintoxicación de dosis elevadas de metadona en una Unidad de Desintoxicación Hospitalaria (udh). Experiencia clínica / High-dose methadone detoxification in a hospital unit. Clinical experience

El aumento de adictos a opiáceos en tratamiento en metadona, junto con la mayor supervivencia de los pacientes VIH, ha supuesto en nuestro medio un incremento de la demanda de desintoxicación de dicha sustancia. Es práctica habitual en las Unidades de Desintoxicación Hospitalaria (UDH) solicitar una dosis máxima de metadona (alrededor de 40 mg) al ingreso para realizar la desintoxicación. Sin embargo, esto no siempre es posible, bien por el tiempo necesario para la disminución gradual ambulatoria, por aparecer sintomatología abstinencial,o por partir el paciente de dosis muy elevadas de metadona. Se muestra la experiencia en 22 pacientes que en los últimos dos años realizan desintoxicación de metadona sin solicitar a los centros remitentes dosis límite máxima para su ingreso. Reciben durante la desintoxicación tratamiento con clonidina y benzodiacepinas (ajustada la dosis de éstos fármacos según el consumo concomitante de alcohol, benzodiacepinas o cocaína) y analgesia no opiácea. Al séptimo día se administra 50 mg denaltrexona. De estos adictos, 21 realizaron la desintoxicación de forma adecuada

The increase in opiate addicts in treatment with methadone, coupled with improved survival of HIV patients, has meant an increase in the demand for detoxification from this substance in our environment. It is common practice in hospital detoxification units to request a maximum dose of methadone (around 40mg) on beginning detoxification treatment. However this is notalways possible, due to the time needed for a gradual decrease for outpatients making daily visits to the methadone dispensing centres, due to the appearance of with drawal symptoms, or because the patient starts out from very high doses of methadone. Reported here is an experience with 22 inpatients who over the last two years underwent detoxification from methadone without requesting from their treatment centresa maximum-limit dose at the start of their treatment. During the detoxification they are given treatment with clonidine and benzodiazepines (dosage being adjusted according to concomitant use of alcohol, benzodiazepines and cocaine) and non-opiate-based painkillers. On the seventh day they are given 50 mg of naltrexone. Of these addicts, 21 completed the detoxification adequately

Situación actual de los programas con naltrexona en la dependencia de opiáceos. Revisión de su efectividad / Update on naltrexone programmes in the treatment of opioid dependence: a review of their effectiveness

En el tratamiento de la dependencia de opiáceos, los tratamientos con antagonistas opiáceos (naltrexona) se incluyen dentro de los programas libres de drogas, que junto con las terapias con agonistas opiáceos constituyen hoy día las principales alternativas terapéuticas de la dependencia de opiáceos. Ambas terapéuticas no caben considerarse opuestas y excluyentes sino necesarias y complementarias para el tratamiento de una patología de curso crónico, que busca disminuir el número e intensidad de las recaídas como paso previo a la plena abstinencia. Se revisan los programas de naltrexona valorando la efectividad de la misma en los diferentes parámetros usualmente admitidos (en especial la tasa de retención), destacando aquellos factores sociodemográficos y sanitarios que se relacionan con el pronóstico del tratamiento, y recogiendo el perfil de paciente para el que la literatura señala una mayor probabilidad de éxito terapéutico. Se benefician más, en principio, sujetos con buen apoyo familiar, escaso deterioro social, altamente motivados, que presenten recaída reciente, que procedan de programas de comunidad terapéutica o que se encuentren abstinentes pero percibiendo situación de riesgo. La naltrexona se muestra como una alternativa terapéutica efectiva en el tratamiento de la dependencia de opiáceos, siendo necesario clarificar el perfil de paciente que mejor se beneficie, en un momento dado de la evolución de la adicción, de dicha terapia (AU)

There exist two main therapeutic strategies in order to treat opioid dependence. One of them is based on the use of an opiate agonist; the other one, called drug-free therapy, includes opiate antagonistic treatment programme (naltrexone). At the present time, we can not consider these two choices as reciprocally exclusive, but as necesary y complementary in the treatment of heroin dependence, a chronic pathology. In this article, we review naltrexone maintenance programmes y their effectiveness (specially retention rates); we summarize those social, demographic, medical, y treatment factors that predict outcome; y we indicate subject profile pointed as successful by literature. Those with adequate family and/or social involvement or with high motivation, users fear of relapse or those with recent relapse, those admitted from Therapeutic Community, gain more from the naltrexone program. Naltrexone appears to be an effective choice in the opioid dependence treatment. Nonetheless, it’s necessary to clarify the patient profile that better takes advantage of this therapy in a specifical stage of his addiction evolution (AU)