Follow-up of inpatient cocaine withdrawal for cocaine-using methadone patients.

Significant proportions of opiate-dependent persons entering methadone treatment are also addicted to cocaine and continue to use cocaine during treatment. One standard response to cocaine use has been inpatient detoxification. This study examined the effectiveness of this procedure by comparing pre- and posttreatment urine toxicologies for methadone patients who had been hospitalized for cocaine withdrawal. The results showed a negligible effect on cocaine abstinence (less than 1 out of 10 patients abstinent 12 weeks after detox) and a modest reduction in the frequency of cocaine use (one-quarter decline in urine tests positive after 12 weeks). These findings raise serious doubts about the cost-effectiveness of inpatient cocaine detoxification. Better strategies need to be implemented to enhance the chances of remaining abstinent once detoxified.

Cocaine use in persons on methadone maintenance.

Although cocaine use had increased dramatically among all levels of society over the past several years, its use by heroin addicts has existed for decades. To determine whether the prevalence or the pattern of cocaine use changes once an addict enrolls in methadone maintenance, a survey of cocaine use among persons in methadone maintenance therapy was conducted. Of the 613 persons surveyed, 229 (37%) chose to participate, with 33 (14%) considered invalid because of incomplete responses. Of the remaining 196 (86% of the participants), 64 (33%) indicated no cocaine use prior to methadone maintenance, and 132 (67%) reported some prior use. Once treatment had begun, 9 (14%) with no history of prior use admitted to at least one event within the last 6 months, and 55 (86%) reported no use. Of those reporting use prior to methadone maintenance, 41 (31%) stopped usage and 91 (69%) continued. Of the total participants, approximately half used cocaine at least once during methadone maintenance. Among those who used cocaine before and during methadone maintenance, the predominant route of administration was parenteral, 72 (54%) and 46 (51%) participants, respectively. It should be noted that there was a net gain of 17% of patients who stopped using cocaine as a result of entering methadone maintenance. Indices of cocaine use by random urinalysis over the preceding 6 months, for the entire clinic population, revealed only 86 (14%) to 110 (18%) patients to have urine samples positive for cocaine. Although cocaine use decreased on methadone maintenance, its use is still considerable, with the pattern of use differing from the recreational cocaine use in a non-narcotic-dependent population. Random urinalysis for cocaine appears to be an insensitive indication of prevalence of use.

Is treatment for alcoholism effective in persons on methadone maintenance?

A randomized prospective study of 625 drug addicts on methadone maintenance revealed that 105 (17%) were active alcoholics, 47 (8%) were inactive alcoholics, and 473 (76%) were not alcoholics. The active alcoholics were randomly assigned to abstinence therapy, controlled drinking with behavior modification, or a control group receiving the usual clinic services. There were no differences between treatment and control groups at baseline and during follow-up of up to 2 1/2 years, and there was no relation between remission and treatment, suggesting that the effectiveness of currently employed specific interventions for alcoholism in active alcoholic addicts maintained on methadone cannot be demonstrated.

Alcoholism among narcotic addicts and patients on methadone maintenance.

There was no difference in prevalence of current alcoholism between new admissions to a methadone-maintenance treatment program (MMTP) and patients already in MMTP at least one year, by previous treatment for drug misuse, or between MMTP patients and the population of the surrounding community.

Alcoholism as a risk factor in methadone maintenance. A randomized controlled trial.

A randomized controlled trial of 625 addicts on methadone maintenance identified 105 (17 percent) as active alcoholics, 47 (8 percent) as inactive alcoholics, and 473 (75 percent) as nonalcoholics. Subjects were followed for up to 29 months (mean 53.7 weeks) to assess the influence of alcoholism on the rehabilitative process. During the study, alcohol consumption significantly decreased (p less than 0.001) in active alcoholics. Indexes of productive activity on entry or during follow-up revealed no significant differences between active alcoholics and other patients with the exception of alcohol-related hospitalizations (p less than 0.001). Behavioral indexes consistently improved with treatment in all patients, being greatest among active alcoholics (p less than 0.01). During the study, 28 (7 percent) of 399 nonalcoholics were recategorized as active alcoholics, and remission from alcoholism was noted in 28 (27 percent) of patients who were initially classified as alcoholic. These findings suggest that alcoholism does not significantly affect rehabilitation from narcotic use and therefore should not be cause for detoxification from methadone maintenance.

Alcohol consumption in persons on methadone maintenance therapy.

Alcohol use among methadone maintenance treatment program (MMTP) patients is substantial and a frequent impression is that addicts accelerate their consumption once in MMTP. This study reports an attempt to more clearly define alcohol consumption in opioid dependence as well as changes associated with methadone maintenance therapy. Two-day alcohol consumption (2-day EtOH) data were collected initially and quarterly on participants in a randomized controlled trial of intervention for alcoholism. Blood alcohol levels (BAL) were also determined. 17% of the participants were classified as active alcoholics (AA) and 8% as inactive alcoholics (IA). Two-day EtOH and BAL were significantly higher for AA than AI and nonalcoholics (NA, and AI higher than NA. Two-day EtOH decreased significantly over time for AA, AI, and NA. These findings indicate that AA among narcotic addicts and those on MMTP consume large quantities of EtOH but that consumption decreases with time on MMTP. The results, in confirmation of the work of others, suggest that entry and participation in MMTP has a broader effect than just on the use of narcotic drugs.

The effect of alcoholism in methadone-maintained persons on productive activity: a randomized control trial.

The effect of alcoholism on indices of productive activity was determined in a prospective, randomized, and controlled study of alcoholism in narcotic addicts undergoing methadone maintenance (MM) therapy. Indices of productive activity included: percentage of persons engaged in productive activities; number of days worked per quarter; number of arrests per quarter; number of hospitalizations; and days of hospitalizations per quarter. Baseline as well as longitudinal data were obtained on operative alcoholics (OA), inactive alcoholics (IA), and nonalcoholics (NA). OA patients were subsequently randomized to a control group or groups receiving either abstinence-oriented insight group therapy or controlled drinking-oriented behavioral modification group therapy. The retention rate in MM of OA versus NA during the 29-month clinical phase of the study did not differ significantly. Similarly, no significance was reported with respect to any index of productive activity. Indices of productive activity in OA undergoing treatment as compared to those randomized to the control group also did not reveal any significant differences. The compliance of OA in seeking and maintaining therapy for their alcoholism, however, was sufficiently poor so that any conclusions concerning the effectiveness of therapy on indices of productive activity should be viewed cautiously.

The ability of a Self-Administered Alcohol Screening Test (mSAAST) to detect future excessive alcohol consumption in persons on methadone maintenance.

A modified Self-Administered Alcoholism Screening Test (mSAAST) was prospectively administered to 625 narcotic addicts participating in a randomized clinical control trial to study its effectiveness in detecting future excessive alcohol consumption. At entry into the study, of 105 patients categorized as active alcoholics, 84 (80%) obtained a positive score on the mSAAST. Of 77 patients initially identified as being at risk for developing alcoholism (potential alcoholics) by mSAAST scores, 31 (40%) subsequently developed characteristics of excessive alcohol consumption. Of the 321 patients classified as nonalcoholic by history as well as mSAAST score, a significantly lesser proportion (15%) developed characteristics of excessive alcohol consumption (p less than 0.001). These findings suggest the mSAAST to be a useful adjunctive indicator of persons at risk of developing excessive consumption of alcohol. It is probable that the usefulness of the mSAAST extends beyond narcotic-dependent populations and may be of value in identifying the potential for excessive alcohol consumption in other populations.