Naltrexone treatment--the problem of patient acceptance.

Since the release of naltrexone for general use, we have offered it to approximately 300 narcotics-addicted patients admitted to our 4-week intensive treatment program at the Psychiatric Institute of Washington. Despite active persuasion, only 15 patients agreed to take the drug, and 11 started the outpatient phase of treatment. Only 3 of the 11 remained on naltrexone for more than 2 months. Negative local community attitudes toward all pharmacologic treatments, a strong focus on total abstinence by the recovering patient group, and self-elimination of poor candidates in this unselected population appear to be important factors in the poor acceptance of naltrexone.

The outpatient treatment of heroin addicts with methadone: a two- to five-year follow-up study.

This study is a two- to five-year follow-up of 40 patients who were discharged from a methadone maintenance program. Both "graduates" and prematurely discharged patients were surveyed. Forty-five percent of patients had been in treatment for one year or more. Outcome evaluation was based on a reduction of illicit drug use, an increase in social stability, and a decline in criminal activity. Eighteen of 40 clients were located and interviewed. Seven (39 percent) were found to be either drug free or using only prescribed methadone, and five had substantially reduced their drug use. Relapse to illicit drug use was associated with a pre-treatment history of poly-drug use, poorer work and arrest records, and a greater number of previous treatments. Abstinence appeared to be a realistic goal for only a few. The importance of retaining patients in treatment longer is discussed.

Thyroid hormone and the TRH stimulation test in refractory depression.

Seven of 21 refractory depressed patients responded within 7 days to combined thyroid hormone-antidepressant treatment. Five of the 7 responders revealed evidence of subclinical hypothyroidism, suggesting that this subpopulation of depressed patients may benefit most from adjunctive thyroid hormone.

L-Histidine: failure to affect the sleep-waking cycle in man.

L-Histidine was administered to three patients with intractable narcolepsy (20 g/day for 2 weeks), to 4 normal volunteers (32.4 g/day for 5 days), and to a patient with progressive systemic sclerosis (48.6 g/day for 16 days). No effect was observed on noctural EEG sleep patterns in any of the subjects or on the symptoms of the patients with narcolepsy. These results fail to support the hypothesis that histamine is a waking factor.