Indicators Of Good Prognosis In Naltrexone Treatment: A Five-Year Prospective Study

DSM IV axis II traits can influence compliance to treatment with oral naltrexone: a preliminary study on 30 opiate dependent patients

For many decades, health specialists have successfully used their clinical ingenuity to increase the efficiency of opiate detoxification protocols. However, even if drop-out rate has decreased significantly in today's protocols, relapse after opiate detoxification remains a major problem. Therefore, naltrexone hydrochloride, an opiate antagonist, has been considered by many as a potential tool to support abstinence in what has been called "antagonist-assisted abstinence" (AAA). Nevertheless, while naltrexone implants are becoming more accessible, a large majority of centers still use oral naltrexone and adherence to treatment remains a major obstacle to AAA's efficiency. As the personality profile could give an insight into compliance, we investigated the relationship between personality profiles and naltrexone adherence in a cohort of 30 patients. The results indicate that the Axis II profile influences the likely pattern of oral naltrexone compliance. As clinicians need to identify opiate dependent patients who are most likely to benefit from oral naltrexone treatment, it therefore carries important implications and could lead to a better adjustment of therapeutic strategies for opiate dependent patients.

Systematic review of prospective studies investigating "remission" from amphetamine, cannabis, cocaine or opioid dependence

AIMS

To review and summarize existing prospective studies reporting on remission from dependence upon amphetamines, cannabis, cocaine or opioids.

METHODS

Systematic searches of the peer-reviewed literature were conducted to identify prospective studies reporting on remission from amphetamines, cannabis, cocaine or opioid dependence. Searches were limited to publication between 1990 and 2009. Reference lists of review articles and important studies were searched to identify additional studies. Remission was defined as no longer meeting diagnostic criteria for drug dependence or abstinence from drug use; follow-up periods of at least three years were investigated. The remission rate was estimated for each drug type, allowing pooling across studies with varying follow-up times.

RESULTS

There were few studies examining the course of psychostimulant dependence that met inclusion criteria (one for amphetamines and four for cocaine). There were ten studies of opioid and three for cannabis dependence. Definitions of remission varied and most did not clearly assess remission from dependence. Amphetamine dependence had the highest remission rate (0.4477; 95%CI 0.3991, 0.4945), followed by opioid (0.2235; 95%CI 0.2091, 0.2408) and cocaine dependence (0.1366; 95%CI 0.1244, 0.1498). Conservative estimates of remission rates followed the same pattern with cannabis dependence (0.1734; 95%CI 0.1430, 0.2078) followed by amphetamine (0.1637; 95%CI 0.1475, 0.1797), opioid (0.0917; 95%CI 0.0842, 0.0979) and cocaine dependence (0.0532; 95%CI 0.0502, 0.0597).

CONCLUSIONS

The limited prospective evidence suggests that "remission" from dependence may occur relatively frequently but rates may differ across drugs. There is very little research on remission from drug dependence; definitions used are often imprecise and inconsistent across studies and there remains considerable uncertainty about the longitudinal course of dependence upon these most commonly used illicit drugs.

Improvement in naltrexone treatment compliance with contingency management

The efficacy of a voucher-based incentive program for improving adherence to outpatient, thrice weekly naltrexone maintenance was tested in a three group, randomized, 12-week clinical trial. Voucher incentives were given as follows: contingent group (n = 19) for each consecutive naltrexone dose ingested; non-contingent group (n = 19) on unpredictable schedule independently of taking naltrexone; no-voucher group (n = 20) none. Vouchers were exchangeable for goods and services. The contingent group had significantly longer treatment retention and ingested significantly more doses of naltrexone (consecutive and total) than either control group. Voucher incentives can significantly increase adherence to naltrexone maintenance in recently detoxified opioid dependent individuals.