Long-Term Outcomes of Treatment-Resistant Heroin Addicts with and without DSM-IV Axis 1 Psychiatric Comorbidity (Dual Diagnosis)

Abstract

Objective: The aim of this study was to compare the long-term outcomes of treatment-resistant heroin addicts with and without DSM-IV axis I psychiatric comorbidity (dual diagnosis). Method: 129 heroin addicts who also met criteria for treatment resistance, 66 with one or more DSM-IV axis I psychiatric diagnosis (DD patients), and 63 without DSM-IV axis I psychiatric comorbidity (NDD patients) were monitored prospectively (6 years on average, min. 1, max. 9) along a methadone maintenance treatment program (MMTP). Results: The rates for survival-in-treatment were about 50% for NDD patients and about 70% for DD patients. After 4 years of treatment onwards, such rates tended to become stable. DD patients showed better outcome measures than NDD patients. A significantly higher methadone dose was needed to have DD patients stabilized. Conclusions: Contrary to expectations, treatment-resistant patients with psychiatric comorbidity showed a better long-term outcome than treatment-resistant patients without psychiatric comorbidity.

Effect of Psychiatric Severity on the Outcome of Methadone Maintenance Treatment

“…Conversely, our results are consistent with those obtained in longitudinal studies carried out on methadonemaintained opioid addict populations [19,20,23,24,40] . Specifically, our findings on retention in treatment are consistent with those obtained in a previous retrospective study in which psychiatric severity was established on the basis of the referral of patients to a consultant psychiatrist [20] , and in other studies discriminating patients on the basis of formal psychiatric diagnosis [21][22][23][24] .…”

“…Specifically, our findings on retention in treatment are consistent with those obtained in a previous retrospective study in which psychiatric severity was established on the basis of the referral of patients to a consultant psychiatrist [20] , and in other studies discriminating patients on the basis of formal psychiatric diagnosis [21][22][23][24] . These studies found no statistically significant difference between patients with and without psychiatric comorbidity, at times revealing an even higher retention rate for patients with psychiatric comorbidity.…”

“…These studies found no statistically significant difference between patients with and without psychiatric comorbidity, at times revealing an even higher retention rate for patients with psychiatric comorbidity. With regard to toxicological urinalysis, similar results have been reported by previous studies investigating MMTPs, revealing no negative influence of psychiatric comorbidity/psychiatric severity on heroin or cocaine use [19,20,23,24] . Finally, the observation obtained in the present study on psychological/psychiatric changes during treatment, showing a higher, statistically significant reduction in severity of psychiatric symptoms in patients affected with more severe psychopathology, is consistent with findings obtained in other longitudinal studies [19,24,40] .…”

“…However, studies carried out to evaluate patients enrolled in methadone maintenance treatment programs (MMTP), and specifically outcomes strictly linked to methadone efficacy, such as retention in treatment and use of heroin, featured a large variation in results [19][20][21][22][23][24] . According to these studies, psychiatric comorbidity does not seem to predict the heroin abstention rate or retention in program.…”

Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample

“…The last 2 variables also predicted longer retention and no opioid and benzodiazepine abuse, among others. In this study, no psychiatric diagnosis was a positive predictor, while Maremmani et al [45,46] found the opposite result. A 4.5 years' prospective study in Macao also showed a high long-term retention of patients in opioid maintenance therapy [47].…”