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Concurrent substance use and outcome in combined behavioral and naltrexone therapy for opiate dependence.
Am J Drug Alcohol Abuse. 2001 Aug; 27(3):441-52.AJ

Abstract

The effect of concurrent nonopiate drug use on outcome of treatment for opiate dependence.

METHOD

Forty-seven opiate-dependent patients received a 6-month course of outpatient treatment with naltrexone and cognitive-behavioral therapy (behavioral naltrexone therapy, BNT) at a university-based research clinic. Opiate-negative urines and naltrexone ingestion were rewarded with monetary vouchers. Abstinence from other drugs was encouraged verbally, but no contingencies were placed on nonopiate drug use. The proportions of all urines (collected twice weekly) positive for cocaine, cannabis, and benzodiazepines over the course of treatment were evaluated as predictors of outcome of opiate dependence treatment, as measured by proportion of opiate-positive urines, days retained in treatment, and proportion of naltrexone doses taken, using Pearson product moment correlations and one-way analysis of variance (ANOVA).

RESULTS

The majority of patients (78%) used a nonopiate drug at least once during the trial. There were no significant correlations between concurrent drug use measures and opiate dependence treatment outcomes, indicating no simple linear relationship between these measures. However, when concurrent drug use was trichotomized into abstinent, intermittent, and heavy use groups, groups with intermittent use had superior outcome compared to both abstinent and heavy use groups in several contrasts.

CONCLUSIONS

Intermittent use of nonopiate drugs is common during outpatient treatment for opiate dependence and may be a favorable prognostic indicator. This may support a "harm reduction" approach as opposed to a strict abstinence-oriented approach. Further research is needed to identify the optimal therapeutic stance toward other drug use during treatment for opiate dependence.

Authors+Show Affiliations

New York State Psychiatric Institute, Substance Treatment and Research Service, New York 10032, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11506261

Citation

Church, S H., et al. "Concurrent Substance Use and Outcome in Combined Behavioral and Naltrexone Therapy for Opiate Dependence." The American Journal of Drug and Alcohol Abuse, vol. 27, no. 3, 2001, pp. 441-52.
Church SH, Rothenberg JL, Sullivan MA, et al. Concurrent substance use and outcome in combined behavioral and naltrexone therapy for opiate dependence. Am J Drug Alcohol Abuse. 2001;27(3):441-52.
Church, S. H., Rothenberg, J. L., Sullivan, M. A., Bornstein, G., & Nunes, E. V. (2001). Concurrent substance use and outcome in combined behavioral and naltrexone therapy for opiate dependence. The American Journal of Drug and Alcohol Abuse, 27(3), 441-52.
Church SH, et al. Concurrent Substance Use and Outcome in Combined Behavioral and Naltrexone Therapy for Opiate Dependence. Am J Drug Alcohol Abuse. 2001;27(3):441-52. PubMed PMID: 11506261.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concurrent substance use and outcome in combined behavioral and naltrexone therapy for opiate dependence. AU - Church,S H, AU - Rothenberg,J L, AU - Sullivan,M A, AU - Bornstein,G, AU - Nunes,E V, PY - 2001/8/17/pubmed PY - 2002/1/5/medline PY - 2001/8/17/entrez SP - 441 EP - 52 JF - The American journal of drug and alcohol abuse JO - Am J Drug Alcohol Abuse VL - 27 IS - 3 N2 - UNLABELLED: The effect of concurrent nonopiate drug use on outcome of treatment for opiate dependence. METHOD: Forty-seven opiate-dependent patients received a 6-month course of outpatient treatment with naltrexone and cognitive-behavioral therapy (behavioral naltrexone therapy, BNT) at a university-based research clinic. Opiate-negative urines and naltrexone ingestion were rewarded with monetary vouchers. Abstinence from other drugs was encouraged verbally, but no contingencies were placed on nonopiate drug use. The proportions of all urines (collected twice weekly) positive for cocaine, cannabis, and benzodiazepines over the course of treatment were evaluated as predictors of outcome of opiate dependence treatment, as measured by proportion of opiate-positive urines, days retained in treatment, and proportion of naltrexone doses taken, using Pearson product moment correlations and one-way analysis of variance (ANOVA). RESULTS: The majority of patients (78%) used a nonopiate drug at least once during the trial. There were no significant correlations between concurrent drug use measures and opiate dependence treatment outcomes, indicating no simple linear relationship between these measures. However, when concurrent drug use was trichotomized into abstinent, intermittent, and heavy use groups, groups with intermittent use had superior outcome compared to both abstinent and heavy use groups in several contrasts. CONCLUSIONS: Intermittent use of nonopiate drugs is common during outpatient treatment for opiate dependence and may be a favorable prognostic indicator. This may support a "harm reduction" approach as opposed to a strict abstinence-oriented approach. Further research is needed to identify the optimal therapeutic stance toward other drug use during treatment for opiate dependence. SN - 0095-2990 UR - https://www.unboundmedicine.com/medline/citation/11506261/Concurrent_substance_use_and_outcome_in_combined_behavioral_and_naltrexone_therapy_for_opiate_dependence_ L2 - https://www.tandfonline.com/doi/full/10.1081/ada-100104511 DB - PRIME DP - Unbound Medicine ER -