Treatment abstinence

Chick et al. (2003) conducted a meta-analysis that included data from 15 studies of acamprosate in an effort to determine whether acamprosate reduces the severity of relapse for patients in abstinence-oriented treatment who fail to abstain completely. Among patients who relapsed to drinking, acamprosate was significantly associated with less quantity and frequency of drinking, compared with placebo, at each of four follow-up periods (i.e., at 30, 90, 180, and 360 treatment days). During each of these periods, there were also fewer acamprosate-treated patients who drank an average of five or more drinks per day. 

In summary, despite evidence that most instances of postwithdrawal depression spontaneously remit within a few days to several weeks of abstinence from alcohol (Brown and Schuckit 1988 Schuckit 1983), persistent depression requires treatment. SRIs have become the first-line treatment for depression... 

Amit Z, Brown Z, Sutherland A, et al Reduction in alcohol intake in humans as a function of treatment with zimelidine implications for rrearment, in Research Advances in New Psychopharmacological Treatments for Alcoholism. Edired by Naranjo CA, Sellers EM. Amsrerdam, Elsevier, 1985 Angelone SM, Bellini L, Di Bella D, er al Effects of fluvoxamine and citalopram in maintaining abstinence in a sample of Italian detoxified alcoholics. Alcohol Alcohol 33 151-156, 1998... 

The factors that correlate with treatment success do not clearly apply to success after detoxification from methadone maintenance. Correlates of successful detoxification include 1) less criminal behavior 2) more stable family 3) more stable employment 4) shorter drug history 5) long maintenance with lower dosage and 6) discharge status, with patient and staff consensus as opposed to unilateral discharge from treatment (Dole and Joseph 1978). In one study, addicts were followed an average of 2 years after detoxification (Stim-mel et al. 1977). Although only 28% of the total sample remained abstinent, 83% of those who had fully completed treatment remained abstinent. Another study of 105 patients detoxified after methadone maintenance treatment documented an 82% relapse rate within 12 months (Ball and Ross 1991). These... 

Naltrexone (Trexan) is the only opioid antagonist currently in use for treatment of addiction. Naloxone is used to treat opioid overdose and to test for opioid addiction but has a short half-life and is relatively ineffective orally cyclazocine s dysphoric side effects make it unacceptable (Resnick et al. 1980). Patients who are likely to continue to use naltrexone and to benefit from treatment are those who have established careers (e.g., health professionals) and family support and are well motivated. Up to 70% of such clients are abstinent at 1-year follow-up (Washton et al. 1984). Programs that utili2e additional rehabilitative services have better results than those that provide minimal services. Successful treatment is also associated with taking naltrexone... 

Outpatient drug-free programs, like therapeutic communities, seek to achieve abstinence without the use of psychoactive medication. Programs range from unstructured drop-in centers with discussion groups and recreational activities to organi2ed day treatment programs. 

Hien DA, Nunes E, Levin FR, et al Posttraumatic stress disorder and short-term outcome in early methadone treatment. J Subst Abuse Treat 19 31-37, 2000 Himmelsbach CK The morphine abstinence syndrome, its nature and treatment. Ann Intern Med 13 829-839, 1941... 

Kosten TR, Rounsaville BJ, Kleber HD A 2.3-year follow-up of depression, life crises, and treatment effects on abstinence among opioid addicts. Arch Gen Psychiatry 43 733-738, 1986a... 

An abstinence syndrome after long-term, low-dose treatment has also been described (Busto et al. 1986a Covi et al. 1973 Petursson and Lader 1981b Tyrer et al. 1981). Reported symptoms include muscle twitching, abnormal perception of movement, depersonalization or derealization, anxiety, headache, insomnia, diaphoresis, difficulty concentrating, tremor, fear, fatigue, lowered threshold to perception of sensory stimuh, and dysphoria. 

In subjects with sedative-hypnotic dependence who underwent detoxification in an addictions treatment unit, a significant association was not found between abstinence rate and either gender or psychiatric status (Charney et al. 2000). Patients dependent on benzodiazepines reported decreased anxiety during follow-up, even though their use of these agents had decreased. 

More than 40 medications have been investigated but none have shown consistent efficacy for primary cocaine or amphetamine dependence. These medications include dopaminergic agonists, antidepressants, and more recently disulfiram, selegiline, and a cocaine vaccine (see Table 5—2 for summary). Studies have been relatively brief and have focused on abstinence initiation rather than on relapse prevention, but even these modest treatment goals have not been attained. The focus in the discussion that follows is on pharmacotherapies for cocaine dependence, because very few clinical trials have been completed with amphetamine-dependent patients. Furthermore, none of the studies of amphetamine dependence have shown results different from those described for cocaine dependence (Rawson et al. 2002b Srisurapanont et al. 2001). 

With all of these pharmacotherapies, concurrent behavioral treatment is critical to retain the patient in treatment and maintain adherence to medication treatment. Contingency management programs in which patients receive vouchers that can be used to purchase pro-social goods and services are the most common reinforcer approaches used to initiate and maintain stimulant-free urine test results (Anker and Crowley 1982 Boudin 1972 Higgins et al. 1991, 1993, 1994). The major problem with these approaches has been maintaining abstinence after the reinforcers are withdrawn completely and devel-... 

McDougle CJ, Price LH, Palumbo JM, et al Dopaminergic responsivity during cocaine abstinence a pilot smdy. Psychiatry Res 43 77-85, 1992 McDougle CJ, Black JE, Malison RT, et al Noradrenergic dysregulation during discontinuation of cocaine use in addicts. Arch Gen Psychiatry 51 713-719,1994 Misra L, Kofoed L Risperidone treatment of methamphetamine psychosis (letter). Am J Psychiatry 154 1170, 1997... 

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