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PubMed2002

Kindling of withdrawal: a study of craving and anxiety after multiple detoxifications in alcoholic inpatients.

BACKGROUND: The increased severity of withdrawal during successive detoxifications from alcohol is well documented for seizures, but the importance of the number of withdrawal events for other withdrawal symptoms such as anxiety and for alcohol craving is not known. Studies in animals are consistent with increases in reinforcing properties of alcohol with a greater number of withdrawal experiences. Thus, we predicted that patients who had undergone multiple detoxifications would show greater desire for alcohol and might experience more anxiety compared with patients with fewer detoxifications or compared with social drinkers. METHODS: Forty-two alcoholic inpatients were divided on the basis of medically supervised detoxifications into HI-med (more than two previous detoxifications, n = 6) and LO-med (two or fewer previous detoxifications, n = 36) and compared with a group of social drinkers matched for age, sex, and verbal IQ (n = 43). An additional analysis was performed by dividing the participants into HI-total (n = 22) and LO-total (n = 20) previous detoxification groups (three or more and less than three previous detoxifications, respectively) by using all previous detoxifications, which included unsupervised attempts. Anxiety was measured by Spielberger's State-Trait Anxiety Inventory; mood was evaluated by using the Profile of Mood States; craving was evaluated with a short version of the Desire for Alcohol Questionnaire; and an emotional Stroop test was used that employed positive, negative, and alcohol-related words. RESULTS: When the analysis was based on the medically supervised detoxifications only, alcoholic participants (HI- and LO-med) had higher ratings in trait anxiety and in feelings of anger, anxiety, depression, and confusion, but also friendliness; had higher craving ratings; and made more errors in the alcohol Stroop compared with social drinkers. In addition, the number of errors in the emotional Stroop for negative words was higher in the group with the higher number of detoxifications. When we analyzed the total number of detoxifications, this effect for the emotional Stroop errors was no longer seen. Instead, ratings of anger in the Profile of Mood States were greater in the HI-total compared with the LO-total detoxification group. These effects remained when the correlates alcohol consumption and degree of dependency were introduced as covariates, which showed that the effects found are probably attributable to the number of withdrawals. CONCLUSIONS: These data suggest that for inpatients with short history of alcoholism, the consequences of multiple withdrawals may not relate to anxiety or craving.

Adult↗

PubMed2005

Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial.

CONTEXT: Rapid opioid detoxification with opioid antagonist induction using general anesthesia has emerged as an expensive, potentially dangerous, unproven approach to treat opioid dependence. OBJECTIVE: To determine how anesthesia-assisted detoxification with rapid antagonist induction for heroin dependence compared with 2 alternative detoxification and antagonist induction methods. DESIGN, SETTING, AND PATIENTS: A total of 106 treatment-seeking heroin-dependent patients, aged 21 through 50 years, were randomly assigned to 1 of 3 inpatient withdrawal treatments over 72 hours followed by 12 weeks of outpatient naltrexone maintenance with relapse prevention psychotherapy. This randomized trial was conducted between 2000 and 2003 at Columbia University Medical Center's Clinical Research Center. Outpatient treatment occurred at the Columbia University research service for substance use disorders. Patients were included if they had an American Society of Anesthesiologists physical status of I or II, were without major comorbid psychiatric illness, and were not dependent on other drugs or alcohol. INTERVENTIONS: Anesthesia-assisted rapid opioid detoxification with naltrexone induction, buprenorphine-assisted rapid opioid detoxification with naltrexone induction, and clonidine-assisted opioid detoxification with delayed naltrexone induction. MAIN OUTCOME MEASURES: Withdrawal severity scores on objective and subjective scales; proportions of patients receiving naltrexone, completing inpatient detoxification, and retained in treatment; proportion of opioid-positive urine specimens. RESULTS: Mean withdrawal severities were comparable across the 3 treatments. Compared with clonidine-assisted detoxification, the anesthesia- and buprenorphine-assisted detoxification interventions had significantly greater rates of naltrexone induction (94% anesthesia, 97% buprenorphine, and 21% clonidine), but the groups did not differ in rates of completion of inpatient detoxification. Treatment retention over 12 weeks was not significantly different among groups with 7 of 35 (20%) retained in the anesthesia-assisted group, 9 of 37 (24%) in the buprenorphine-assisted group, and 3 of 34 (9%) in the clonidine-assisted group. Induction with 50 mg of naltrexone significantly reduced the risk of dropping out (odds ratio, 0.28; 95% confidence interval, 0.15-0.51). There were no significant group differences in proportions of opioid-positive urine specimens. The anesthesia procedure was associated with 3 potentially life-threatening adverse events. CONCLUSION: These data do not support the use of general anesthesia for heroin detoxification and rapid opioid antagonist induction.

Adult↗

PubMed2005

Inpatient versus other settings for detoxification for opioid dependence.

BACKGROUND: There are a complex range of variables that can influence the course and subjective severity of opioid withdrawal. There is a growing evidence for the effectiveness of a range of medically-supported detoxification strategies, but little attention has been paid to the influence of the setting in which the process takes place. OBJECTIVES: To evaluate the effectiveness of any inpatient opioid detoxification programme when compared with all other time-limited detoxification programmes on the level of completion of detoxification, the intensity and duration of withdrawal symptoms, the nature and incidence of adverse effects, the level of engagement in further treatment post-detoxification, and the rates of relapse post-detoxification. SEARCH STRATEGY: Electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library Issue 3, 2004); MEDLINE (January 1966-March 2004); EMBASE (January 1988-March 2004); PsycInfo (January 1967-March 2004); CINAHL (January 1982-March 2004). In addition the Current Contents, Biological Abstracts, Science Citation Index and Social Sciences Index were searched. SELECTION CRITERIA: Randomised controlled clinical trials comparing inpatient opioid detoxification (any drug or psychosocial therapy) with other time-limited detoxification programmes (including residential units that are not staffed 24 hours per day, day-care facilities where the patient is not resident for 24 hours per day, and outpatient or ambulatory programmes, and using any drug or psychosocial therapy). DATA COLLECTION AND ANALYSIS: All abstracts were independently inspected by two reviewers (ED & JI) and relevant papers were retrieved and assessed for methodological quality using Cochrane Reviewers' Handbook criteria. MAIN RESULTS: Only one study met the inclusion criteria. This did not explicitly report the number of participants in each group that successfully completed the detoxification process, but the published data allowed us to deduce that 7 out of 10 (70%) in the inpatient detoxification group were opioid-free on discharge, compared with 11 out of 30 (37%) in the outpatient group. There was very limited data about the other outcomes of interest. AUTHORS' CONCLUSIONS: This review demonstrates that there is no good available research to guide the clinician about the outcomes or cost-effectiveness of inpatient or outpatient approaches to opioid detoxification.

Hospitalization↗

PubMed1998

Complications related to osteopenia in the thoracic spine on admission chest radiographs of substance abuse detoxification patients.

OBJECTIVE: To assess the prevalence of complications related to osteopenia in the thoracic spine (anterior wedging and fish vertebrae) of patients admitted for substance abuse detoxification. DESIGN AND PATIENTS: We retrospectively identified 150 sequential patients admitted to our drug and alcohol detoxification ward in whom posteroanterior and lateral admission chest radiographs and clinical charts were available for review. There were 116 men and 34 women with a mean age of 37 years (range 19-67 years). Thirty-eight patients were admitted for drug detoxification, 37 for alcohol detoxification, and 75 for drug and alcohol detoxification. These patients were compared with 66 age- and sex-matched controls from our hospital's employee health service. Two radiologists reviewed all chest radiographs for the presence of anterior wedging and fish vertebrae in the thoracic spine and other nonspinal fractures. Serum calcium and inorganic phosphorus levels were recorded for the substance abuse detoxification patients. RESULTS: Forty-nine percent (n=73) of detoxification patients had complications of osteopenia in the thoracic spine including: anterior wedging (n=47), fish vertebrae (n=21), or both (n=5). Twenty-four percent (n=36) of patients had an elevated serum inorganic phosphorus level and one patient had an elevated serum calcium level. Patients with anterior wedging or fish vertebrae included: 45% (n=45) of patients below age 40 years, 35% (n=12) of women, 41% (n= 15) of drug detoxification patients, 58% (n=22) of alcohol detoxification patients, 48% (n=36) of drug and alcohol detoxification patients, and 47% (n=17) of patients with elevated serum inorganic phosphorus (P=NS). Six percent (n=9) of our study population had nonspinal fractures on their chest radiographs. Twenty-one percent (n=14) of controls had complications of osteopenia in the thoracic spine (all anterior wedging). This prevalence differed significantly (P<0.05, chi-squared) from the study population. CONCLUSION: Osteopenia-related anterior wedging and fish vertebrae in the thoracic spine are common findings on chest radiographs of patients hospitalized for substance abuse detoxification. Serum inorganic phosphorus and calcium levels did not correlate with the presence of anterior wedging or fish vertebrae.

Adult↗

PubMed1999

Multiple previous alcohol detoxifications are associated with decreased medial temporal and paralimbic function in the postwithdrawal period.

BACKGROUND: Functional neuroimaging studies after alcohol cessation have demonstrated that chronic alcohol use globally reduces neuronal activity for several weeks. Less is known about the effects of previous alcohol use patterns on regional brain activity. Multiple previous alcohol detoxifications are associated with a worse clinical course and increased risk of seizures, perhaps due to sensitization of key brain structures. We performed the following imaging study in alcoholics in the postwithdrawal period to determine if blood flow in medial temporal structures would differ as a function of previous alcohol use (i.e., whether regions were kindled or sensitized due to multiple detoxifications). METHODS: Fourteen adults meeting DSM-IV criteria for alcohol dependence (mean age 35, 8 SD; 10 men) and participating in a double-blind detoxification medication study underwent a brain perfusion Tc99 m-ECD (Neurolite) single photon emission computed tomography scan on days 7 through 9 (mean 7.6, .5 SD) after their last drink and 2 to 3 days since their last detoxification medication. Seven nonpsychiatrically ill, nonalcohol-dependent healthy adults were scanned as control subjects. RESULTS: Alcoholics compared with controls had widely reduced relative activity in cortical secondary association areas and relatively increased activity in the medial temporal lobes (p < 0.01). Five alcoholic patients with > or = 2 previous detoxifications were compared with five patients in their first detoxification (age and detoxification medication matched). Multiple detoxification patients had significantly lower relative activity in bilateral anterior temporal poles and medial temporal lobes and in visual cortex (p < 0.01) compared with first episode patients. CONCLUSIONS: These studies are consistent with other studies comparing alcoholics and controls. They also suggest that on day 7 of detoxification, alcoholic subjects with multiple previous detoxifications have decreased visual cortex, medial temporal lobes, and anterior paralimbic blood flow, compared with those in their first detoxification. Further studies seem warranted to confirm these initial exploratory results.

Adult↗

PubMed2005

Relationship of depressive symptoms and mental health functioning to repeat detoxification.

To better understand residential detoxification use, we assessed the roles of depressive symptoms (DS) and mental health functioning (MHF) on repeat detoxification. A prospective cohort of residential detoxification patients (N=400) without primary medical care was followed over 2 years at 6-month intervals. Subsequent detoxification admissions were examined using a statewide administrative database and DS (Center for Epidemiologic Studies Depression Scale) and MHF (SF-36 mental component summary subscale) measurements at follow-up. Incidence rate ratios of return to detoxification were estimated using multivariable longitudinal Poisson regression. In separate analyses, greater DS and worse MHF predicted higher detoxification use rates. Clinically significant worsening (10 points) of DS and MHF on objective scales predicted a 20% increased rate of detoxification readmission. Male sex, heroin as a problem substance, and race/ethnicity each predicted detoxification use. These data suggest that identifying individuals with DS or worse MHF after detoxification may provide opportunities for clinical intervention to reduce recurrent residential detoxification.

Adolescent↗

PubMed2004

Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification.

AIMS: To compare the cost and cost-effectiveness of methadone maintenance treatment and 180-day methadone detoxification enriched with psychosocial services. DESIGN: Randomized controlled study conducted from May 1995 to April 1999. SETTING: Research clinic in an established drug treatment program. PARTICIPANTS: One hundred and seventy-nine adults with diagnosed opioid dependence. Intervention Patients were randomized to methadone maintenance (n = 91), which required monthly 1 hour/week of psychosocial therapy during the first 6 months or 180-day detoxification (n = 88), which required 3 hours/week of psychosocial therapy and 14 education sessions during the first 6 months. MEASUREMENTS: Total health-care costs and self-reported injection drug use. A two-state Markov model was used to estimate quality-adjusted years of survival. Findings Methadone maintenance produced significantly greater reductions in illicit opioid use than 180-day detoxification during the last 6 months of treatment. Total health-care costs were greater for maintenance than detoxification treatment ($7564 versus $6687; P < 0.001). Although study costs were significantly higher for methadone maintenance than detoxification patients ($4739 versus $2855, P < 0.001), detoxification patients incurred significantly higher costs for substance abuse and mental health care received outside the study. Methadone maintenance may provide a modest survival advantage compared with detoxification. The cost per life-year gained is $16 967. Sensitivity analysis revealed a cost-effectiveness ratio of less than $20 000 per quality-adjusted life-year over a wide range of modeling assumptions. CONCLUSIONS: Compared with enriched detoxification services, methadone maintenance is more effective than enriched detoxification services with a cost-effectiveness ratio within the range of many accepted medical interventions and may provide a survival advantage. Results provide additional support for the use of sustained methadone therapy as opposed to detoxification for treating opioid addiction.

Adult↗

PubMed1997

Outcomes of patients in a VA ambulatory detoxification program.

OBJECTIVE: The study examined outcomes of patients enrolled in a Veterans Affairs ambulatory detoxification program. METHODS: Descriptive statistical data were collected by routine clerical processes at a VA medical center. Patients' outcomes were operationally defined to include completion of the detoxification program, dropout or discharge, or re-enrollment in the program; admission to inpatient detoxification; and referral to, entry into, and completion of substance abuse rehabilitation after detoxification. Outcomes were determined for 517 of the 577 patients consecutively referred to the program during nine months in 1995. Patients met established criteria for mild to moderate alcohol withdrawal syndrome. RESULTS: Of the 517 patients, 453 successfully completed outpatient detoxification. Twenty patients dropped out, 19 were discharged, 37 re-enrolled, and 25 were admitted for inpatient detoxification. Of the 453 patients who completed outpatient detoxification, 434 were referred for further treatment; 415 entered and 322 completed the next treatment phase. CONCLUSIONS: The completion rate for patients in the outpatient detoxification program and rates for continuing and completing further treatment were higher than in previous studies. Measures of poor short-term outcome (dropout, re-enrollment, and admission to inpatient detoxification) also compared favorably with previous studies. Unique factors contributing to outcomes included systematic screening, medical protocols for detoxification, psychosocial therapies, program-supported housing, and attention to patient satisfaction.

Adult↗

PubMed2001

Relationships between patient characteristics and unsuccessful substance abuse detoxification.

OBJECTIVE: History and laboratory evaluations are common for patients entering substance abuse detoxification programs. We sought to identify if patient history and laboratory characteristics entering a detoxification program were associated with unsuccessful detoxification. DESIGN: Retrospective cohort study of 186 patients of a residential-inpatient short-term medical detoxification facility. Unsuccessful detoxification was defined as leaving for urgent medical referral or against program advice. RESULTS: Patients were predominantly male, middle-aged, minority, unemployed, and poly-substance users. Twenty-four patients (13%) did not complete the detoxification program (4 left for urgent medical referral, 20 left against program advice). Unsuccessful detoxification was associated with nausea and/or vomiting (p = 0.032), Caucasian race (p = 0.002), and opiates as a drug of choice (p = 0.018). Laboratory abnormalities were common but none were associated with unsuccessful detoxification. CONCLUSIONS: For patients admitted to a medically monitored detoxification facility, few patient characteristics were associated with detoxification outcome. Routine admission laboratories without clinical correlation may be unwarranted.

Adult↗

PubMed2004

Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification.

BACKGROUND: Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the rehabilitation of dependent heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological symptoms rather than physiological symptoms associated with the withdrawal syndrome. OBJECTIVES: To evaluate the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the treatment, reduce the use of substances and improve health and social status. SEARCH STRATEGY: We searched the Cochrane Central Register of Trials (CENTRAL) issue 3, 2003; MEDLINE 1966-2003; EMBASE 1980-2003; PsycINFO 1985-2003; relevant web sites; scan of reference list of relevant articles. There were no language or publication restrictions. SELECTION CRITERIA: Randomised controlled trials which focus on any psychosocial associated with any pharmacological intervention aimed at opioid detoxification. People less than 18 years of age and pregnant women were excluded. DATA COLLECTION AND ANALYSIS: The trials were independently assessed for inclusion and methodological quality by three reviewers. Data were extracted independently and double checked. MAIN RESULTS: The searching process resulted in the identification of 77 different studies: 8 studies met inclusion criteria. These studies considered 5 different psychosocial interventions and 2 substitution detoxification treatments: Methadone and Buprenorphine. The results show promising benefit from adding any psychosocial treatment to any substitution detoxification treatment in terms of completion of treatment RR 1.68 (95% CI 1.11-2.55), results at follow-up RR 2.43 (95% CI 1.61-3.66), and compliance RR 0.48 (95% CI 0.38-0.59). In respect of the use of heroin during the treatment, the differences were not statistically significant but favoured the combined treatments. REVIEWERS' CONCLUSIONS: Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, results at follow-up and compliance. Although a treatment, like detoxification, that exclusively attenuates the severity of opiate withdrawal symptoms can be at best partially effective for a chronic relapsing disorder like opiate dependence, this type of treatment is an essential step prior to longer-term drug-free treatment and it is desirable to develop adjunct psychosocial approaches that might make detoxification more effective. Limitations to this review are imposed by the heterogeneity of the assessment of outcomes. Because of lack of detailed information no meta analysis could be performed to analyse the results related to several outcomes.

Humans↗

PubMed1978

Abstinence following detoxification and methadone maintenance treatment.

During an 11 year overview of methadone treatment, 161 (72 per cent) of 225 patients who completed detoxification were followed up to eight years. Fifty-one (22.6 per cent) of those were classified as stable and narcotic free 2.9 years after detoxification. Of 89 self-selected patients who had undergone a planned, supported, "therapeutic" detoxification, 37 (42 per cent) were classified narcotic-free; whereas many fewer were so judged after other methods of detoxification. Relapse to nonprescribed opioid use, detected in 34 (38.7 per cent) of those traced, was inversely related to time since detoxification. Relapse potential was very low after three years of apparent continuous narcotic-free existence; three years should be a minimal time for successful detoxification. Some subjects had several cycles of methadone treatment and detoxification. Most patients with combined alcohol-methadone dependencies did poorly, whether or not detoxification from opioids was undertaken. Since the frequency of enduring narcotic-free state was only 9.7 per cent of 522 patients in the treatment sample, detoxification should not be a realistic goal for all patients who enter treatment.

Adolescent↗

PubMed1999

Predicting outcome of inpatient detoxification of substance abusers.

OBJECTIVE: Variables that have been identified as predictors of outcome of substance abuse treatment--coping style, addiction severity and addiction-related problems, psychopathology, and treatment motivation--were examined as predictors of outcome of inpatient detoxification. METHODS: A cohort of 175 drug abuse patients consecutively admitted to an inpatient detoxification clinic in the Netherlands were assessed. Baseline data were obtained on psychopathology using the Symptom Checklist-90, on severity and addiction-related problems using the Addiction Severity Index (ASI), on personal coping style using the Utrecht Coping List, on motivation using the CMRS scales, and on sociodemographic background. Positive detoxification outcome was defined as transfer to inpatient rehabilitation treatment. RESULTS: Of the 175 admissions, 81 (46 percent) had a positive outcome, and 94 (54 percent) had a negative outcome. Severe drug use and severe medical problems, as measured by the ASI, were the best predictors of a negative outcome of detoxification. Self-rated suitability of postdetoxification treatment was also a predictor of positive outcome, although to a lesser degree than the ASI variables. Established predictors of residential drug abuse treatment outcome, such as psychopathology, coping style, and sociodemographic variables, did not predict outcome of detoxification. CONCLUSIONS: Caution is necessary when applying results of inpatient treatment outcome studies to inpatient detoxification programs. Different factors may play a role in the outcome of detoxification. To improve the rate at which patients in detoxification programs are transferred to longer-term rehabilitation, more attention should be paid to medical conditions and to the direct consequences of drug use, such as withdrawal symptoms and craving during detoxification.

Adaptation, Psychological↗

PubMed2007

Buprenorphine versus dihydrocodeine for opiate detoxification in primary care: a randomised controlled trial.

BACKGROUND: Many drug users present to primary care requesting detoxification from illicit opiates. There are a number of detoxification agents but no recommended drug of choice. The purpose of this study is to compare buprenorphine with dihydrocodeine for detoxification from illicit opiates in primary care. METHODS: Open label randomised controlled trial in NHS Primary Care (General Practices), Leeds, UK. Sixty consenting adults using illicit opiates received either daily sublingual buprenorphine or daily oral dihydrocodeine. Reducing regimens for both interventions were at the discretion of prescribing doctor within a standard regimen of not more than 15 days. Primary outcome was abstinence from illicit opiates at final prescription as indicated by a urine sample. Secondary outcomes during detoxification period and at three and six months post detoxification were recorded. RESULTS: Only 23% completed the prescribed course of detoxification medication and gave a urine sample on collection of their final prescription. Risk of non-completion of detoxification was reduced if allocated buprenorphine (68% vs 88%, RR 0.58 CI 0.35-0.96, p = 0.065). A higher proportion of people allocated to buprenorphine provided a clean urine sample compared with those who received dihydrocodeine (21% vs 3%, RR 2.06 CI 1.33-3.21, p = 0.028). People allocated to buprenorphine had fewer visits to professional carers during detoxification and more were abstinent at three months (10 vs 4, RR 1.55 CI 0.96-2.52) and six months post detoxification (7 vs 3, RR 1.45 CI 0.84-2.49). CONCLUSION: Informative randomised trials evaluating routine care within the primary care setting are possible amongst drug using populations. This small study generates unique data on commonly used treatment regimens.

Adult↗

PubMed1999

Needle-exchange attendance and health care utilization promote entry into detoxification.

This study was undertaken to identify factors associated with entry into detoxification among injection drug users (IDUs), and to assess the role of needle-exchange programs (NEPs) as a bridge to treatment. IDUs undergoing semiannual human immunodeficiency virus (HIV) tests and interviews were studied prospectively between 1994 and 1998, during which time an NEP was introduced in Baltimore. Logistic regression was used to identify independent predictors of entry into detoxification, stratifying by HIV serostatus. Of 1,490 IDUs, similar proportions of HIV-infected and uninfected IDUs entered detoxification (25% vs. 23%, respectively). After accounting for recent drug use, hospital admission was associated with four-fold increased odds of entering detoxification for HIV-seronegative subjects. Among HIV-infected subjects, hospital admission, outpatient medical care, and having health insurance independently increased the odds of entering detoxification. After accounting for these and other variables, needle-exchange attendance also was associated independently with entering detoxification for both HIV-infected (adjusted odds ratio [AOR] = 3.2) and uninfected IDUs (AOR = 1.4). However, among HIV-infected subjects, the increased odds of detoxification associated with needle exchange diminished significantly over time, concomitant with statewide reductions in detoxification admissions. These findings indicate that health care providers and NEPs represent an important bridge to drug abuse treatment for HIV-infected and uninfected IDUs. Creating and sustaining these linkages may facilitate entry into drug abuse treatment and serve the important public health goal of increasing the number of drug users in treatment.

Adult↗

PubMed1988

Behavioral assessment of narcotic detoxification fear.

Recent data reveal that only a small number of opioid addicts who attempt to detoxify from methadone maintenance programs will be successful. An irrational fear of detoxification has been postulated to be one reason for detoxification not being more efficacious. The present investigation attempted to assess both self-report and psychophysiological responses to detoxification and neutral scenes in two groups of persons on methadone maintenance. The two groups (N = 8 each) were selected by two blind interviewers as either having or not having a detoxification fear. After imagery training, subjects were asked to imagine 10 scenes, alternating between neutral and detoxification scenes with random counterbalancing for order, while the psychophysiological dependent measures and self-report anxiety and clarity ratings were assessed. Some of the self-report and psychophysiological measures were significantly different for scene type, indicating a successful manipulation of scene imagery. Further, pulse volume measures indicated greater activation in the fear group than in the non-fear group to the detoxification scenes. The results are discussed in terms of providing evidence for greater activation, presumably due to greater anxiety, for the detoxification fear subjects than the non-fear subjects specific to the detoxification imagery and in terms of potential treatment implications.

Adult↗

PubMed2005

Short-term outcomes of five heroin detoxification methods in the Australian NEPOD Project.

This study included 380 participants in five heroin detoxification trials whose data were pooled to enable direct comparison of five detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Rapid detoxification achieved similar initial abstinence rates with either anaesthesia or sedation (average 59%), which were higher than was achieved by inpatient detoxification using clonidine plus other symptomatic medications (24%), which in turn was higher than outpatient detoxification using either buprenorphine (12%) or clonidine plus other symptomatic medications (4%). Older participants and those using more illicit drugs were more likely to achieve abstinence. Entry rates into ongoing postdetoxification treatment were as follows: buprenorphine outpatient (65%), sedation (63%), anaesthesia (42%), symptomatic outpatient (27%), and symptomatic inpatient (12%). Postdetoxification treatment with buprenorphine or methadone was preferred over naltrexone. Participants with more previous detoxification attempts were more likely to enter postdetoxification treatment. Given that outpatient detoxification was more effective with buprenorphine than with symptomatic medications and that rapid detoxification was more effective than the symptomatic inpatient method, the roles of the symptomatic methods should be reconsidered.

Adolescent↗

PubMed2005

A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD).

This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used-achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD 491 dollars(buprenorphine-based outpatient); to AUD 605 dollars for conventional outpatient; AUD 1404 dollars for conventional inpatient; AUD 1990 dollars for rapid detoxification under sedation; and to AUD 2689 dollars for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most cost-effective inpatient method.

Adult↗

PubMed2006

Factors affecting detoxification readmission: analysis of public sector data from three states.

The objective of this study was to understand the rate of detoxification readmissions and the factors associated with readmission within a public sector population. The study sample was drawn from an integrated database that includes Medicaid and state mental health and substance abuse agency data from three states (Delaware, Oklahoma, and Washington) for 1996-1998. Clients with at least one state agency-sponsored detoxification event in 1996 or 1997 were included in the study. Twenty-seven percent of the sample was readmitted for detoxification within 1 year of their index detoxification. Clients who received two or more substance-abuse-related services within 30 days of their index detoxification were less likely to be readmitted and had a longer time until their second detoxification admission. Detoxification readmission is common in the public sector. Engaging patients in treatment following detoxification may reduce readmission rates and time to readmission.

Adult↗