Inpatient opiate detoxification in Geneva: follow-up at 1 and 6 months

Abstract

The aim of this study was to identify predictors of treatment success and of relapse, 1 and 6 months after inpatient opiate detoxification in an 8-bed unit in Geneva. Of all 73 patients admitted between June 1994 and June 1995, a majority (73%) successfully finished opiate detoxification. Detoxification was performed mainly with methadone tapering; the average duration of hospitalisation was 15 days. Factors associated with treatment failure were: cocaine abuse, presence of legal problems, and short duration of hospital stay. After 1 month, 65% of the patients were using drugs (half of them were dependent again, half of them had used occasionally) and 35% were completely abstinent (21% when excluding those in residential treatment). Predictors of rapid relapse were cocaine abuse and little concern with own psychological situation at baseline. After 6 months, 50% were physically dependent again, 13% had lapsed occasionally, 37% were abstinent (28% when excluding those in residential treatment). Only high benzodiazepine use at baseline was associated with medium term abstinence. Addiction severity index composite scores had considerably improved between baseline and 6 months. Prevention of relapse to opiate use after inpatient detoxification, especially for those with a concurrent cocaine abuse, should be improved.

Introduction

Compared with other types of substance abuse treatment, studies on inpatient opiate detoxification are rare. Especially, data on relapse after inpatient detoxification are lacking. Still, clinicians admit in general that relapse after inpatient detoxification is frequent (Duvall et al., 1963, Craig, 1984, Gossop et al., 1987, Gossop et al., 1989, Alling, 1992). In French-speaking settings, inpatient detoxification was, until recently, the most frequently used treatment, but to date studies evaluating its effectiveness in the short or long-term have not been published (Agence Nationale d’Accréditation et d’Evaluation en Santé, 1998)

Studies from English-speaking settings show that inpatient detoxification programmes differ considerably in length of treatment, type and intensity of pharmacological treatment or associated services offered, but that in general between 50 to 80% of the patients finish the treatment successfully (Gossop et al., 1982, Gossop et al., 1987, Gossop et al., 1989, San et al., 1989, Alling, 1992). Patient factors such as gender, age, duration of drug use are not associated with treatment success (Craig, 1984, San et al., 1989), whereas factors such as family and social support, and psychological or psychiatric status are inconsistently related to treatment outcome (Craig, 1984).

Studies on relapse to drug use after inpatient detoxification show that, in general, initial relapse occurs in the first few weeks after the end of treatment. Relapse rates vary between 9–50% at 6 months, but samples are often small and response rates low (Hunt and Odorroff, 1962, Duvall et al., 1963, Gossop et al., 1986, Gossop et al., 1987, Gossop et al., 1989). Gossop shows that certain subjects can take opiates after successful inpatient detoxification, without becoming dependent again, this event is called ‘lapse’ or ‘mistake’ (Marlatt and Gordon, 1985, Gossop et al., 1989). Relapse is thus defined as a return to dependence and daily use of the drug. The factors associated with relapse after inpatient detoxification are female gender, younger age, poly-drug use, intravenous drug use, absence of protective factors (family support, work, housing, access to care), social pressure and lack of confidence about the ability to maintain a drug-free life (Duvall et al., 1963, Winnick, 1964, Gossop et al., 1987, Gossop et al., 1990).

There are no published studies on the evaluation of inpatient detoxification programmes while using the Addiction severity index (ASI) as a baseline characteristic. The ASI is a standardised score of severity of addiction and is widely used in many studies evaluating other types of drug abuse treatment (McLellan et al., 1992).

The aim of this study is to describe the results of an inpatient opiate detoxification programme in Geneva and relapse rates at 1 and 6 months, to analyse the correlation between ASI characteristics and treatment outcome or relapse, and to assess the retention rate into treatment. It is the first study in this domain from a French-speaking community using the ASI and a systematic methodology to describe the evaluation of patients after inpatient detoxification.