Charles E. Riordan

Clonidine and Naltrexone in the Outpatient Treatment of Heroin Withdrawal

Clonidine hydrochloride (an alpha-2 adrenergic agonist) and naltrexone hydrochloride (an opioid antagonist), given in combination, provided a safe and effective treatment of abrupt opioid withdrawal over 5 days in an outpatient/day setting. Before starting the clonidine, a naloxone challenge test was used to verify and quantify opioid dependence, and the naloxone challenge test score was then used to determine initial medication doses. Initial naloxone challenge test scores predicted subsequent patient discomfort during the 5-day clonidine-naltrexone protocol. Twelve of 14 (86%) heroin users successfully withdrew from opioids and simultaneously initiated naltrexone maintenance.

Methylphenidate treatment of cocaine abusers without attention deficit disorder: a negative report.

Five cocaine abusers without diagnoses of Attention Deficit Disorder (ADD) were treated with methylphenidate in an open trial. In contrast to previously described patients with ADD, none of these patients showed clinical improvement or decreased cocaine use.

Methylphenidate (Ritalin®) treatment of cocaine dependence—A preliminary report

The authors report on three cases of cocaine dependence treated with methylphenidate. All patients treated showed marked to dramatic improvement with regard to toxic/abstinence signs and symptoms, craving behavior and other behavioral disturbances associated with heavy and chronic cocaine abuse. The authors explore the possibility that cocaine dependence is associated with pre-existing or resulting psychopathology, particularly mood disturbances. Emphasis is also placed on a predisposing or de novo attention deficit disorder (ADD) as possibly contributing to heavy or continued reliance on cocaine.

Multiple family therapy and naltrexone in the treatment of opiate dependence

The effect of multiple family therapy on client compliance and retention in a high intervention, naltrexone treatment program was examined retrospectively. The population consisted of 65 opiate-dependent individuals consecutively treated with naltrexone and a standard program of counseling and supportive psychotherapy. Twenty-five of these individuals, in addition, received multiple family therapy. The data presented are suggestive of the efficacy of combining multiple family therapy and high intervention in patients being treated with naltrexone. Analysis of the data demonstrated that the group receiving multiple family therapy had a larger continuous time of naltrexone ingestion and remained in the treatment program longer than clients who did not receive multiple family therapy. These effects were independent of race and employment status. The implication of the results for treatment and avenues for future research are discussed.

The Organization of a Methadone Maintenance Program

This paper examines the organizational structure and operation of a methadone maintenance program whose major emphasis is on rehabilitation. Explicit program goals include teaching clients real life problem solving and enabling some program members to give up methadone. The program is hierarchically structured and rule making and rule enforcement are managed through a clearly defined “chain of command”. Small counseling groups are the major rehabilitative structure. They help to motivate client collaboration and teach problem solving in order to enhance skills, model behaviors, provide success experiences and allow individuals to master difficulties in order to limit social anxiety. These small groups engage and maintain addicts in treatment. However, they may paradoxically impede full return to the community because the clients dependency needs are met in the group setting. Problems for the programs organization include 1) monitoring psychiatric disorder in the client population since deviant behaviors and affective experiences in the small group are routinely identified as reflecting socially determined individual problems, and 2) development of more adequate structures to help to prepare clients for withdrawal from methadone, graduation from the program and the loss of small group and organizational supports.

Prevalence of movement disorder in a methadone-maintained population.

Opioids and neuroleptics have similar effects in a variety of behavioral, biochemical, and clinical situations. Prolonged treatment with dopamine antagonists is associated with the development of a movement disorder, tardive dyskinesia. Animals treated with methadone for prolonged periods may also develop abnormal movements when challenged with amphetamines. In this study, 243 patients on methadone maintenance were examined for abnormal movements using the Abnormal Involuntary Movement Scale. Methadone treatment alone was not associated with increased abnormal movements. Three patients with abnormal movements were found, but each was also receiving neuroleptics.