David Korts

Alcoholism as a risk factor in methadone maintenance: A randomized controlled trial

A randomized controlled trial of 625 addicts on methadone maintenance identified 105 (17 percent) as active alcoholics, 47 (8 percent) as inactive alcoholics, and 473 (75 percent) as nonalcoholics. Subjects were followed for up to 29 months (mean 53.7 weeks) to assess the influence of alcoholism on the rehabilitative process. During the study, alcohol consumption significantly decreased (p less than 0.001) in active alcoholics. Indexes of productive activity on entry or during follow-up revealed no significant differences between active alcoholics and other patients with the exception of alcohol-related hospitalizations (p less than 0.001). Behavioral indexes consistently improved with treatment in all patients, being greatest among active alcoholics (p less than 0.01). During the study, 28 (7 percent) of 399 nonalcoholics were recategorized as active alcoholics, and remission from alcoholism was noted in 28 (27 percent) of patients who were initially classified as alcoholic. These findings suggest that alcoholism does not significantly affect rehabilitation from narcotic use and therefore should not be cause for detoxification from methadone maintenance.

Alcohol Consumption in Persons on Methadone Maintenance Therapy

Alcohol use among methadone maintenance treatment program (MMTP) patients is substantial and a frequent impression is that addicts accelerate their consumption once in MMTP. This study reports an attempt to more clearly define alcohol consumption in opioid dependence as well as changes associated with methadone maintenance therapy. Two-day alcohol consumption (2-day EtOH) data were collected initially and quarterly on participants in a randomized controlled trial of intervention for alcoholism. Blood alcohol levels (BAL) were also determined. 17% of the participants were classified as active alcoholics (AA) and 8% as inactive alcoholics (IA). Two-day EtOH and BAL were significantly higher for AA than AI and nonalcoholics (NA, and AI higher than NA. Two-day EtOH decreased significantly over time for AA, AI, and NA. These findings indicate that AA among narcotic addicts and those on MMTP consume large quantities of EtOH but that consumption decreases with time on MMTP. The results, in confirmation of the work of others, suggest that entry and participation in MMTP has a broader effect than just on the use of narcotic drugs.

Failure of mean red cell volume to serve as a biologic marker for alcoholism in narcotic dependence: A randomized control trial☆

Mean red cell volume, mean red cell hemoglobin, and mean red cell hemoglobin concentration were measured in a prospective, longitudinal, single-bind study of alcoholism and its treatment in 625 patients receiving methadone. Mean red cell volume and mean red cell hemoglobin were significantly elevated in alcoholic as compared with nonalcoholic patients (p less than 0.001), with a sensitivity of 40 and 51 percent, respectively. The ability of an elevated mean red cell volume and mean red cell hemoglobin to exclude active alcoholism (specificity) was 86 and 76 percent, respectively. Development of excessive consumption of alcohol during the course of the study was not associated with significant elevations over baseline values of either mean red cell volume or mean red cell hemoglobin. Similarly, the mean red cell volume and mean red cell hemoglobin in the small number of patients whose consumption of alcohol markedly decreased did not significantly change from baseline values. These findings suggest that although the specificity of mean red cell volume may be helpful in eliminating those persons who are not actively alcoholic, its sensitivity does not permit its use as a biologic marker for alcoholism. The inclusion of an elevated mean red cell volume as a major criterion for the diagnosis of alcoholism should be reconsidered.

Abnormal Liver Function Tests as Biological Markers for Alcoholism in Narcotic Addicts

Liver Function Test (LFT) abnormalities are frequently observed in narcotic addicts. However, the role of alcohol in producing such changes remains unclear. In order to evaluate the effects of alcohol in producing LFT elevations as well as the use of routine LFTs to serve as biochemical markers for alcoholism in narcotic addicts, 612 addicts participating in a randomized control trial of intervention in alcoholism were studied. Baseline parameters including LFTs and history of alcohol use were obtained on entry into the study and subsequently periodically during follow-up which varied from 6 months to 2 1/2 years (mean 13.5 months). On entry to the study, 104 of 612 (17%) of addicts were classified as alcoholics. Mean values of LFTs (SGOT, SGPT, Alkaline phosphatase, GGTP) in the alcoholic cohort were significantly increased compared to those among nonalcoholics (p less than 0.01 to less than 0.001 for individual tests). Mean values of LFTs did not significantly change during methadone maintenance in either group. Although a greater proportion of alcoholic addicts had elevated LFTs, the predictive values for each test (18 to 35%) were sufficiently low to prevent them from being used as biochemical markers of alcoholism. These findings suggest that although elevations in LFTs are frequently present in narcotic addicts and are significantly greater among addicts who are also alcoholic, most elevations are not specifically due to alcohol. Conventional LFTs are therefore of limited value in assessing alcoholism among narcotic addicts.

The relationship between Hepatitis B surface antigen and antibody and continued drug use in narcotic dependency: A randomized controlled study

Hepatitis B surface antigen (HBsAg) and antibody (antiHBs) were determined in 556 narcotic addicts entering a randomized prospective study of alcoholism in patients on methadone maintenance. Only 37% of patients were either negative for HBsAg or without detectable titers of antiHBs. No difference in reactivity existed between alcoholic as compared to nonalcoholic patients and the use of street heroin as compared to use of methadone upon entry to the study. At least a one year follow-up was obtained in 229 (41%) patients with 25 of 88 (28%) patients initially without titers to antiHBs developing detectable titers. No relationship existed between development of antiHBs titers and elevation of liver function tests or the subsequent use of parenteral heroin. These findings suggest that the development of titers to antiHBs in persons on methadone maintenance should not be used as an indication of parenteral drug use.

OPIATE ADDICTION AND ALCOHOLISM: THE FEASIBILITY OF COMBINED TREATMENT APPROACHES*

This discussion will focus on two aspects of the interaction between narcotic addiction and alcoholism: 1 ) the effectiveness of a single center to treat both alcoholics and narcotic addicts and 2 ) the importance of study design in trying to develop a therapeutic approach for management of the alcoholic-narcotic addict. Both of these subjects have generated a great deal of controversy and are particularly relevant. The money allocated for treatment programs on both federal and state levels is declining. There is a real need to consolidate resources to provide the most effective therapy. Epidemiologically, the profile of the heroin addict is also changing. There is a greater prevalence of polydrug use amongst heroin addicts, with alcohol being one of the more prominent drugs of abuse. A brief review of each area is therefore timely.

BIOSTATISTICAL PERSPECTIVES IN THE EPIDEMIOLOGY OF NARCOTIC ABUSE

INTRODUCTION Biostatistical methods of analysis are useful in identifying narcotic abuse. Accordingly, three of these methods, the Randoniized Response Technique, the Linear Model Analysis of Multi-Dimensional Contingency Tables and Life-Table analysis of longitudinal data will be discussed. Brief descriptions of each technique and its potential areas of application follow. The Randomized Response Technique deals with gathering sensitive information which in some way is threatening to the respondent; Multi-Dimensional Contingency table methods deal with the analysis of cross-sectional data; and Life-Table or actuarial methods deal with the problem of estimating from follow-up data the probabilities of surviving without return to narcotic drug use.