Murry Cohen

Adequacy of sexual performance in men maintained on methadone.

Impairment of sexual performance may occur in men on methadone maintenance. A random sample of 50 of 355 men enrolled in a methadone program was interviewed with respect ot sexual activity. Seventeen (33%) reported sexual dysfunction, occurring in 50% within 1 month after initiating methadone therapy. A comparison between these individuals and those without a reported change in sexual activity revealed no differences with respect to demographic parameters, methadone dose, or presence of polydrug abuse. Inadequate sexual function on heroin, however, was reported in 12 (71%) of those experiencing similar difficulties on methadone. This finding was present in only one person (3%) of those individuals whose sexual function on methadone maintenance was considered adequate. This study suggests that those persons with altered sexual function while on street heroin represent a high risk group for the development of inadequate sexual function upon initiation of methadone maintenance.

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.

Alcoholism, heroin dependency, and methadone maintenance: alternatives and aids to conventional methods of therapy.

Alcohol is one of the drugs most frequently used by heroin addicts prior to inception of heroin addiction. It is therefore not surprising that alcohol also represents the drug most frequently abused by persons on methadone maintenance. This abuse not only results in the appearance of all the previously known complications secondary to excessive alcohol intake, but is also a major factor in preventing successful rehabilitation while on methadone therapy. Conventional means of therapy, through abstinence and/or Antabuse, have not met with success or a good degree of patient acceptance. A multimodal approach utilizing controlled drinking, abstinence, and Antabuse along with identification of cues triggering excessive drinking may serve to attract greater numbers of persons with dependency for narcotics and alcohol into the therapeutic setting.

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.