Peter Blanken

University Medical Center Utrecht, Utrecht, Utrecht, Netherlands

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Publications (37)96.63 Total impact

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    ABSTRACT: Aims: Age of onset is an important criterion to distinguish subgroups of alcohol-dependent patients. This study investigated physical and mental health and social functioning of older inpatients with early (age <25), late (25-44), and very late (≥45) onset of alcohol dependence. Methods: In a specialized detoxification ward for older patients in The Hague, the Netherlands, 157 older alcohol-dependent inpatients (38% women, mean age 62.7 ± 6.5) were interviewed with the European version of the Addiction Severity Index. Results: As a group, older alcohol-dependent patients had substantial physical, mental and social problems, which were largely independent of the age of onset of alcohol dependence. Patients with early-onset alcohol dependence had more chronic medical problems and more suicidal thoughts than patients with late-onset alcohol dependence. The very-late-onset group did not significantly differ from the other two groups in any of the variables under study. Conclusions: Despite previous studies showing more favourable outcomes for the (very) late-onset compared to the early-onset alcohol-dependent group, their comorbid (mental) health and social problems are in many respects similar, and require careful assessment and treatment. This may be crucial for successful treatment and improving quality of life in these patients. © 2014 S. Karger AG, Basel.
    European Addiction Research 04/2014; 20(5):226-232. · 2.36 Impact Factor
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    ABSTRACT: Background Crack-cocaine dependence is a complex disorder with limited treatment options. Topiramate is one of the promising medications with reported reductions in cocaine use and craving in former studies. The present study evaluated the acceptance and effectiveness of topiramate as an add-on to cognitive behavioral therapy (CBT) in crack-cocaine dependent patients. Methods Seventy-four crack-cocaine dependent outpatients participated in an open-label, randomized feasibility trial. They were randomized to receive either 12-week CBT plus topiramate (200 mg/day) or 12-week CBT only. The primary outcome measure was treatment retention. Secondary outcomes included medication adherence, safety, cocaine and other substance use, health, social functioning, and patient satisfaction. Results Adherence to topiramate treatment was low. In the intent-to-treat analyses, topiramate neither improved treatment retention nor reduced cocaine and other substance use. Post-hoc, exploratory analyses suggested a moderation effect of comorbid opioid dependence, with a significant effect of topiramate on cocaine use reduction only in crack-cocaine dependent patients with comorbid opioid dependence. Conclusions Topiramate was safe and well-tolerated in this sample of crack-cocaine dependent patients, but efficacy was not supported probably due to low acceptance of the treatment. Given the equivocal results of previous studies and the negative findings in our study, the potential of topiramate in the treatment of cocaine dependence seems limited.
    Drug and alcohol dependence 01/2014; · 3.60 Impact Factor
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    ABSTRACT: Background Most studies investigating the role of personality as a risk factor for the development of opioid dependence compare dependent opioid users with healthy controls who never used heroin. In order to understand the potential protective role of personality, it is crucial to compare illicit opioid users who never became dependent with dependent opioid users. Aims This study aims to examine the role of personality as a risk factor for opioid use and as a protective factor for the development of opioid dependence. Methods Comparing personality factors between three groups: (1) 161 never-dependent illicit opioid users who have been using illicit opioids but never became opioid dependent; (2) 402 dependent opioid users in methadone maintenance treatment or heroin-assisted treatment; and (3) 135 healthy controls who never used heroin. Personality was assessed with a short version of Cloninger's Temperament and Character Inventory. Results Never-dependent opioid users reported more Novelty Seeking and Harm Avoidance and less Self-Directedness and Cooperativeness than healthy controls and more Reward Dependence and Self-Directedness, and less Harm Avoidance than dependent opioid users. Furthermore, never-dependent opioid users reported more Self-Transcendence than both dependent opioid users and healthy controls. Conclusions Never-dependent opioid users may have started to use opioids partly due to their tendency to seek novel and/or spiritual experiences (high Novelty Seeking, high Self-Transcendence) and their tendency to avoid aversive stimuli (high Harm Avoidance), whereas they may have been protected against the development of dependence by their need for social approval (high Reward Dependence) and their self-efficacy (high Self-Directedness).
    Drug and Alcohol Dependence. 01/2014;
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    ABSTRACT: More and more adolescents with cannabis problems are seeking treatment at addiction clinics. There is an urgent need for new types of treatment in this field. To evaluate the effectiveness of multidimensional family therapy ( mdft ) and cognitive behavioral therapy ( cbt ) in adolescents with a cannabis use disorder. One hundred and nine adolescents were randomly assigned to outpatient mdft or cbt . Both types of therapy groups had a planned treatment course lasting 5 to 6 months. After 12 months the two groups were compared in terms of changes in cannabis use and in terms of secondary outcome measures, including delinquency. Adolescents in both treatment groups showed significant and relevant reductions in cannabis use and delinquency over 12 months. Although the mdft treatment lasted longer and was more intensive than the cbt treatment, there was no difference in the key outcome measures of the treatments. Secondary analyses indicated that older adolescents and those without comorbid psychiatric problems derived considerably more benefit from cbt , whereas younger adolescents and those with comorbid psychiatric problems benefited much more from mdft . mdft and cbt are equally effective in reducing cannabis use and delinquent behavior in adolescents with a cannabis use disorder. Age and comorbid psychiatric problems turned out to be important moderators of the treatment results of mdft and cbt and could therefore be used as a starting point for matching adolescent substance abusers to the most appropriate type of treatment.
    Tijdschrift voor psychiatrie 01/2013; 55(10):747-59.
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    ABSTRACT: In a recent randomized controlled trial (Hendriks et al., 2011), multidimensional family therapy (MDFT) and cognitive behavioral therapy (CBT) were equally effective in reducing cannabis use in adolescents (13-18 years old) with a cannabis use disorder (n=109). In a secondary analysis of the trial data, we investigated which pretreatment patient characteristics differentially predicted treatment effect in MDFT and CBT, in order to generate hypotheses for future patient-treatment matching. The predictive value of twenty patient characteristics, in the area of demographic background, substance use, substance-related problems, delinquency, treatment history, psychopathology, family functioning and school or work related problems, was investigated in bivariate and subsequent multivariate linear regression analyses, with baseline to month 12 reductions in cannabis use days and smoked joints as dependent variables. Older adolescents (17-18 years old) benefited considerably more from CBT, and younger adolescents considerably more from MDFT (p<0.01). Similarly, adolescents with a past year conduct or oppositional defiant disorder, and those with internalizing problems achieved considerably better results in MDFT, while those without these coexisting psychiatric problems benefited much more from CBT (p<0.01, and p=0.02, respectively). The current study strongly suggests that age, disruptive behavior disorders and internalizing problems are important treatment effect moderators of MDFT and CBT in adolescents with a cannabis use disorder. If replicated, this finding suggests directions for future patient-treatment matching in adolescent substance abuse treatment.
    Drug and alcohol dependence 05/2012; 125(1-2):119-26. · 3.60 Impact Factor
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    ABSTRACT: Na de start in 1998 van een eerste fase in Amsterdam en Rotterdam is in de loop van 2000 in zes gemeenten in Nederland, te weten de genoemde en Den Haag, Groningen, Heerlen en Utrecht, het onderzoek naar de effectiviteit van heroïne op medisch voorschrift van start gegaan. In dit artikel wordt ingegaan op de achtergrond en onderzoeksopzet van dit multicenter onderzoek en worden enkele eerste ervaringen beschreven.
    05/2012; 4(6):145-149.
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    ABSTRACT: The co-occurrence of severe mental illness (SMI) and substance use disorder (SUD) in dual diagnosis patients is common and associated with negative treatment outcomes. Therefore, integrated treatments, combining proven effective mental health and substance abuse interventions, have emerged. However, evidence about the effectiveness of integrated outpatient versus inpatient treatment for dual diagnosis patients from randomised controlled trials is lacking. The aim of the paper is to determine whether integrated outpatient treatment for patients with SMI and SUD is more effective than integrated inpatient treatment. Three months of post-treatment hospitalisation, problem drug use and psychiatric status were assessed in 82 patients with SMI and SUD in a randomised controlled trial (RCT) comparing five months of integrated inpatient treatment (n = 40) with five-months integrated outpatient treatment (n = 42) following a shared one-month inpatient stabilisation phase. No significant differences in outcomes were found between the two treatment conditions using intention-to-treat analyses. However, considerable crossover of patients between treatment conditions occurred. This crossover occurred significantly more in the outpatient treatment group, where patients remained in inpatient treatment longer than the intended one month stabilisation phase. As a consequence, actual time in inpatient treatment did not differ between the study groups. Post hoc analyses showed that baseline patient characteristics did not predict actual time in inpatient treatment. Due to considerable crossover of study participants, we were unable to answer our study question regarding the comparative effectiveness of inpatient versus outpatient treatment. This raises serious questions regarding the feasibility of RCTs investigating inpatient versus outpatient integrated treatment in patients with SMI and co-occurring SUD.
    Mental Health and Substance Use dual diagnosis 01/2012; 5(2):132-147.
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    ABSTRACT: Cocaine, particularly in its base form ('crack'), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options for cocaine dependent users are limited, and a substantial part of the cocaine dependent population is not reached by the addiction treatment system. Psychosocial interventions for cocaine dependence generally show modest results, and there are no registered pharmacological treatments to date, despite the wide range of medications tested for this type of dependence. The present study (Cocaine Addiction Treatments to improve Control and reduce Harm; CATCH) investigates the possibilities and problems associated with new pharmacological treatments for crack dependent patients. The CATCH-study consists of three separate randomised controlled, open-label, parallel-group feasibility trials, conducted at three separate addiction treatment institutes in the Netherlands. Patients are either new referrals or patients already in treatment. A total of 216 eligible outpatients are randomised using pre-randomisation double-consent design and receive either 12 weeks treatment with oral topiramate (n = 36; Brijder Addiction Treatment, The Hague), oral modafinil (n = 36; Arkin, Amsterdam), or oral dexamphetamine sustained-release (n = 36; Bouman GGZ, Rotterdam) as an add-on to cognitive behavioural therapy (CBT), or receive a 12-week CBT only (controls: n = 3 × 36). Primary outcome in these feasibility trials is retention in the underlying psychosocial treatment (CBT). Secondary outcomes are acceptance and compliance with the study medication, safety, changes in cocaine (and other drug) use, physical and mental health, social functioning, and patient satisfaction. To date, the CATCH-study is the first study in the Netherlands that explores new treatment options for crack-cocaine dependence focusing on both abstinence and harm minimisation. It is expected that the study will contribute to the development of new treatments for one of the most problematic substance use disorders. The Netherlands National Trial Register NTR2576The European Union Drug Regulating Authorities Clinical Trials EudraCT2009-010584-16.
    BMC Psychiatry 08/2011; 11:135. · 2.23 Impact Factor
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    ABSTRACT: To investigate in heroin-assisted treatment (HAT) compared to methadone maintenance treatment (MMT): the course of heroin craving and illicit heroin use, their mutual association, and their association with multi-domain treatment response. RCTs on the efficacy of 12 months co-prescribed injectable or inhalable HAT compared to 12 months continued oral MMT. Outpatient treatment in MMT- or specialized HAT-centers in the Netherlands. Chronic, treatment-refractory heroin dependent patients (n=73). STUDY PARAMETERS: General craving for heroin (Obsessive Compulsive Drug Use Scale); self-reported illicit heroin use; multi-domain treatment response in physical, mental and social health and illicit drug use. The course of heroin craving and illicit heroin use differed significantly, with strong reductions in HAT but not in MMT. General heroin craving was significantly related to illicit heroin use. Heroin craving was not and illicit heroin use was marginally related to multi-domain treatment response, but only in MMT and not in HAT. Heroin craving and illicit heroin use were significantly associated and both strongly decreased in HAT but not in MMT. Craving was not related to multi-domain treatment response and illicit heroin use was marginally related to treatment response in MMT, but not in HAT. The latter was probably due to the strong reduction in illicit heroin use in most patients in HAT and the small sample size of the sub-study. It is hypothesized that the strong reductions in craving for heroin in HAT are related to the stable availability of prescribed, pharmaceutical grade heroin.
    Drug and alcohol dependence 07/2011; 120(1-3):74-80. · 3.60 Impact Factor
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    ABSTRACT: To meet the treatment needs of the growing number of adolescents who seek help for cannabis use problems, new or supplementary types of treatment are needed. We investigated whether multidimensional family therapy (MDFT) was more effective than cognitive behavioral therapy (CBT) in treatment-seeking adolescents with a DSM-IV cannabis use disorder in The Netherlands. One hundred and nine adolescents participated in a randomized controlled trial, with study assessments at baseline and at 3, 6, 9 and 12 months following baseline. They were randomly assigned to receive either outpatient MDFT or CBT, both with a planned treatment duration of 5-6 months. Main outcome measures were cannabis use, delinquent behavior, treatment response and recovery at one-year follow-up, and treatment intensity and retention. MDFT was not found to be superior to CBT on any of the outcome measures. Adolescents in both treatments did show significant and clinically meaningful reductions in cannabis use and delinquency from baseline to one-year follow-up, with treatment effects in the moderate range. A substantial percentage of adolescents in both groups met the criteria for treatment response at month 12. Treatment intensity and retention was significantly higher in MDFT than in CBT. Post hoc subgroup analyses suggested that high problem severity subgroups at baseline may benefit more from MDFT than from CBT. The current study indicates that MDFT and CBT are equally effective in reducing cannabis use and delinquent behavior in adolescents with a cannabis use disorder in The Netherlands.
    Drug and alcohol dependence 06/2011; 119(1-2):64-71. · 3.60 Impact Factor
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    ABSTRACT: The present study investigated the effects of added outpatient services aimed at reintegration assistance and prolonged aftercare on continuity of care and risk of re-hospitalization among patients suffering from both a severe mental illness and a substance use disorder. Administrative data on inpatient and outpatient care of all patients with at least one inpatient treatment episode at the treatment facility for dual diagnosis patients (CDP) of the Parnassia Bavo Psychiatric Institute in The Hague were analyzed (n = 616). The CDP began in 1996 as an inpatient service. In early 1999, the CDP was expanded by outpatient services. The time between discharge and readmission was estimated in a survival time analysis in connection with calendar year (1996–2006) and patient's characteristics. No consistent or substantial differences in the duration of first in-hospital stay at the CDP could be established. The time from admission to enrollment in an outpatient program decreased and the number of outpatient days with actual presence increased. The median interval between discharge and first readmission increased from 308 days among those discharged in 1996–1998 to 490 for those discharged in 1999–2001. However, this reduction in risk of re-hospitalization disappeared after adjustment for the presence of a psychotic disorder, a cluster B Axis II disorder, a history of homelessness, and use of heroin and/or cocaine. Our results indicate that the risk of readmission is above all an attribute of the patient's illness rather than a feature of the service provided.
    Mental Health and Substance Use dual diagnosis 01/2011;
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    ABSTRACT: This monograph describes the history, findings and international context of heroin-assisted treatment (HAT) in the Netherlands. The monograph consists of (1) a short introduction and seven paragraphs describing the following aspects of HAT in the Netherlands: (2) history of HAT studies and implementation of routine HAT in the Netherlands; (3) main findings on efficacy, safety and cost-effectiveness from the two randomized controlled HAT trials in the Netherlands; (4) new findings from a large cohort study on the effectiveness of HAT in routine clinical practice in the Netherlands; (5) unique data on the patient's perspective of HAT; (6) data on the pharmacological and pharmaceutical basis for HAT in the Netherlands; (7) description of the registration process; and (8) account of the international context of HAT. Together, these data show that HAT can now be considered a safe and proven-effective intervention for the treatment of chronic, treatment-resistant heroin dependent patients.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 04/2010; 20 Suppl 2:S105-58. · 3.68 Impact Factor
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    ABSTRACT: To describe 4-year treatment retention and treatment response among chronic, treatment-resistant heroin-dependent patients offered long-term heroin-assisted treatment (HAT) in the Netherlands. Observational cohort study. Out-patient treatment in specialized heroin treatment centres in six cities in the Netherlands, with methadone plus injectable or inhalable heroin offered 7 days per week, three times per day. Prescription of methadone plus heroin was supplemented with individually tailored psychosocial and medical support. Heroin-dependent patients who had responded positively to HAT in two randomized controlled trials and were eligible for long-term heroin-assisted treatment (n = 149). Primary outcome measures were treatment retention after 4 years and treatment response on a dichotomous, multi-domain response index, comprising physical, mental and social health and illicit substance use. Four-year retention was 55.7% [95% confidence interval (CI): 47.6-63.8%]. Response was significantly better for patients continuing 4 years of HAT compared to patients who discontinued treatment: 90.4% versus 21.2% [difference 69.2%; odds ratio (OR) = 48.4, 95% CI: 17.6-159.1]. Continued HAT treatment was also associated with an increasing proportion of patients without health problems and who had stopped illicit drug and excessive alcohol use: from 12% after the first year to 25% after 4 years of HAT. Long-term HAT is an effective treatment for chronic heroin addicts who have failed to benefit from methadone maintenance treatment. Four years of HAT is associated with stable physical, mental and social health and with absence of illicit heroin use and substantial reductions in cocaine use. HAT should be continued as long as there is no compelling reason to stop treatment.
    Addiction 11/2009; 105(2):300-8. · 4.58 Impact Factor
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    ABSTRACT: Since the initial Swiss heroin-assisted treatment (HAT) study conducted in the mid-1990s, several other jurisdictions in Europe and North America have implemented HAT trials. All of these studies embrace the same goal-investigating the utility of medical heroin prescribing for problematic opioid users-yet are distinct in various key details. This paper briefly reviews (initiated or completed) studies and their main parameters, including primary research objectives, design, target populations, outcome measures, current status and-where available-key results. We conclude this overview with some final observations on a decade of intensive HAT research in the jurisdictions examined, including the suggestion that there is a mounting onus on the realm of politics to translate the-largely positive-data from completed HAT science into corresponding policy and programming in order to expand effective treatment options for the high-risk population of illicit opioid users.
    Journal of Urban Health 08/2007; 84(4):552-62. · 1.89 Impact Factor
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    ABSTRACT: Persistent cue reactivity to drug-related stimuli is a well-known phenomenon among abstinent drug users and has been found to be a predictor of relapse. Cue exposure therapy (CET) aims to reduce this cue reactivity by exposing abstinent drug users to conditioned drug-related stimuli while preventing their habitual response, i.e. drug use. 127 abstinent heroin-dependent Dutch inpatients were randomized to CET (n = 65; 55 completers) and placebo psychotherapy treatment (PPT) (n = 62; 59 completers). It was examined whether CET would lead to a decrease in drug-related cue reactivity (using mixed-design ANOVA) and subsequently to lower dropout and relapse rates (using logistic regression) compared to PPT. Both groups responded with a similar decrease in self-reported cue reactivity (craving, mood). The CET group did show a significant decrease in physiological reactivity (skin conductance) compared to PPT. However, dropout and relapse rates were, contrary to our expectations, significantly higher in the CET group. This is the first randomized controlled trial showing that CET, compared to a non-specific psychotherapy, might increase dropout and relapse rates among abstinent heroin-dependent clients in a drug-free setting. Caution is warranted when applying CET in this specific context.
    Psychotherapy and Psychosomatics 02/2007; 76(2):97-105. · 9.38 Impact Factor
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    ABSTRACT: To determine the patterns of acquisitive crime during methadone maintenance treatment among chronic, treatment-resistant heroin users eligible for heroin assisted treatment in the Netherlands. We retrospectively assessed the type and number of illegal activities during 1 month of standard methadone maintenance treatment in 51 patients prior to the start of heroin assisted treatment. Data were collected using a semi-structured interview focussed on crime with special emphasis on property crime. Volume analyses consisted of frequencies and descriptives of mean numbers of offences per day and per type. In a Dutch population of problematic drug users eligible for and prior to commencing heroin assisted treatment, 70% reported criminal activities and 50% reported acquisitive crimes. Offending took place on 20.5 days per month with on average 3.1 offences a day. Acquisitive crime consisted mainly of shoplifting (mean 12.8 days, 2.2 times/day) and theft of bicycles (mean 5.8 days, 2.4 times/day); theft from a vehicle and burglaries were committed less frequently. The majority of these patients (63%) reported to have started offending in order to acquire illicit drugs and alcohol. During methadone maintenance treatment, 50% of criminally active, problematic heroin users eligible for heroin assisted treatment reported acquisitive crime. Shoplifting, thefts and/or other property crimes were committed on average two to three times on a crime day. This study discusses that the detail provided by self-reported crime data can improve cost estimates in economic evaluations of heroin assisted treatment.
    Drug and Alcohol Dependence 02/2007; 86(1):84-90. · 3.14 Impact Factor
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    ABSTRACT: Previous studies have shown that abstinent heroin addicts exhibit an attentional bias to heroin-related stimuli. It has been suggested that attentional bias may represent a vulnerability to relapse into drug use. In the present study, the predictive value of pre-treatment attentional bias on relapse was examined in a population of abstinent heroin addicts. Further, the effect of cue exposure therapy (CET) on attentional bias was studied. Participants were assigned randomly to receive nine sessions of CET or placebo psychotherapy. An in-patient drug abuse treatment setting. Abstinent heroin-dependent patients. Participants completed the emotional Stroop task both before and after completing treatment. Pre-treatment attentional bias predicted relapse at 3-month follow-up, even when controlling for self-reported cravings at the test session. Further, attentional bias was reduced in both groups after therapy, independent of treatment condition. Attentional bias may tap an important component of drug dependence as it is a predictor of opiate relapse. However, CET does not specifically reduce attentional bias.
    Addiction 10/2006; 101(9):1306-12. · 4.58 Impact Factor
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    ABSTRACT: To evaluate the validity of the EuroQol (EQ-5D) in a population of chronic, treatment-resistant heroin-dependent patients. The EQ-5D is studied relative to the Maudsley Addiction Profile (MAP), the Symptom Checklist (SCL-90) and the European Addiction Severity Index (EuropASI) which were used to assess the participant's physical functioning, mental health and social integration, respectively. Data were gathered from 430 patients participating in the Dutch heroin trials with an intended 12-month treatment period. The EQ-5D was used as a separate health outcome measure. Statistical analyses were conducted using Spearman's and Pearson's correlations. The EQ-5D dimensions mobility, self-care and usual activities generally showed low correlations with relevant parameters of the MAP-HSS, SCL-90 and EuropASI (r=0.132-0.369). The EQ-5D dimension pain/discomfort showed low to moderate hypothesized correlations with all disease-specific measures (r=0.153-0.496). The EQ-5D dimension anxiety/depression showed moderate to high correlations with the SCL-90 (including the sum score) and some of the EuropASI parameters (r=0.133-0.615). The EQ-5D utility scores were moderately correlated with the MAP-HSS (r=-0.468) and the SCL-90 (r=-0.491) total score and with response to treatment at month 12. The majority of hypothesized associations between the EQ-5D and the disease or domain-specific measures could be confirmed. The validity of the EQ-5D-based utility score appears to be suitable in the evaluation of chronic, heroin-dependent populations.
    Drug and Alcohol Dependence 05/2006; 82(2):111-8. · 3.14 Impact Factor
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    ABSTRACT: To determine the cost utility of medical co-prescription of heroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts. Cost utility analysis of two pooled open label randomised controlled trials. Methadone maintenance programmes in six cities in the Netherlands. 430 heroin addicts. Inhalable or injectable heroin prescribed over 12 months. Methadone (maximum 150 mg a day) plus heroin (maximum 1000 mg a day) compared with methadone alone (maximum 150 mg a day). Psychosocial treatment was offered throughout. One year costs estimated from a societal perspective. Quality adjusted life years (QALYs) based on responses to the EuroQol EQ-5D at baseline and during the treatment period. Co-prescription of heroin was associated with 0.058 more QALYs per patient per year (95% confidence interval 0.016 to 0.099) and a mean saving of 12,793 euros (8793 pounds sterling, 16,122 dollars) (1083 to 25,229 euros) per patient per year. The higher programme costs (16 222 euros; lower 95% confidence limit 15,084 euros) were compensated for by lower costs of law enforcement (- 4129 euros; upper 95% confidence limit - 486 euros) and damage to victims of crime (- 25,374 euros; upper 95% confidence limit - 16,625 euros). The results were robust for the use of national EQ-5D tariffs and for the exclusion of the initial implementation costs of heroin treatment. Completion of treatment is essential; having participated in any abstinence treatment in the past is not. Co-prescription of heroin is cost effective compared with treatment with methadone alone for chronic, treatment resistant heroin addicts.
    BMJ (online) 07/2005; 330(7503):1297. · 17.22 Impact Factor
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    ABSTRACT: To investigate which baseline patient characteristics of treatment-resistant heroin addicts differentially predicted treatment response to medical heroin prescription compared to standard methadone maintenance treatment. Two open-label randomized controlled trials; pooled data. Methadone maintenance programmes and heroin treatment centres in six cities in the Netherlands. Four hundred and thirty heroin addicts. Methadone plus injectable heroin or methadone plus inhalable heroin compared to methadone alone prescribed over 12 months: heroin maximum 1000 mg per day, methadone maximum 150 mg per day. Dichotomous, multi-domain response index, including validated indicators of physical health, mental status and social functioning. Data of the inhalable and injectable heroin trials were pooled. Intention-to-treat analysis showed that treatment with medically prescribed heroin plus methadone was significantly more effective (51.8% response) than standard methadone maintenance treatment (28.7%) (95% CI of response difference: 14.1-32.2%). Multivariate logistic regression analyses showed that only one of all baseline characteristics was predictive of a differential treatment effect: patients who had previously participated in abstinence-orientated treatment responded significantly better to heroin-assisted treatment than to methadone treatment (61% versus 24%), while patients without experience in abstinence-orientated treatment did equally well in heroin-assisted or methadone maintenance treatment (39% and 38%, respectively). The effect of heroin-assisted treatment is not dependent on clinical characteristics, with the exception of previous abstinence-orientated treatment: medical prescription of heroin is most effective for those patients who have previously participated in abstinence-orientated treatment.
    Addiction 02/2005; 100(1):89-95. · 4.58 Impact Factor