Behavioral Treatment + Naltrexone Reduces Drug Use and Legal Problems in the Republic of Georgia

Addiction Research Center, Alternative Georgia, Tbilisi, Georgia.
The American Journal of Drug and Alcohol Abuse (Impact Factor: 1.78). 03/2012; 38(2):171-5. DOI: 10.3109/00952990.2011.643996
Source: PubMed


Known drug users in the Republic of Georgia are 99% male. Georgian social context includes close family social structure, intense police scrutiny over daily life, and minimal social service infrastructure. Drug use is dangerous and individuals rely on family support to address socially stigmatizing problems.
The aim was to examine the changes in problem severity over time experienced by 40 adult opioid-injecting men with drug-free female partners in the Republic of Georgia who participated in a randomized clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone.
This secondary data analysis study examined the results from a project that had randomized participants to either a comprehensive intervention that paired behavioral treatment with naltrexone or usual care (UC) and examined changes in Addiction Severity Index (ASI) composite scores.
The comprehensive intervention showed three times the decline in ASI drug use and legal composite scores than did the UC condition in males in the Republic of Georgia, both p < .009.
The results suggest that the use of a comprehensive behavioral intervention paired with naltrexone leads to significant reductions in drug use and legal problems in opioid-injecting males in the Republic of Georgia.
A comprehensive intervention that paired behavioral treatment with naltrexone provides a promising approach to protect drug users against relapse and legal risks.

Download full-text


Available from: Kevin O'Grady, Feb 03, 2014
  • Source
    • "A total of 74 men between May 2006 and January 2009 were screened. Of these men, 19 failed to show for their initial intake appointment, while 55 were evaluated for eligibility on the following criteria: 18 years or older, having a current illicit-drug-free intimate female partner with whom they had regular contact, lack of current suicidal ideation, meeting DSM-IV criteria for current opioid dependence, not meeting DSM-IV criteria for thought disorder and free of cognitive impairment that prevent them from completing the study [19,20]). Men who indicated current physical abuse of their female partner to an extent that might be life threatening were excluded from the study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background HIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners. Methods In order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners’ study intake. Results The female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship. Conclusions The alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug–using males into the general population. [This secondary analysis study was funded by an international supplement to the parent randomized clinical trial “Treating the Partners of Drug Using Pregnant Women: Stage II (HOPE)”. Identifier: NCT00496990.]
    Full-text · Article · Nov 2012 · Substance Abuse Treatment Prevention and Policy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services. Methods: This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services. Results: The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour. Factors that had a negative impact on use of drug treatment services included an absence of gender-specific services, judgmental attitudes of service providers, the cost of treatment and a punitive legal position in regard to substance use. Having a substance-using partner served as an additional factor inhibiting a woman's willingness to seek assistance. Conclusion: Within the context of orthodox Georgian society, low self-esteem, combined with severe family and social stigma play a critical role in creating barriers to the use of both general health and substance-use-treatment services for women. Education of the public, including policy makers and health care providers is urgently needed to focus on addiction as a treatable medical illness. The need for more women centred services is also critical to the provision of effective treatment for substance-using women.
    Full-text · Article · Jun 2013 · The International journal on drug policy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper is the thirty-fifth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2012 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
    Full-text · Article · Oct 2013 · Peptides
Show more