Correlates of Hospitalization for Alcohol-Using Methadone-Maintained Persons With Physical Health Problems

University of California, Los Angeles, CA, USA.
Western Journal of Nursing Research (Impact Factor: 1.03). 02/2009; 31(4):525-43. DOI: 10.1177/0193945908328784
Source: PubMed


This cross-sectional study (n = 190) examined correlates of hospitalization for physical health problems among methadone maintenance therapy (MMT) clients with a history of alcohol abuse. The study was derived from baseline data collected for a longitudinal trial assessing the effect of motivational interviewing among alcohol-abusing adults undergoing MMT. The sample included clients who were 18-55 years of age, abusing alcohol, and receiving MMT from five large methadone maintenance clinics in the Los Angeles area. A structured questionnaire was used to collect the data. Correlates of hospitalization in logistic regression analysis included lack of social support, recent victimization, age of first alcohol use, chronic severe pain in the previous 6 months, not having children, and ethnicity. Identification of hospitalization risk factors among alcohol-abusing MMT clients is a first step to developing risk-reducing interventions designed to lower hospitalization rates in this population.

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    • "Almost one half of OD individuals reported at-risk alcohol use, a fi nding consistent with the existing literature (Nyamathi et al., 2009; Senbanjo et al., 2007; Stenbacka et al., 2007). To our knowledge, this is the fi rst report of an adverse infl uence of alcohol use on the manifestation of opioid withdrawal and on the outcome of opioid detoxifi cation. "
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    ABSTRACT: The influence of alcohol use on opioid dependence is a major problem that warrants a search for more effective treatment strategies. The addition of very-low-dose naltrexone (VLNTX) to methadone taper was recently associated with reduced withdrawal intensity during detoxification. In a secondary analysis of these data, we sought to determine whether problem drinking affects detoxification outcomes and whether symptoms are influenced by VLNTX use. Opioid-dependent patients (N = 174) received naltrexone (0.125 or 0.250 mg/day) or placebo in a double-blind, randomized design during methadone-based, 6-day inpatient detoxification. Alcohol consumption was assessed at admission using the Addiction Severity Index and selfreport. Outcome measures were opioid withdrawal intensity, craving, and retention in treatment. Problem drinking-opioid dependent patients (n = 79) showed episodic heavy alcohol use and reported increased subjective opioid withdrawal intensity (p = .001), craving (p = .001), and significantly lower rate of retention in treatment (p = .02). Individuals with problem drinking and opioid dependence who were treated with VLNTX (n = 55) showed reduced withdrawal (p = .05) and a lower rate of treatment discontinuation (p = .03), resuming alcohol intake in smaller numbers the day following discharge (p = .03). Treatment effects were more pronounced on anxiety, perspiration, shakiness, nausea, stomach cramps, and craving. There were no group differences in use of adjuvant medications and no treatment-related adverse events. Heavy drinking is associated with worse opioid detoxification outcomes. The addition of VLNTX is safe and is associated with reduced withdrawal symptoms and better completion rate in these patients. Further studies should explore the use of VLNTX in detoxification and long-term treatment of combined alcohol-opioid dependence and alcohol dependence alone.
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    ABSTRACT: Literature review tables pertaining to various issues and sub-themes regarding Methadone Maintenance Treatment (MMT) policy and practice, composed by Dr. Christopher B. R. Smith as a consultant for the College of Physician and Surgeons of Ontario (CPSO) Research Advisory Group (RAG), towards the revision of the most recent edition of the ‘Methadone Maintenance Treatment Program Standards and Clinical Guidelines’ (4th Edition, February 2011).
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    ABSTRACT: We examined the associations of recent victimization with subsequent participation in alcohol-related treatment and mutual help, and with short- and long-term drinking and health outcomes. Treatment-naïve men and women having an alcohol use disorder with (n = 73) or without (n = 491) recent violence victimization were assessed at baseline and 1 and 8 years later. Victimized individuals had more days intoxicated, drinking problems, symptoms of depression, and physical health problems at baseline, and were more likely to attend Alcoholics Anonymous (AA) during Year 1. Victimization at baseline predicted re-victimization at 1 year, and more depressive symptoms and physical health problems at 8 years. Participation in alcohol-related treatment or AA during Year 1 was associated with fewer drinking problems. In addition, treatment or AA participation was of greater benefit to victimized individuals in terms of reducing drinking-related or health problems. Alcohol use disorder interventions are effective for men and women with recent victimization, but additional services may be needed to remedy problems with depression and physical health and to prevent further victimization.
    No preview · Article · Jan 2011 · Addiction Research and Theory
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