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Therapieerfolg von Methadonpatienten mit unterschiedlicher Indikation
Abstract
38 Patienten aus Methadonprogrammen im Kanton Zürich und ihre Betreuer wurden interviewt. Wir versuchten einen Zusammenhang zwischen diagnostischen und anamnestischen Kriterien zum Behandlungserfolg herzustellen. Die Resultate ergaben, dass wir keine solchen leicht messbaren Variablen fanden, die sich zur Indikationsstellung eigneten. Hingegen konnten wir mit guter Signifikanz beweisen, dass die Parameter der laufenden Behandlung, wie Abstinenz, Behandlungsmotivation und Beziehung zwischen Betreuer und Patient den Behandlungserfolg weitgehend bestimmen.
Methadone substitution in the treatment of opiate addiction was introduced by Dole and Nyswander (1965). 24 years later, 689 methadone treatment programs are conducted in the USA (Maany 1989). This therapy was and still is less popular in Europe, but particularly in Great Britain (Marx 1987), Sweden (Blix 1989), the Netherlands (Kooyman 1986), Austria (Pfersmann 1990), Switzerland (Uchtenhagen 1988) and Italy (Serraino and Franceschi 1989), numerous patients were treated. In Germany, the experience with methadone is rather limited and only a small number of publications exists (a.o. Elias 1990; Prütting 1990).
The Drug Abuse Reporting Programme (DARP) is a large-scale evaluation project focused on the effectiveness of drug abuse treatment, based on almost 44,000 clients admitted to 52 treatment centres located throughout the United States and in Puerto Rico between June 1969 and March 1973. The present paper summarizes research on post-DARP follow-up data (representing up to six years after DARP) for a sample of 3,131 persons admitted to treatment during 1969 to 1972. Treatments included methadone maintenance (MM), therapeutic community (TC), out-patient drug-free (DF), and out-patient detoxification programmes (DT); a comparison group of intake only (IO) clients with no DARP treatment was also followed up. The data showed in general that three treatments, MM, TC and DF, led to favourable results - MM and TC for heroin and other opioid addicts, and DF for non-addicts (users of opioids less-than-daily, usually in conjunction with other non-opioid drugs and users of non-opioids only).
Thirty-four drug addicts, aged 20 - 24 years, with a history of 4 - 8 years of intravenous heroin abuse, were randomly assigned either to a methadone maintenance treatment (MMT) (17) or to an untreated group (17). The untreated controls could not apply for entrance to the program until two years later. It was found that after two years 12 MMT patients had abandoned their drug habits and begun work, whereas 5 had recurrent drug abuse problems. Of the controls, one was drug-free and gainfully employed, 12 were continuously abusing heroin (3 of these had incurred potentially fatal diseases in consequence), 2 were in prison and 2 had diet. Two to seven years after their first visit to the Psychiatric Research Center 8 of the original control group have been accepted into the program. At present 19 (out of 25 admitted) are gainfully employed and no longer abusing drugs. Among the remaining controls 4 are dead, 3 are in prison, one in spite of a serious heart condition abuses heroin and one is drug-free. The rehabilitation rate was thus 76 per cent in the program as compared to 6 per cent among the control group. In addition, MMT obviously reduced the high morbidity and mortality rates found in a selection of heroin addicts who fulfilled the admittance criteria of the Swedish program.
A comparative evaluation outcome model designed to aid in referral of clients to appropriate drug abuse treatment centers was developed for a multimodality drug abuse rehabilitation network in Newark, New Jersey. The model analyzes retention rates and treatment dropout outcome to assess impact, and graduate outcome to assess the effectiveness of the various drug abuse treatment centers. Study of 3,943 addicts found a number of demographic and psychosocial variables that correlated with retention in specific programs; retention of some subgroups in specific treatments was substantially longer than overall retention rates. One year retention rates of 65% in methadone maintenance; 22, 16, and 8.5% in the three therapeutic communities; and less than 5% in two outpatient drug-free programs suggested a study of treatment dropouts outcome. Significant reduction in criminality and drug use were found for all treatment dropouts including a “no-treatment” comparison group; however, significantly larger improvements were noted for dropouts of the methadone maintenance program, two of the three therapeutic communities, and one of the outpatient drug-free clinics when compared with the comparison group in these and other compounded indices designed to assess the effectiveness of treatment. Analysis of graduate outcome showed further reduction in drug use and criminality among methadone maintenance and one of the three therapeutic community graduates. Graduates of this therapeutic community exhibited substantial improvement in employment and productivity. The evaluation model is applicable for treatments for alcohol abuse and offers specific recommendations for improvement in allocation of clients and resources to the various treatments.
Empirischer Vergleich von Methadonpatienten mit zeitlich begrenzter und zeitlich unbegrenzter Indikation
- W Baur
Baur W. 1983: Empirischer Vergleich von Methadonpatienten mit zeitlich begrenzter
und zeitlich unbegrenzter Indikation. Med. Diss. Universität Zürich.
Die Methadonbehandlung von Heroinfixern
- M Gmür
Gmür M. 1981 : Die Methadonbehandlung von Heroinfixern. Psychiatrische Praxis,
8 (2), 54-59.
Zimmer-Höfler D. 1985: Heroinabhängige und ihre «normalen» Altersgenossen
- A Uchtenhagen
Uchtenhagen A., Zimmer-Höfler D. 1985: Heroinabhängige und ihre «normalen»
Altersgenossen. Bern. Haupt.
- Bundesamt Für Gesundheitswesen
Bundesamt für Gesundheitswesen 1984 : Methadonbericht. Beilage zum Bulletin.