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Heroin Addiction and Related Clinical Problems: 2003, 05, 2 (pages: 7 - 98)

Dual diagnosis heroin addicts. The clinical and therapeutic aspects

Maremmani I., Pacini M., Lubrano S., Lovrecic M., Perugi G.

Summary: Addiction and other mental disorders interact in various ways. Substance abuse tends to exacerbate psychiatric symptoms, and to induce a more chronic course with fewer and shorter disease-free intervals. It also often prevents the effectiveness of psychoactive therapies. At the same time coexisting mental disorders worsen the course of addiction itself. Mentally ill abusers tend to have a turbulent lifestyle and be prone to risky behaviours. Lastly, the risk of relapse is often heightened to the point of discouraging any therapeutic intervention. In this paper we focus on particularly important aspects of maintenance treatment and delineate guidelines for clinical practice. The authors have taken part in a collaborative effort to develop the field of comorbidity and this paper is built on literature surveys and clinical experiences in their own treatment centre. We suggest that dually diagnosed addicts should first be treated for their addictive disease by using adequate methadone dosages, which can be expected to be higher than those required for the treatment of uncomplicated addicts; stabilization should be considered a medium-term goal. Some dually diagnosed patients may benefit from treatment that targets their addictive problem while taking into account their mental disorder. Apart from their anticraving activity, opioid agonists should be reconsidered as psychotropic instruments for the treatment of mental illness, especially mood, anxiety and psychotic syndromes. Lastly, dually diagnosed addicts are expected to benefit from facilities offered within integrated programmes to the same extent as uncomplicated addicts, once programmes are based on adequate dosages for a sufficient length of treatment.