Advanced

Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.

Öhlin, Leif; Fridell, Mats LU and Nyhlén, Anna LU (2015) In BMC Psychiatry 15(1). p.56-68
Abstract
Background

A seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed.



Methods

A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions.... (More)
Background

A seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed.



Methods

A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions.



Results

148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children.



At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year.



More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years.



Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year).



Conclusions

After seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group.



Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men.



The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Heroin dependence, Seven year outcome, Buprenorphine, treatment contract, work, education, low tolerance for non prescribed drugs
in
BMC Psychiatry
volume
15
issue
1
pages
56 - 68
publisher
BioMed Central
external identifiers
  • pmid:25881164
  • wos:000353536900001
  • scopus:84928560324
ISSN
1471-244X
DOI
10.1186/s12888-015-0415-z
language
English
LU publication?
yes
id
ec9c4b0b-4c7d-4192-9635-04585b7c9580 (old id 5341623)
date added to LUP
2015-05-05 17:14:58
date last changed
2017-11-05 04:13:15
@article{ec9c4b0b-4c7d-4192-9635-04585b7c9580,
  abstract     = {Background<br/><br>
A seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed. <br/><br>
<br/><br>
Methods<br/><br>
A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions. <br/><br>
<br/><br>
Results<br/><br>
148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p &lt; .001). All women regained custody of their children. <br/><br>
<br/><br>
At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year. <br/><br>
<br/><br>
More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years. <br/><br>
<br/><br>
Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year). <br/><br>
<br/><br>
Conclusions<br/><br>
After seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group. <br/><br>
<br/><br>
Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men. <br/><br>
<br/><br>
The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use.},
  author       = {Öhlin, Leif and Fridell, Mats and Nyhlén, Anna},
  issn         = {1471-244X},
  keyword      = {Heroin dependence,Seven year outcome,Buprenorphine,treatment contract,work,education,low tolerance for non prescribed drugs},
  language     = {eng},
  number       = {1},
  pages        = {56--68},
  publisher    = {BioMed Central},
  series       = {BMC Psychiatry},
  title        = {Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.},
  url          = {http://dx.doi.org/10.1186/s12888-015-0415-z},
  volume       = {15},
  year         = {2015},
}