Follow-up study of heroin-addicted persons admitted for treatment in Barcelona

Sections

ABSTRACT
Introduction
Method
Results

Details

Author: J. GUARDIA SERECIGNI , J. MASIP VIDAL , M.C. VILADRICH SEGUES
Pages: 71 to 74
Creation Date: 1988/01/01

Follow-up study of heroin-addicted persons admitted for treatment in Barcelona

J. GUARDIA SERECIGNI Psychiatrist, Unidad de Toxicomanias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
J. MASIP VIDAL Doctor of Medicine, Department of the Prevention of Drug Dependence and Guidance and Treatment of Drug Dependent Persons, SocialService, Provincial Administration, Barcelona, Spain
M.C. VILADRICH SEGUES Professor of Psychology, Faculty of Psychology and Letters, University of Barcelona, Spain

ABSTRACT

A follow-up study of 73 heroin-addicted persons three years after their firstvisit for treatment in 1981 to the Department of the Prevention of DrugDependence and Guidance and Treatment of Drug Dependent Persons at Barcelona,Spain, was compared to a study of the same persons carried out after one year.The comparison showed that after one year 37 per cent of the cases had afavourable and 36 per cent an unfavourable outcome; for 27 per cent of thecases, information was lacking. After three years, 56 per cent showed afavourable and 30.3 per cent an unfavourable outcome; for 13.7 per centinformation was lacking. Certain factors, such as a longer duration oftreatment, a change in residence from an urban to a rural environment andtreatment in a therapeutic community, were found to have enhanced thelikelihood of achieving favourable results. Detoxification when notsupplemented with supportive measures aimed at rehabilitation had a pooroutcome.

Introduction

The problem of drug dependence is a recent phenomenon in Spain, and the developmentof treatment programmes and their follow-up and evaluation only began towardsthe end of the last decade in the country [ 1-3] . Some countries that have experienced long-standing heroin-addiction problems have already madesignificant advances in evaluating various types of treatment, making itpossible to determine success or failure in diagnosis, prognosis, treatment andthe natural course of drug-dependence [ 4-12] . The results of evaluation provide a basis for planning and formulating short- and long-term programmes for theprevention and reduction of drug abuse [ 13-17] .

This article summarizes the method used and the results obtained in a follow-up study of 73heroin-addicted persons who received treatment in 1981 at the Department of thePrevention of Drug Dependence and Guidance and Treatment of Drug DependentPersons, Social Service, Provincial Administration, Barcelona.

Method

Aprofessional team of the Department studied 73 heroin-addicted persons, oneyear and three years after their first visit for treatment to the Department in1981. The method for obtaining information on a subject's personal situation was by interview. In order to make an initial contact with theindividuals, family and neighbourhood assistance was enlisted.

The objectives of the study were to determine: (a)the current status of the target population of treated heroin-addicted persons with respect to relevant toxicological andpsycho-social variables; and (b)the relationship between the current status of the population and the characteristics of the treatmentreceived.

In order to ascertain the current status of individuals, three toxicological and three psycho-social variables wereselected and used during the follow-up interview of the target population. Thetoxicological variables were: (a)use of opiates during the month preceding the interview (no use, occasional use, daily use); (b)use of alcohol during the month preceding the interview (abstinence, occasional use, dependence); and (c)use of other drugs during the month preceding the interview (abstinence, occasional use, daily use). The psychosocial variables were: (a)occupational earnings (sufficient for self-support, insufficient for self-support, unemployed); (b)family integration (good, major conflicts, broken relationships); and (c)incidents brought to the attention of criminal justice authorities during the month preceding the interview (none, proceedingspending, detention).

In order to ascertain the relationship between the current status of individuals and the characteristics of theirtreatment, the following therapeutic variables were used: (a)the type of treatment received; (b)the duration of the treatment; and (c) incidents that might have affectedtreatment.

On the basis of the evaluation of the toxicological and psycho-social variables, the team determined the status ofindividuals involved in the study and classified them into one of threecategories: (a)favourable status; (b)unfavourable status; or (c) lack of information.

Favourable status was defined as total abstinence from opiates during the month preceding the follow-up interview or occasional use ofopiates, but no use of any other drug; not having been re-admitted fortreatment and not having had a (major) conflict with criminal justiceauthorities.

A majority of the individuals in the study were males from 18 to 25 years of age who were residing with parentsin a large community in the Barcelona metropolitan area. They had primarygeneral or basic secondary education, were unskilled workers and unemployed andnot receiving unemployment benefits, and belonged to the middle or lowersocio-economic segments of the population. These persons had their firstcontact with heroin between the ages of 16 and 22 years and had been dependenton heroin for periods ranging from seven months to three years. They had beenself-administering between 1/8 and 1/2 of a gram of heroin intravenously, fromtwo to four times daily, while taking other drugs and had experienced anabstinence-syndrome following abrupt withdrawal from heroin.

Results

An effort was made to determine whether there was a trend towards an overall improvement or a deterioration with respect to theoutcome of treatment after one and after three years. Given the limitations ofthe field study situation, it was not possible to make causal interpretationsof results.

However, data indicated that those individuals whose status was favourable at the time of the one-year follow-up study werelikely to have the same status after the three-year follow-up study. Many ofthose with unfavourable status after one year progressed to favourable status.

In fact, at the time of the one-year follow-up study, 37 per cent of the target population had a favourable and 36 per cent had anunfavourable status. In 27 per cent of the cases, information was lacking.After a three-year period, 56 per cent had a favourable status, 30.3 per centan unfavourable status. For 13.7 per cent there was a lack of information.

There were visible, positive changes in status effected by treatment that were not observed in situations of non-treatment. Significantimprovements were observed for those who underwent treatment in a therapeuticcommunity setting. The longer the treatment lasted, the more favourable werethe results. Moreover, therapeutic community treatment in combination with achange of residence, from an urban to a rural, relatively drug-freeenvironment, enhanced the likelihood of favourable status.

For individuals who underwent out-patient detoxification only, results werepoor. Detoxification alone was not a sufficient basis for progress, unlesssupplemented with other supportive measures aimed at rehabilitation.

Thus, favourable status, for the largest number of cases, was accompanied by the presence of certain factors. These included: the length oftime spent in treatment; a change in residence from an urban to a ruralenvironment; and treatment in a therapeutic community setting.

References

01

J. Guardia andS. Gonzales, "Estudio de seguimiento de adictos a la heroína", RevistaPsiquiatría, vol. 10, No. 6 (1983), pp. 357-381.

02

J. Guardia and M. L. Mateos, "Estudio clínico deadictos a la heroína", Revista Psiquiatría. vol. 10, No. 5 (1983), pp. 277-308.

03

J. Guardia, Todo sobre ladrogadicción (Barcelona, Tibidabo Edicions, 1985).

04

M. R. Burt, B. S. Brown, and R. L. du Pont, "Follow-up of former clients of a large multi-modality drug treatment program",International Journal of the Addictions, vol. 15, No. 3 (1980), pp. 391-408.

05

V. P. Dole and M. E. Nyswander, "Methadone maintenance treatment: a ten-year perspective", Journal of theAmerican Medical Association, vol. 235, No. 19 (1976), pp. 2,117-2,119.

06

V. Dole and B. Singer, "On the evaluation of treatments for narcotic addiction", Journal of Drug Issues. vol. 9, 1979,pp. 205-211.

07

S. B. Sells and D. D. Simpson, "On the effectiveness for drug abuse: evidence from the DARP researchprogramme in the United States", Bulletin on Narcotics (United Nationspublication), vol. 31, No. l (1979), pp. 1-11.

08

S. B. Sells and D. D. Simpson, "The case for drug abuse treatment effectiveness based on the DARP research program", British Journal onAddiction, vol. 75, No. 2 (1980), pp. 1 17-131.

09

D. D. Simpson and L. J. Savage, "Drug abuse treatment readmissions and outcomes, Three year follow-up of DARP patients", Archives ofGeneral Psychiatry. vol. 37, No. 8 (1980), pp. 896-901.

10

D. D. Simpson, "Treatment for drug abuse, Follow-up outcomes and length of time spent", Archives of General Psychiatry. vol. 38,1981, pp. 875-880.

11

G. E. Vaillant, "A 20 year follow-up of New York narcotic addicts, Archives of GeneratePsychiatry, vol. 29, 1973, pp. 237-241.

12

G. E. Vaillant, "Outcome research in narcotic addiction: Problems and perspectives", American Journal of Drug and Alcohol Abuse, vol. f, 1974, pp.25-36.

13

A. Arif, "Policy design, programme planning and the sociocultural perspective", in Drug Problems in thesociocultural Context, G. Edwards and A. Arif, eds., Public Health Papers, No.73 (Geneva, World Health Organization, 1980).

14

D. C. Desjarlais, "Evaluation research paradigms and drug abuse treatment evaluation", Psychedelic Drugs. vol. 10, No. 1 (1978), pp.51-55.

15

R. L. Hubbard, J. V. Rachal, S. G. Craddock and E. R. Cavanaugh, "Treatment outcome prospective study (TOPS):client characteristics and behaviours before, during and after treatment", inF. J. Tims and J. P. Ludorf, eds., Drug Abuse Treatment Evaluation: Strategies.Progress and Prospects. Research Monograph, No. 51 (Maryland, 1984), pp.842-68.

16

J. C. Marsh, "The goal-oriented approach to evaluation critique and case study from drug abusetreatment evaluation", Program Planning, vol. 1, No. 1 (1978), pp. 41-49.

17

F. C. McCaslin, and E. Ershoff, "A critique of project evaluations", International Journal of the Addictions. vol. 13, No.8 (1979), pp. 1,263-1,284.