Heroin Add
& Rel Clin Probl 2000; 2(2):1-18.
Managing Benzodiazepine Withdrawal.
Frare F, Perugi G.
Department of Psychiatry, neurobiology, Pharmacology and Biotechnologies
- University of Pisa, Via Roma 67 -56100 Pisa – Italy
Abstract: The long-term use of Benzodiazepines (BZs) is currently
a source of growing concern, owing to increasing doubts about their
efficacy, and evidence of important adverse effects, including physical
dependence and neuropsychological impairment. The long-term use of
BZs in patients with anxiety and mood disorders calls for special
concern; in these patients, in fact, interepisodic chronicity and
residual symptoms often appear to be related to inappropriate long-term
use of BZs. The problem of dependence on benzodiazepines has been
aggravated by iatrogenic physiological dependence on these medications
and by polysubstance-abusing patients using them in addition to other
agents, in particular opioids or cocaine. A safe, rapid, and effective
way to detoxify patients from benzodiazepines is of prime importance
in facilitating further treatment of their psychiatric or substance
use disorder. Correct withdrawal strategies should combine gradual
dosage reduction, psychological support and adjuvant medications in
selected patients. The tapering schedule should be individually titrated
and adjusted according to the patient’s reactions; substitution with
a long-acting BZ is often useful. Psychological support should include
information about BZ withdrawal, general encouragement and the correction
of misconceptions about discontinuing medicines; it should be available
both during tapering and after withdrawal. Some antiepileptics and
sedative antidepressants may be useful to mitigate withdrawal phenomena.
Adequate dosages of antidepressants should be used to treat the re-emergence
of an underlying mood or anxiety disorder. Success rates of withdrawal
are high (54-92%); the follow-up studies, however, indicate that long-term
discontinuation of BZ is a slow process, taking many weeks or months
- in some cases years - with a protracted clinical course after drug
cessation.
Publication Type: Review Article
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Heroin Add & Rel Clin Probl 2000; 2(2):19-27.
Addiction and Methadone: One American's View.
Newman RG.
Continuum Health Partners, Inc., 555 West 57th Street, 10019 New York,
NY, USA
Abstract: To refer to America’s War on drugs as a failure
is overly generous. It is a disaster! Other nations should ignore
what Americans say and consider instead the consequences of what they
do. With specific regard to the treatment of addiction, all modalities
that offer hope should be supported. None, however, approaches the
proven ability of methadone maintenance to attract, retain and help
addicts. Accordingly, the unique constraints on methadone’s availability
must be removed, and the general practicing physician given the same
authority to prescribe methadone as she/he has to prescribe any other
medication.
Publication Type: Point of View
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Heroin Add & Rel Clin Probl 2000; 2(2):29-33.
An Evaluation Study on Share Care Methadone Treatment Between a Specialized
Clinic and a Network of General Practitioners.
Coppel A.
Institute Emergence Espace Tolbiac, 58-60 rue de Tolbiac, F-75013,
Paris, France
Abstract: This article discusses recent changes in France from
what has mainly been a repressively oriented drug policy towards accepting
and supporting a variety of harm reduction measures. The introduction
of harm reduction in the early nineties proved to be very successful
in terms of harm reduction and is already a reality. Most officials,
however, are still reluctant to support this implicit policy change
openly, or work coherently for a reduction of current inconsistencies
or admit the overwhelming success those changes have brought about,
so the author is afraid of a serious backlash. The positive effects
may be threatened if the public is not adequately informed about the
new situation and its positive effects. The government may be unwilling
to continue supporting harm reduction in the face of increasing public
criticism based on ignorance and an inadequate conception of how to
preserve public order in connection with illicit drugs.
Publication Type: Policy Initiatives
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Heroin Add & Rel Clin Probl 2000; 2(2):35-42.
Opioids and Cannabinoids Abuse Among Bipolar Patients.
Maremmani I, Canoniero S, Pacini M, Lazzeri A, Placidi GF.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies,
University of Pisa, Via Roma, 67-56100 Pisa, Italy
Abstract: Substance abuse is known to be a risk factor for
the development of some types of mental illness, especially in individuals
with premorbid vulnerability or psychopathology, but the psychopathology
itself may be a risk factor for addictive disorders or a modifier
of the course of addictive disorders. In our clinical experience with
heroin addiction, the prevalence rates for the bipolar disorder was
quite high. More than 50% of the patients had an adjunctive diagnosis
of bipolar disorders. In many cases they met the criteria for a diagnosis
of bipolar I, bipolar II or cyclothymic disorder. So bipolar I and
bipolar II disorders are more frequent than depressive ones. Bipolar
patients are well represented among cannabinoid abusers, and schizophrenic
spectrum patients among cannabinoid non-abusers. Interestingly, the
number of bipolar patients who continued to abuse cannabinoids after
the onset of the first episode was higher than that of schizophrenic
spectrum patients. In conclusion, our data support the increasing
evidence of high rates of co-occurring bipolar and addictive disorders.
Publication Type: Brief Research Report
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Heroin Add & Rel Clin Probl 2000; 2(2):43-50.
Pregnant Addict Care in Methadone Treatment Programs.
Bilangi RJ.
Connecticut Counseling Centers, Inc., 984 Southford Road, Middleburry,
Connecticut 06762, USA
Abstract: Since 1992 Connecticut Counseling Centers, Inc. has
been providing two models of pre-natal and post-natal care, including
obstetrical and gynaecological examinations, and patient education
and care, to our pregnant opioid addicts in two methadone treatment
programmes in Connecticut, U.S.A. Connecticut Counseling Centers,
Inc.’s two pregnant addict care programmes provide a wealth of patient
education, nutritional analysis and education, parenting skills training
and pre-natal and post-natal medical care, along with comprehensive
methadone treatment.
The first model provides pre-natal obstetrical and gynaecological
exams, primary medical care and a full range of other services within
our Waterbury, Connecticut, U.S.A. Methadone Clinic. We have formal
linkages to birthing centres at two local community hospitals. Our
second model provides counselling, nutritional and parenting skills
training in our Norwalk, Connecticut, U.S.A. Methadone Clinic and
the obstetrical and gynecological services are provided by cooperative
agreement at the local hospital. These two low-cost models have resulted
in significantly successful treatment and pregnancy outcomes.
Publication Type: Policy Initiatives
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Heroin Add & Rel Clin Probl 2000; 2(2):51-55.
Aprohibitionism, a Feasible way Forward.
Michelazzi A.
GIMGET-SITD, San Lazzaro, 19 - 34100 Trieste, Italy
Abstract: Drug (ab)use is a phenomenon that has continued to
advance in western and westernised society, starting at the end of
the sixteenth century and the beginning of the seventeenth. In the
same period a capitalist form of society developed out of a mercantile
one. Psychiatric disease can be viewed as representing the failure
of production based on the division of work; similarly, disease connected
with addiction can be seen as representing the failure of reproduction
resulting from work mechanisation.
The legal idea of a danger to society, once linked to mental disease,
survives in the case of drug dependency, and it conditions what is
often called policy of damage reduction. Current policies are failing
to solve the problem. Drug abuse is spreading, and is causing many
deaths, as well as many severe viral infections. Prisons are full
of drug addicts. Organised crime keeps getting wealthier, and it recycles
its profits; the spread of drugs continues apace, and crime connected
with drug-dealing is still thriving. Prohibitionism and antiprohibitionism
now confront each other in the political arena.
To find a way forward, it may be better to talk of aprohibitionism,
where a distancing effect can be perceived at first sight - in the
signifier. In practice, this means there is a need to devise ways
of thinking that go beyond the logics of prohibitionism and antiprohibitionism.
Publication Type: Point of view
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Heroin Add & Rel Clin Probl 2000; 2(2):57-58.
Hepatitis C Infected Patients and Higher Doses of Methadone [Letter].
Okruhlica L, Klempova D.
Centre for Treatment of Drug Dependencies, Hranicra 2, P.O. Box 51
- 82799 Bratislava, Slovack Republic
Abstract: Not available
Publication Type: Letter to the Editor
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Heroin Add & Rel Clin Probl 2000; 2(2):59-60.
Introducing the European Collaborating Centres in Addiction Studies [Letter].
Schifano F.
SerT 1, Via Berchet, 2035100-Padova, Italy
Abstract: Not available
Publication Type: Letter to the Editor
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