Alcohol Use Disorders in Opioid Maintenance Therapy: Prevalence, Clinical Correlates and Treatment

Abstract

Maintenance therapy with methadone or buprenorphine is an established and first-line treatment for opioid dependence. Clinical studies indicate that about a third of patients in opioid maintenance therapy show increased alcohol consumption and alcohol use disorders. Comorbid alcohol use disorders have been identified as a risk factor for clinical outcome and can cause poor physical and mental health, including liver disorders, noncompliance, social deterioration and increased mortality risk. The effects of opioid maintenance therapy on alcohol consumption are controversial and no clear pattern has emerged. Most studies have not found a change in alcohol use after initiation of maintenance therapy. Methadone and buprenorphine appear to carry little risk of liver toxicity, but further research on this topic is required. Recent data indicate that brief intervention strategies may help reduce alcohol intake, but the existing evidence is still limited. This review discusses further clinical implications of alcohol use disorders in opioid dependence.

The Impact of Enrolment in Methadone Maintenance Therapy on Initiation of Heavy Drinking among People Who Use Heroin

“…Such findings are consistent with previous research [24]. Although stimulants (cocaine), and other drugs, including cannabis and benzodiazepines, have been previously found to be potential predictors of changes in alcohol consumption [5], our research confirmed this for cannabis only. Irrespective of the reasons for heavy drinking, our study confirmed a high prevalence of this problem (32%); therefore, the national guidelines and policies should give clear guidance about the management of concurrent heavy drinking among this population.…”

“…Methadone maintenance therapy (MMT) has been shown to reduce morbidity and mortality among people who use heroin and other opiates [3,4]; however, previous studies have suggested a high prevalence of heavy alcohol use among MMT patients [5-7], and interventions to reduce heavy drinking in this population are lacking [8]. MMT patients who engage in heavy alcohol use do not appear to benefit from MMT to the same extent as those who do not, and most of them develop further complications [9-11].…”

“…Many patients overdose because of alcohol [12,13]. While recent systematic reviews have indicated that alcohol, heroin and methadone are correlated, the impact of enrolment in MMT on heavy drinking has not been fully characterized [5,14,15]. Phases of heavy drinking seem to follow after bouts of abstinence from heroin use, and this pattern often repeats over time [16].…”

Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample

“…Polydrug use remains a major concern in these patients. The relatively high number of individuals with alcohol use found in this study corresponds to similar findings in other studies (for review see [38]).…”

Outcomes of Patients in Long-Term Opioid Maintenance Treatment

“…The rate of patients with suspected alcohol related problems is in the range of those reported for untreated heroin users, for patients entering OMT, or for OMT patients with mixed treatment durations (Soyka, 2015). In the German general population, alcohol abuse or dependence has a 7.5% prevalence rate in males, and 2% in females (Jacobi et al, 2014); there is some evidence, though, that the rate of alcohol use disorders in opiate dependents is not significantly higher than in the general population with similar socioeconomic characteristics (Ottomanelli, 1999).…”