Change in alcohol and other drug use during five years of continuous opioid substitution treatment

Eastwood, Brian J.; Strang, John; Marsden, John

doi:10.1016/j.drugalcdep.2018.11.008

Cited by 18 publications

(7 citation statements)

References 45 publications

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“…13 A recent publication from the English National Drug Treatment Monitoring System (NDTMS) reported that 39% of heroin users receiving OAMT were using alcohol at 5-year follow-up. 14 Of those using alcohol, 17.1% had "continued high-level alcohol use", 49.4% "continued low-level", 0.9% "increasing" and 17.6% "decreasing alcohol use". In Australia, at 2-year follow-up, decreases in heroin use were not associated with increases in other licit or illicit substance use.…”

Section: Introductionmentioning

confidence: 99%

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Morgan¹,

Daniels²,

Subramaney³

2020

SAR

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Background: Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use. Methods: 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints. Results: Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased. Conclusion: After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.

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Section: Introductionmentioning

confidence: 99%

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Morgan¹,

Daniels²,

Subramaney³

2020

SAR

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“…Although the use of alcohol after crack was related to a reduction in paranoia and craving, this strategy, identified by people who use crack as a way of diminishing the negative effects of crack (as it has been observed also with the use of marijuana [ 14 , 35 , 41 ], may stimulate a desire for crack, therefore inciting crack craving. Thus, alcohol might induce a vicious consumption circle of the two substances, contributing to a greater risk of alcohol and crack dependence [ 42 ], overdose [ 43 ], and other health damages caused by the use of crack cocaine [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

Association between alcohol and crack: Prevalence, effects, associated factors and experiences of combined use

Valois-Santos

Almeida²,

Jacques

et al. 2021

PLoS ONE

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Objective To estimate the prevalence and factors associated with the effect of alcohol on crack cocaine use and to analyze experiences related to combined use. Materials and methods: sequential mixed methods (qualitative and quantitative) research, carried out between August 2014 and August 2015 with people who use crack. In the quantitative approach, a cross-sectional study was conducted with 1,062 participants. Factors associated with “alcohol use with the effect of increasing the effect of crack/crack craving” were estimated by multiple regression. In the qualitative approach, 39 interviews were conducted using Bardin’s content analysis technique. Results 871 (82.0%) participants reported consuming alcohol, among them, 668 (76.7%) used alcohol combined with crack: 219 (32.8%) reported feeling an effect of reduction in paranoia and/or crack craving and 384 (57.5%) reported feeling an increase in the effect of crack and in the craving to consume the drug. This relationship was also observed in the narratives of the people who use crack, with the possibility of a cyclic effect of consumption of the two substances. Those who related alcohol use to the effect of increasing crack craving (384) were more likely to use alcohol before crack (OR: 1.81; 95%CI: 1.13–2.89); to consume more than 20 stones daily (OR: 1.48; 95%CI: 1.01–2.16); to remain in abstinence from crack for less than one month (OR: 3.20; 95%CI: 1.91–5.35); to use dependence treatment services (OR: 1.85; 95%CI: 1.26–2.71); and to commit physical violence (OR:1.67; 95%CI:1.08–2.56). Conclusion The findings of this study indicate that the modulation of the effect of alcohol use on crack cocaine depends on the moment when the drugs are consumed, and the use of alcohol before crack consumption is associated with characteristics that suggest a greater vulnerability to patterns of harmful crack use. Even though combined use is referred to as a way of reducing the negative effects of crack, the damage of this association may be greater than its possible benefits.

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“…Another factor may involve behavioral or personality characteristics of individuals with OUD. In the longitudinal trajectory analysis of substitution therapy (Eastwood et al, 2019), those categorized into a "continued high-level heroin use" trajectory category also were more likely to use alcohol and crack than those in other trajectory categories. Such results suggest that alcohol use may be one of the multiple drugs of misuse in a subset was not the alcohol use per se that increased problems, but rather the fact that alcohol use was associated with an increased likelihood of sedative use, and that sedative use led to poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…A longitudinal trajectory analysis of 7,717 patients receiving methadone or buprenorphine substitution therapy found that among the 50% of the sample with significant levels of alcohol consumption, about a third increased, a third decreased, and a third remained unchanged in the frequency of alcohol intake over a 5‐year period (Eastwood et al, 2019). Other studies have shown decreases (Caputo et al, 2002; Nava et al, 2008) or no change in alcohol use (Klimas et al, 2016, 2018) with methadone or buprenorphine treatment, although an older literature had reported treatment‐related increases in alcohol use (Anglin et al, 1989; Gelb et al, 1978; Simpson & Lloyd, 1978).…”

Section: Discussionmentioning

confidence: 99%

“…AUD has been reported to occur in as many as one‐third of patients in opioid maintenance treatment where it is associated with clinically worse treatment outcomes (see Soyka, 2015 and Nolan et al, 2016). A longitudinal trajectory analysis over 5 years of methadone or buprenorphine substitution therapy reported that among the 50% of the sample with significant levels of alcohol consumption, about a third increased, a third decreased, and a third remained unchanged in the frequency of alcohol intake (Eastwood et al, 2019). Although improved drinking outcomes would be a desirable goal for individuals in the treatment for OUD, controlled clinical trials evaluating treatment outcomes for dually comorbid opioid and AUDs are generally lacking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is extended release naltrexone superior to buprenorphine‐naloxone to reduce drinking among outpatients receiving treatment for opioid use disorder? A secondary analysis of the CTN X:BOT trial

Roache

Pavlicová

Campbell

et al. 2021

Alcoholism Clin & Exp Res

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Background:The comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT) trial showed that following induction, treatment with the sublingual agonist (buprenorphine-naloxone, BUP-NX) or injected antagonist (extended release naltrexone, XR-NTX) produced similar reductions in opioid relapse in injection users with opioid use disorder (OUD).Because XR-NTX reduces drinking in alcohol use disorder (AUD), we conducted a secondary analysis of the X:BOT sample of patients successfully inducted onto treatment to determine whether XR-NTX (n = 204) was superior to BUP-NX (n = 270) in reducing drinking or heavy drinking in patients with OUD.Methods: Standard drink units consumed were measured using the Timeline Followback method. Mixed-models regression was used to examine the monthly frequency of any drinking and heavy drinking over 6 months of treatment. We used a proportional hazard survival analysis to examine the time to first drink.Results: Both treatment groups reduced drinking from baseline to posttreatment (small to medium effect), but no differences between groups were detected. However, only 29% (n = 136) of the sample had AUD and 19% (n = 26/136) of those were abstinent before treatment. Analysis of a subsample enriched for possible drinking included 136 individuals with an AUD diagnosis plus 43 who did not have AUD, but reported at least one day of heavy drinking prior to the study. However, this subsample reported only 32% of days of any drinking with a median of only 13% of days designated as "heavy." Within this subsample, at baseline, the BUP-NX group reported more mean drinks per drinking day than the XR-NTX group (p = 0.03); however, there were no other significant group differences on drinking observed before, during, or at the end of treatment. Conclusions:There was an overall reduction in drinking during treatment of OUD using both agonist and antagonist medications, so that the hypothesis that XR-NTX

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Change in alcohol and other drug use during five years of continuous opioid substitution treatment

Cited by 18 publications

References 45 publications

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Association between alcohol and crack: Prevalence, effects, associated factors and experiences of combined use

Is extended release naltrexone superior to buprenorphine‐naloxone to reduce drinking among outpatients receiving treatment for opioid use disorder? A secondary analysis of the CTN X:BOT trial

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