Treatment of benzodiazepine dependence in methadone maintenance treatment patients: a comparison of two therapeutic modalities and the role of psychiatric comorbidity.
OBJECTIVE
Therapeutic approaches for benzodiazepine (BZD) dependence in patients in methadone maintenance treatment (MMT) have met with limited success. Clonazepam detoxification (CDTX) and clonazepam maintenance treatment (CMT) were compared in an open, clinical naturalistic study on such patients.


METHODS
Benzodiazepine dependent patients substituted their BZD of abuse for clonazepam and were then either detoxified (CDTX) or a maintenance dose was reached and maintained (CMT). Patients were considered as failing the trial if they either abused BZDs (CDTX group) or abused BZDs over the maintenance dose (CMT group). Treatment outcome was evaluated based upon self and staff reports over 1 year after beginning treatment. Axis I and II psychiatric diagnosis was assessed and methadone dosage and history of abuse was recorded.


RESULTS
In the CDTX group, 9/33 (27.3%), were BZD-free after 2 months. In the CMT group, 26/33 (78.8%) refrained from abusing additional BZDs over the maintenance dose after 2 months. The same success rate remained over the entire year. Survival analysis showed CMT to be more successful than the CDTX. Axis I psychiatric comorbidity was found to be positively related to treatment success in the CMT group while axis II antisocial personality disorder was found to be negatively related to treatment success in that group. It had no impact in the CDTX group.


CONCLUSIONS
Maintenance strategy with clonazepam is a useful BZD treatment modality for BZD-dependent MMT patients with a long-term history of abuse and previous attempts at detoxification. Psychiatric comorbidity may have an important role in choosing the adequate treatment modality and influencing treatment outcome.
Weizman
Tal
T
Psychiatric Service, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Gelkopf
Marc
M
Melamed
Yuval
Y
Adelson
Miriam
M
Bleich
Avraham
A
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines; D016009:Chi-Square Distribution; D002998:Clonazepam / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000927:Anticonvulsants; D009294:Narcotics; D001569:Benzodiazepines; D002998:Clonazepam; D008691:Methadone