Predictors of retention in naltrexone maintenance for opioid dependence: analysis of a stage I trial.
Behavioral naltrexone therapy (BNT) was developed to address the shortcomings of naltrexone maintenance for opiate dependence and improve compliance by integrating several empirically validated methods, including the use of a significant other to monitor compliance, voucher incentives, and motivational techniques. An uncontrolled Stage I pilot trial (N = 47) of BNT was conducted. Baseline demographic and clinical variables were evaluated as predictors of retention with univariate tests. Significant predictors were entered together into a multiple regression model. Poorer (shorter) retention in treatment was associated with methadone use and higher average bags per day of heroin. Other variables that became non-significant in multiple regression analysis included older age and depressive symptoms. Individuals with greater physiologic dependence and/or dependence on longer-acting opiates are at higher risk to drop out from naltrexone maintenance and may require a more gradual detoxification and more intensive behavioral therapy aimed at enhancing initial compliance.
Sullivan
Maria A
MA
Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA. sulliva@pi.cpmc.columbia.edu
Rothenberg
Jami L
JL
Vosburg
Suzanne K
SK
Church
Sarah H
SH
Feldman
Shara J
SJ
Epstein
Eva M
EM
Kleber
Herbert D
HD
Nunes
Edward V
EV
D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000523:psychology / Q000534:rehabilitation*; D014040:Token Economy
D009292:Narcotic Antagonists; D009271:Naltrexone; D008691:Methadone