Effects of psychiatric comorbidity on treatment outcome in patients undergoing diamorphine or methadone maintenance treatment.
BACKGROUND
Comorbid psychiatric disorders among opioid-dependent patients are associated with several negative outcome factors. However, outcomes of maintenance treatment have not been sufficiently established, and no evidence is available with respect to heroin-assisted treatment (HAT).


METHODS
For patients in the German heroin trial outcome measures were analyzed for HAT versus methadone maintenance treatment (MMT) both for patients with and without a comorbid diagnosis according to CIDI.


RESULTS
47.2% of the sample had at least one comorbid psychiatric diagnosis, mainly neurotic, stress-related or somatoform (F4) or affective (F3) disorders. HAT had a better outcome than MMT concerning improvement of health and reduction of illicit drug use in both comorbid and non-comorbid patients, but weaker effects were found in the comorbid group.


CONCLUSIONS
The better outcome of HAT also in comorbid patients suggests that psychiatric comorbidity should be an inclusion criterion for HAT. The weaker advantage of HAT may be due to pharmacological or methodological reasons.
Schäfer
I
I
Center for Interdisciplinary Addiction Research, University Medical Center Eppendorf Hamburg, Hamburg, Germany.
Eiroa-Orosa
F J
FJ
Verthein
U
U
Dilg
C
C
Haasen
C
C
Reimer
J
J
D000328:Adult; D019090:Case Management; D003131:Combined Modality Therapy; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D003932:Heroin / Q000009:adverse effects / Q000627:therapeutic use*; D006556:Heroin Dependence / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use*; D010353:Patient Education as Topic; D011613:Psychotherapy; D016896:Treatment Outcome
D009294:Narcotics; D003932:Heroin; D008691:Methadone