title: Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.
abstract: BACKGROUND
  A seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed.
  
  
  METHODS
  A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions.
  
  
  RESULTS
  148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children. At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year. More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years. Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year).
  
  
  CONCLUSIONS
  After seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group. Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men. The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use.
authors.affiliation: Department of Psychiatry, Lund University Hospital, SE, 221 85, Lund, Sweden. leif.ohlin@skane.se.
authors.forename: Leif
authors.initials: L
authors.lastname: Öhlin
authors.affiliation: Department of Psychology, Lund University, SE, 221 01, Lund, Sweden. mats.fridell@psychology.lu.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Fridell
authors.affiliation: Department of Psychiatry, Lund University Hospital, SE, 221 85, Lund, Sweden. Anna.nyhlen@skane.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Nyhlén
mesh_terms: D000293:Adolescent; D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D003415:Crime / Q000517:prevention & control / Q000523:psychology; D016832:Employment, Supported / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006556:Heroin Dependence / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors; D012944:Social Support; D013548:Sweden / Q000453:epidemiology
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine