What Have We Learned From the Agonist Opioid Treatment of Dual Disorder Heroin Addicts?

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Objectives:Authors tried to delineate the main trends in dual disorder assessment and treatment, and compared them with current state-of-the-art research.Materials and Methods:European studies and reports about dual disorder, when available, were commented upon and summarized. The main sources consisted of the EMCDDA body of data about psychiatric comorbidity of substance abuse in European countries, based on national reports and single studies; and publications in the official journal of the European Opiate Addiction Treatment Association.Results and Conclusions:Data were hard to compare, and were incomplete as regards the type of substance and the diagnostic criteria for psychiatric diagnosis. The state-dependent (intoxication) dual disorder is probably overrated, whereas some diagnoses may be initially disguised by on-going effective treatment, and then reemerge clearly after treatment discontinuation. The chronology of illness does not offer a reasonable criterion for the classification of dual disorder. The anticraving intervention is often the priority, and is likely to produce, as one favorable effect, the retention of dual disorder patients. The dosage of opiate agonists appears to be crucial in improving the outcome of dual disorder heroin addicts, while low dosages could play the role of offering an effective form of initial involvement in higher threshold treatment, instead of drugless harm reduction. A unique, 1-spot treatment organization should be preferred.

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