Outcome

Outcome in opiate dependence is not unitary. It is a dynamic process with bio-psychosocial facets. Outcome parameters may include the individual's level of alcohol and drug use, his or her personal and social functioning, and the impact upon public health and safety. Figures will depend on the particular population of users that is followed up and on the level of intervention they received. Regarding treatment contact samples, what is clear is that longer treatment contacts are associated with better outcomes.(33> It is thought that methadone treatment has to continue for at least 2 years for significant gains to be made, although earlier health benefits may be seen. Generally, the greater the range of treatment services provided (health care, family therapy, cognitive-behavioural therapy, etc.), the better is the outcome. (34) Abstinence rates following treatment vary widely, but 10 to 40 per cent of treated patients would still be drug free at 6 months. (35) The majority of those who relapse following treatment do so within 3 to 4 months of discharge. The greater the severity of pretreatment psychopathology and dependence the worse is the outcome. Suicide and accidental overdose account for between one-third and half of all death of opiate addicts, with risk factors including alcohal use, recent dropout from treatment, and social isolation. A 22-year follow-up of 128 heroin addicts revealed that 43 had died (18 due to drug over-dose), with annual mortality running between 1 and 2 per cent, and an excess mortality ratio of about 12.(36) Among the strongest correlates of mortality in this group are level of disability, heavy alcohol use, heavy criminal involvement, and tobacco use.

Long-term follow-up studies suggest that eventual cessation of opiate use is a very slow process and becomes increasingly unlikely if users continue into their late thirties.

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