Hristo Kojuharov, M.D., Hristina Koleva, M.D.

Detoxification is an algorithm of therapeutic procedures and manipulations designed for alleviation and control of withdrawal symptoms following cessation of narcotics in patients with physical dependence. Its focus is on minimizing the immediate health risks related to the initial treatment of withdrawal.

It is well established that heroin addiction is a chronic, relapsing psychiatric disorder. Detoxification is not the definitive therapy plan of addiction in itself. It is more of an element of a broader spectrum of services and provides an opportunity to begin the long-term therapeutic plan.

The “success” of inpatient detoxification is most frequently measured by the number of patients who complete the treatment process as initially planned. The rate of successful accomplishment of detoxification varies between 42% and 82 % in different publications.· The variance in reported rates is due to different patient populations, diagnostic criteria, extent of opiate usage, somatic co-morbidity, type of therapeutic program, definition of “success”, etc. Therefore, we think that the main criterion for success is the way the detoxification phase is accomplished.

Preterm discontinuation of therapy in addiction patients is a central problem. In a retrospective study Stark (1992) demonstrates that patients who discontinue therapy prematurely have similar treatment results to those who were never treated.

We have studied rates of completion of heroin detoxification in a University Clinic in Bulgaria. We have found that inpatient detoxification in a specialized hospital setting is more likely to be successful than detox performed on a general unit. Treatment “success” has been measured by length of hospital stay of at least 10 days, having a planned discharge, control of withdrawal symptoms upon discharge and enrollment into a continuing rehabilitation program.

We have also examined factors associated with successful completion of the heroin detoxification program. We used “Multi-City” questionnaire and “Addiction Severity Index” (European version) and included more than 55 variables in the analysis. The following factors emerged as clinically significant:

1. Female gender – women are more likely to complete treatment as planned.
2. Partner with addiction – this correlates with increased length of stay and likelihood of planned discharge.
3. Frequency of heroin use – daily use of heroin over the last month is a negative predictor.
4. Last heroin use – no use of drug 24 hours before admission increased the likelihood of success.
5. Occupational Status – patients with full-time job or attending regular classes at school are more likely to have planned discharge and follow with a rehab program.
6. Educational Level – university students or graduates have higher success rates than those with lower education.
7. Military Service – patients who have not attended military service are more likely to complete the program and follow-up with rehab.
8. Destructive behavior – patients without aggression or legal problems are more likely to complete the program and follow-up with rehab.

These are only some of the factors included in the study. It has been concluded that there are clusters (groups) of factors that are crucial in predicting sucesss.

In summary, completion of heroin detoxification program is a paramount step towards long-term treatment of heroin addiction. To improve success rates, several predictive characteristics of the patient need to be taken into account and program specifics and approaches need to be tailored accordingly.

References:

• Stark, M. J. (1992). Dropping out of substance abuse treatment: A clinically oriented review. Clinical Psychology Review, 12, 93-116.140
• Roch, I., Küfner, H., Arzt, J., Böhmer, M. & Denis, A. (1992). Empirische Ergebnisse zum Therapieabbruch bei Drogenabhängigen: Ein Literaturüberblick. Sucht, 38, 304-322.
• Stark, M. J. & Campbell, B. K. (1988). Personality, drug use, and early attrition from substance abuse treatment. American Journal of Drug and Alcohol Abuse,14, 475-485