Abstract
Objectives: During 1994-96 some 800 slots were made available for heroin-assisted treatment within trials of medical prescription of narcotics (PROVE). Studies carried out with scientifically monitored assessment examined the extent to which the most severely addicted can be guided to therapeutic options when all previous efforts to reach them have proved insufficient. This study describes the mental health of patients in heroin-assisted treatment.
Methods: Entry criteria were minimal age of 20, minimal duration of daily opiate consumption of 2 years, negative outcome of at least 2 previous treatments, documented social and/or health deficits as a consequence of their opiate dependence. On admission and during all six month of treatment, the state of mental health was examined by physicians. External interviewers asked the patients about their mental symptoms.
Results: On admission, 41 % of patients were found in a poor mental state. The mental-addictive disorder comorbidity rate was high. The treatment prevalence of schizophrenia was 9 %, of affective disorders 39 %, of personality disorders 68 %. The general state of mental health improved during treatment. The number of patients in mental state was already reduced by half after a few months. Accordingly the patients also indicated less mental disorders, and the number of hospital referrals declined by 59 %.
Conclusions: As is well known, mental disorders arise at an increased rate among intravenous drug addicts. The Swiss trials of medical prescription of narcotics reached a large group of patients with such disorders and symptoms. During the heroin-assisted treatment, a substantial improvement occurred in the mental health of these patients. In future, based on previous experience, psychiatric diagnosis and therapy for these out-patients should be improved even more.
Steffen, Thomas