HOSTILITY IN HEROIN ABUSERS SUBTYPES - FLUOXETINE AND NALTREXONE TREATMENT

1. Substance abusers subtypes have been identified considering underly ing psychobiological disorder, familial factors, age of onset, legal p roblems and drug of choice. 2. In the present study the authors submit ted 98 male heroin addicted individuals (age 19-28 y) to the Buss Durk ee Hostility Inventory (Italian version) and a structured interview co ncerning social and clinical history; legal problems, age of onset of drug abuse, drug of choice. 3. Serotonergic system sensitivity was eva luated with fenfluramine challenge for PRL assay. 4. Thirty two patien ts (group A) showed high score for resentment and guilt at BDHI (hosti lity in), low rate of legal problems, late age of onset, preference fo r heroin and alcohol. Twenty nine patients (group B) showed high score for assault and irritability at BDHI (hostility out), high rate of le gal problems, early age of onset, preference for heroin and cocaine. T he other 37 patients (group C) showed aggression score in the normal r ange at BDHI, no legal problems, late onset of substance abuse, prefer ence for heroin only. 5. PRL responses was blunted in group A (p<0.001 ) and significantly decreased in group B (p<0.05). PRL plasma levels w ere inversely correlated with HRSD scores. 6. All the patients were in cluded in a treatment protocol with fluoxetine and naltrexone or place bo and naltrexone for 6 months. 7. The treatment was effective in grou p A with a significant improvement of BDHI results and decrease of cra ving score, lower level of drop out, lower level of positive urine con trols. No significant differences between fluoxetine and placebo effec ts have been evidenced in patients of group B and C. The present findi ngs suggest that psychopharmacological approach to addiction needs a d iagnostic screening for specific subtypes.