Concurrent substance use and outcome in combined behavioral and naltrexonetherapy for opiate dependence

The effect of concurrent nonopiate drug use on outcome of treatment for opi ate dependence. Method: Forty-seven opiate-dependent patients received a 6- month course of outpatient treatment with naltrexone and cognitive-behavior al therapy (behavioral naltrexone therapy, BNT) at a university-based resea rch clinic. Opiate-negative urines and naltrexone ingestion were rewarded w ith monetary vouchers. Abstinence from other drugs was encouraged verbally, but no contingencies were placed on nonopiate drug use. The proportions of all urines (collected twice weekly) positive for cocaine, cannabis, and be nzodiazepines over the course of treatment were evaluated as predictors of outcome of opiate dependence treatment, as measured by proportion of opiate -positive urines, days retained in treatment, and proportion of naltrexone doses taken, using Pearson product moment correlations and one-way analysis of variance (ANOVA). Results: The majority of patients (78%) used a nonopi ate drug at least once during the trial. There were no significant correlat ions between concurrent drug use measures and opiate dependence treatment o utcomes, indicating no simple linear relationship between these measures. H owever, when concurrent drug use was trichotomized into abstinent, intermit tent, and heavy use groups, groups with intermittent use had superior outco me compared to both abstinent and heavy use groups in several contrasts. Co nclusions: Intermittent use of non-opiate drugs is common during outpatient treatment for opiate dependence and may be a favorable prognostic indicato r. This may support a "harm reduction" approach as opposed to a strict abst inence-oriented approach. Further research is needed to identify the optima l therapeutic stance toward other drug use during treatment for opiate depe ndence.