BACKGROUND: Addiction to heroin and crack cocaine is debilitating and persistent, but such disorders are treatable. We present the first effectiveness study of the main community interventions for addiction to heroin and crack cocaine in England, using data from the National Drug Treatment Monitoring System (NDTMS). METHODS: The study cohort consisted of all adults with a heroin or crack cocaine addiction, or both, who started pharmacological treatment (n=18 428 patients) or psychosocial treatment (n=2647) between Jan 1 and Nov 30, 2008, received at least 6 months' treatment or were discharged by the study endpoint (May 31, 2009), and had outcome data submitted to the NDTMS. Effectiveness was assessed from change in days of heroin or crack cocaine use, or both in the 28 days before the start of treatment and in the 28 days before review. FINDINGS: 14 656 clients-74% of the cohort eligible for analysis at review with available data-were analysed at the study endpoint. During the 28 days before review, 37% (5016/13 542) of heroin users abstained from heroin and 52% (3941/7636) of crack cocaine users abstained from crack cocaine. A higher proportion of users of heroin only abstained than did users of both heroin and crack cocaine (42% [2465/5863] vs 33% [2551/7679]; OR 1.46, 95% CI 1.36-1.56), and more users of crack cocaine only abstained than did users of both drugs (57% [295/522] vs 51% [3646/7114]; 1.24, 1.03-1.48). Overall heroin use reduced by 14.5 days (95% CI 14.3-14.7) and crack cocaine use by 7.7 days (7.5-7.9). For clients given pharmacological treatment, reduction in days of heroin use was smaller for users of both heroin and crack cocaine than for users of heroin alone (p<0.0001), but this differential effectiveness was not recorded for psychosocial treatment in heroin or crack cocaine users compared with users of both drugs. INTERPRETATION: The first 6 months of pharmacological or psychosocial treatment is associated with reduced heroin and crack cocaine use, but the effectiveness of pharmacological treatment is less pronounced for users of both drugs. New strategies are needed to treat individuals with combined heroin and crack cocaine addiction. FUNDING: National Treatment Agency for Substance Misuse.
BACKGROUND: Addiction to heroin and crackcocaine is debilitating and persistent, but such disorders are treatable. We present the first effectiveness study of the main community interventions for addiction to heroin and crackcocaine in England, using data from the National Drug Treatment Monitoring System (NDTMS). METHODS: The study cohort consisted of all adults with a heroin or crackcocaine addiction, or both, who started pharmacological treatment (n=18 428 patients) or psychosocial treatment (n=2647) between Jan 1 and Nov 30, 2008, received at least 6 months' treatment or were discharged by the study endpoint (May 31, 2009), and had outcome data submitted to the NDTMS. Effectiveness was assessed from change in days of heroin or crackcocaine use, or both in the 28 days before the start of treatment and in the 28 days before review. FINDINGS: 14 656 clients-74% of the cohort eligible for analysis at review with available data-were analysed at the study endpoint. During the 28 days before review, 37% (5016/13 542) of heroin users abstained from heroin and 52% (3941/7636) of crackcocaine users abstained from crackcocaine. A higher proportion of users of heroin only abstained than did users of both heroin and crackcocaine (42% [2465/5863] vs 33% [2551/7679]; OR 1.46, 95% CI 1.36-1.56), and more users of crackcocaine only abstained than did users of both drugs (57% [295/522] vs 51% [3646/7114]; 1.24, 1.03-1.48). Overall heroin use reduced by 14.5 days (95% CI 14.3-14.7) and crackcocaine use by 7.7 days (7.5-7.9). For clients given pharmacological treatment, reduction in days of heroin use was smaller for users of both heroin and crackcocaine than for users of heroin alone (p<0.0001), but this differential effectiveness was not recorded for psychosocial treatment in heroin or crackcocaine users compared with users of both drugs. INTERPRETATION: The first 6 months of pharmacological or psychosocial treatment is associated with reduced heroin and crackcocaine use, but the effectiveness of pharmacological treatment is less pronounced for users of both drugs. New strategies are needed to treat individuals with combined heroin and crackcocaine addiction. FUNDING: National Treatment Agency for Substance Misuse.
Authors: C Brendan Clark; Jeffrey A Swails; Karen A Akao; Heidi M Pontinen; Karen L Cropsey Journal: Addict Behav Date: 2018-02-16 Impact factor: 3.913
Authors: Kathleen M Carroll; Brian D Kiluk; Charla Nich; Elise E DeVito; Suzanne Decker; Donna LaPaglia; Dianne Duffey; Theresa A Babuscio; Samuel A Ball Journal: Drug Alcohol Depend Date: 2014-01-31 Impact factor: 4.492
Authors: Hendrée E Jones; Nancy D Berkman; Tracy L Kline; Rachel Middlesteadt Ellerson; Felicia A Browne; Winona Poulton; Wendee M Wechsberg Journal: Int J Pediatr Date: 2011-03-23