Alcohol by drug-dependent persons: a literature review and evaluation.

The literature review very clearly indicated that the majority of drug-dependent persons abused alcohol before becoming addicted to other drugs such as heroin. A conservative estimate of this form of sequential multiple substance abuse would include 80% of all drug-dependent persons. The literature also indicated that substantial numbers of drug-dependent persons used alcohol as a substitute for their preferred drug(s) of abuse, as well as a means of boosting, balancing, counteracting, or sustaining the effects of the other drug(s). Based on the literature, this form of concurrent multiple substance abuse would be evident in the substance abuse histories of at least 30% of all drug-dependent persons. The pernicious effects of alcohol abuse among methadone maintenance patients is documented and discussed, including the medical hazards associated with alcohol-drug abuse. Data from the DARP and CODAP national data systems are also reviewed and discussed. Recommendations for future treatment, prevention, and research on this subject are provided.