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Heroin Addiction and Related Clinical Problems: 2021, 23, N2 (pages: 49 - 57)

How to Improve a Poorly Running Agonist Opioid Treatment (Aot). Part 7: Overcoming the Alcohol Dependence of Methadone Patients

Ulmer A., Frietsch B., and Mueller M.

Summary: Objective: Alcohol dependence is a common problem of AOT patients. Scientific references show almost no approaches for an effective treatment. These patients are a special challenge for us, all the more. Methods: We have tried many, the last >30 years, documented and evaluated them as much as possible. The experiences and results are summarized here. Results: References repeatedly describe a brief intervention. Besides that, we experience intensifying care as an important instrument. We, sometimes, have to fight to end the hanging around in addiction scenes. Zero-Alcohol-Controls are occasionally described as helpful. Many of our patients would need adequate psy-chotherapy, which can accomplish a lot, but it's hardly available. In the pharmacotherapeutic field, a change of the opioid is helpful in individual cases. We could document splitting and a strong increase of the dosage as especially effective. Further substances, Baclofen, Clomethiazole and GHB in Italy can cover the development. Individual cases are also described with Disulfiram and Cannabis. Discussion: This, already rather wide arsenal of possibilities, is in contrast to the meager hints from references. Conclusion: We experience it as encouragement in our patients all the more. We can already achieve much more than is verified in studies. Each patient is a challenge for still better help. We must not give up. It's successful in many cases.