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Heroin Addiction and Related Clinical Problems: 2014, 16, 2 (pages: 37 - 42)

Alcohol use disorder and past heroin addiction. A successfully treated ‘masked heroinism' patient

Maremmani A.G.I., Quaranta G., Bacciardi S., Rovai L., Rugani F., Pacini M., Nisita C., and Maremmani I.

Summary: Background. A history of exposure to opiates and subsequent opiate use disorder is a frequent background in subjects who apply for alcohol abuse treatment. Shifting from heroin to alcohol use can lead to misunderstandings, as it may easily be mistaken for the remission of opiate addiction. Aim. We propose that alcohol abuse in former heroin addicts should be considered a masked form of heroinism, or a sign of enduring opiate dysfunction that needs treatment with an opioid medication. Methods. Case report presentation. Case report. We present a case in which a 5-year heroin-free, methadone treatment discharged patient was totally involved in alcohol misuse, not responding to standard treatments for alcoholism or to psychopharmacotherapy. A successful outcome (drinking cessation) was reached after the reintroduction of agonist opioid medication (buprenorphine). Conclusions. In responding to the challenge of identifying different alcoholic subgroups that can benefit from specific treatment, we want to shed light on the idea that alcoholics with a history of heroin use should be considered a specific group, and a treatment target should be set on the rebalancing of the opioidergic system after passing through agonist opioid treatment.