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Heroin Addiction and Related Clinical Problems: 2013, 15, 4 (pages: 33 - 38)

Self-presentation and health issues of anonymous heroin addicts asking for a free internet medical consultation

Pacini M., Maremmani A.G.I., Rovai L., Rugani F., Bacciardi S., Maremmani I.

Summary: Background: Despite a considerable level of standardization, the practice of opiate addiction treatment remains heterogeneous and is not compliant with evidence-based guidelines. On the other hand, patients often complain about unmet needs with respect to the personalization of treatment and clarity of information about treatment strategies. Also, special conditions may raise specific difficulties, such as those arising in the case of dual diagnosis patients or poly-abusers. Aims: To clarify the characteristics of the unmet needs of heroin addicts (whether treatment-related or support-related). Methods: We examined the features of anonymous web consultation requests through a medical site, including all the details posted in questioners' replies to the expert's response. We grouped cases into three possible categories of requests for information: a) autonomous psychopathological symptoms b) addiction treatment issues c)abuse of non-opiate substances. Results: Most of the requests made are due to a lack of insight, which is a core cognitive symptom of addiction itself, independent psychopathology coming second. The underlying therapeutic substrate is consistent with this situation, since agonist dosages of methadone are, on average, far from being effective, in line with national data. Before any personalization or psychosocial strategy is considered, the discomfort of addicts before treatment entrance and throughout the course of treatment is likely to be no more than a symptom of active addiction, because of patients' persistent cravings and lack of insight, which do not allow them to reason from a heroin-free perspective. Conclusions: As long as therapeutic instruments are not employed according to their standards of effectiveness, such medical needs are bound to remain unmet.