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Heroin Addiction and Related Clinical Problems: 2007, 09, 2 (pages: 55 - 64)

Dihydrocodeine Treatment of Alcohol Addicts with Previous Opiate Addiction — Case Reports

Ulmer A., Mueller M., Frietsch B.

Summary: Objective: In papers already presented at conferences we were able to report that a successful maintenance therapy for alcohol addicts is possible with Dihydrocodeine (DHC). Here we report the case histories of 9 serious alcohol addicts; eight of these were former opiate addicts and the ninth a former non-addicted heroin user. Methods: We describe here all nine of our former heroin users who have more recently been treated with DHC because of a serious alcohol addiction. They had all distanced themselves for several years from their earlier phases of heroin addiction. All these patients had received professional counselling and, with one exception, had experienced professional addiction treatment. We prescribed DHC very cautiously and normally avoided exceeding the dosage of 320 mg daily, a much lower dosage than would have been needed for opiate substitution; higher dosages were prescribed to only two patients in this group. Results: All these patients substantially reduced their alcohol consumption; this led to a clear general improvement. Two patients stopped drinking altogether, the first over a period of 1.5 years at the time of writing, and the second over a period of nearly 3 years; both report an unrestricted feeling of well-being. One has, meanwhile, also completed his DHC-intake treatment. A third patient showing a similar improvement, who now drinks only very occasionally, does not seem to need absolute alcohol abstinence. In most of the patients the improvement was not sustained or absolutely irreproachable. One patient with a severe phasic depression committed suicide after years of clear improvement. Other patients showed an only transient improvement in their GGT, despite having reported nearly complete alcohol reduction and a drastic improvement in their anxiety and panic attacks, or they experienced a gradual relapse back to their original level of alcohol consumption. Two patients refused to undergo a regular DHC therapy as prescribed by us, and switched back to heroin or alcohol consumption. Conclusions: In 7 out of 9 patients a clear improvement in the situation was achieved by prescribing DHC. These seven patients substantially reduced their alcohol intake; in two cases drinking was completely eliminated. But one suicide, one heroin relapse and two apparently definitive alcohol relapses, in addition to other problems, show that we are unable to present DHC as offering all patients an easily won treatment success