The International Journal of the Addictions, 14(1), 143-146, 1979
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Research Note
Alcohol and Narcotic Abuse: Variations on an Addictive Theme Marvin C. Kamback, Ph.D. Families and ChildrenS Center Division of Alcoholism and Drug Abuse University of Maryland Baltimore, Maryland 21201
Abstract
A treatment system developed to treat individuals abusing both narcotics and alcohol is described. The primary goal of treatment is change in the alcohol/drug abuse life-style which is seen as the major obstacle to successful treatment. In the Methadone Maintenance Clinic located at Baltimore City Hospital, Baltimore, Maryland, a large percentage of the addict population has been identified as multiple drug users. Typically, identification of multiple drug abuse occurs at that point in treatment when methadone stabilization is reached. That is, when, by judicious adjustment, a dosage level of methadone is arrived at which is sufficient to prevent withdrawal and yet not produce euphoria, a large number of patients begin exhibiting signs of concommitant nonnarcotic drug abuse. Among the most abused of these drugs is alcohol, with from 15 to 20% of the methadone maintenance populace reported as heavily abusing alcohol. Unlike the alcohol abuser under pressure by the courts or family to cease drinking, the methadone maintenance alcohol abuser considers 143 Copyright @ 1979 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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144
KAMBACK
himself under treatment for narcotic addictions. In order to correct this, the patient usually requires numerous counseling sessions and often extensive pressure in which it is pointed out that alcohol abuse is for most intents and purposes identical to other drug abuse in terms of the disruptive life-style, physiological addiction, and tolerance. In addition, it is pointed out emphatically that alcohol is one of the most dangerous drugs to combine with methadone in terms of overdose fatalities. At this point, if the patient does not agree to voluntarily start an Antabuse regime, a methadone-Antabuse contingency is initiated. That is, the patient is required to take Antabuse in order to receive the daily dose of methadone or begin detoxification (Liebson et al., 1973). Although this form of treatment is usually successful in arresting drinking in the alcohol abuser-at least during the period when Antabuse is administered daily in the methadone clinic-several of the methadone maintenance patients persist in drinking alcohol while on Antabuse, although the amount o f alcohol is much reduced. With the methadone maintenance patient, however, either the urge to drink is much stronger or the anesthetic effects of methadone act to cancel some of the aversive effects of the Antabuse-alcohol reaction for several of the Antabuse-treated methadone patients who continue to drink during the initial phase of Antabuse administration. Self-reports and personal observations of two of these patients suggest that the latter may be true as, although facial flush and increased heart rate may be present, the more potent aversive effects of nausea and anxiety may be reduced or at least tolerated. If significant amounts of alcohol consumption continue during the initial 14-day Antabuse treatment, the patient is placed on a breathalyzer contingency. On this schedule the patient must take a breathalyzer test and receive a 0.0 alcohol blood alcohol content reading prior to receiving his daily dosage of methadone. If the reading is not negative, the patient cannot receive the methadone until the alcohol content reading returns to zero. Unfortunately, because of the rate of alcoholism metabolism, a negative breathalyzer insures abstinence from alcohol for only a 10 to 12 hour period. Thus several of the patients on a breathalyzer-contingency contract alone obtain their 0.0 reading and methadone and then drink afterwards. At the present time we have used this treatment mode on approximately 10 methadone maintenance patients. The method, like conventional Antabuse treatment, works very well when the Antabuse treatment and breathalyzer are monitored daily. In fact, several of the
ALCOHOL AND NARCOTIC ABUSE
145
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146
patients have evidenced relief when the plan has been suggested, again pointing to similarities with the nonnarcotic alcohol abuser who also often experiences relief at having the daily struggle with alcohol removed from his control. With regard to length of treatment, we have continued to monitor alcohol use daily as long as possible (2 to 6 months). The longer it is possjble to maintain the addict on a stabilized dose of methadone and control or eliminate other drug abuse, the greater the probability that significant life-style changes can be effected. Supporting evidence for this conclusion is suggested by the MMPI profiles of four methadone maintenance patients who have been stabilized in terms of drug use, employment, and familial environment for an extended period of time (9 months t o 15 years). Figure 1 represents the composite profile of four methadone maintenance patients who have been “stabilized.” As is evident, the Pd social deviance elevation following extended contact is much reduced. Although this latter evidence is statistically tenuous (Overall, 1973; Rosen, 1960), the sum of our experience and derived data suggests that (1) the “addictive” personality exists or is identifiable only in terms of the drug acquisition and abusing behaviors and that many differing types of “personalities” are identifiable within the overall term “addictive personality,” and (2) the focus of treatment for the drug-addicted personality should be directed at direct intervention and control of the drug abuse behavior with concommitant substitution of less destruction and socially approved behavior. REFERENCES LIEBSON, I., BIGELOW, G., and FLAMER, R. Alcoholism among methadone patients: A specific treatment method. Am. J. Psychiatry 130(4): 483-485, 1973. OVERALL, J.E. MMPI personality patterns of alcoholics and narcotic addicts. Q.J . Stud. Alcohol 34: 104-1 1 1 , 1973. ROSEN, A, A comparative study of alcoholic and psychiatric patients with the MMPI. Q. J. Stud. A/cohol21: 314-343, 1960.
Subst Use Misuse Downloaded from informahealthcare.com by McMaster University on 10/30/14 For personal use only.
Research Note
Alcohol and Narcotic Abuse: Variations on an Addictive Theme Marvin C. Kamback, Ph.D. Families and ChildrenS Center Division of Alcoholism and Drug Abuse University of Maryland Baltimore, Maryland 21201
Abstract
A treatment system developed to treat individuals abusing both narcotics and alcohol is described. The primary goal of treatment is change in the alcohol/drug abuse life-style which is seen as the major obstacle to successful treatment. In the Methadone Maintenance Clinic located at Baltimore City Hospital, Baltimore, Maryland, a large percentage of the addict population has been identified as multiple drug users. Typically, identification of multiple drug abuse occurs at that point in treatment when methadone stabilization is reached. That is, when, by judicious adjustment, a dosage level of methadone is arrived at which is sufficient to prevent withdrawal and yet not produce euphoria, a large number of patients begin exhibiting signs of concommitant nonnarcotic drug abuse. Among the most abused of these drugs is alcohol, with from 15 to 20% of the methadone maintenance populace reported as heavily abusing alcohol. Unlike the alcohol abuser under pressure by the courts or family to cease drinking, the methadone maintenance alcohol abuser considers 143 Copyright @ 1979 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Subst Use Misuse Downloaded from informahealthcare.com by McMaster University on 10/30/14 For personal use only.
144
KAMBACK
himself under treatment for narcotic addictions. In order to correct this, the patient usually requires numerous counseling sessions and often extensive pressure in which it is pointed out that alcohol abuse is for most intents and purposes identical to other drug abuse in terms of the disruptive life-style, physiological addiction, and tolerance. In addition, it is pointed out emphatically that alcohol is one of the most dangerous drugs to combine with methadone in terms of overdose fatalities. At this point, if the patient does not agree to voluntarily start an Antabuse regime, a methadone-Antabuse contingency is initiated. That is, the patient is required to take Antabuse in order to receive the daily dose of methadone or begin detoxification (Liebson et al., 1973). Although this form of treatment is usually successful in arresting drinking in the alcohol abuser-at least during the period when Antabuse is administered daily in the methadone clinic-several of the methadone maintenance patients persist in drinking alcohol while on Antabuse, although the amount o f alcohol is much reduced. With the methadone maintenance patient, however, either the urge to drink is much stronger or the anesthetic effects of methadone act to cancel some of the aversive effects of the Antabuse-alcohol reaction for several of the Antabuse-treated methadone patients who continue to drink during the initial phase of Antabuse administration. Self-reports and personal observations of two of these patients suggest that the latter may be true as, although facial flush and increased heart rate may be present, the more potent aversive effects of nausea and anxiety may be reduced or at least tolerated. If significant amounts of alcohol consumption continue during the initial 14-day Antabuse treatment, the patient is placed on a breathalyzer contingency. On this schedule the patient must take a breathalyzer test and receive a 0.0 alcohol blood alcohol content reading prior to receiving his daily dosage of methadone. If the reading is not negative, the patient cannot receive the methadone until the alcohol content reading returns to zero. Unfortunately, because of the rate of alcoholism metabolism, a negative breathalyzer insures abstinence from alcohol for only a 10 to 12 hour period. Thus several of the patients on a breathalyzer-contingency contract alone obtain their 0.0 reading and methadone and then drink afterwards. At the present time we have used this treatment mode on approximately 10 methadone maintenance patients. The method, like conventional Antabuse treatment, works very well when the Antabuse treatment and breathalyzer are monitored daily. In fact, several of the
ALCOHOL AND NARCOTIC ABUSE
145
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Subst Use Misuse Downloaded from informahealthcare.com by McMaster University on 10/30/14 For personal use only.
146
patients have evidenced relief when the plan has been suggested, again pointing to similarities with the nonnarcotic alcohol abuser who also often experiences relief at having the daily struggle with alcohol removed from his control. With regard to length of treatment, we have continued to monitor alcohol use daily as long as possible (2 to 6 months). The longer it is possjble to maintain the addict on a stabilized dose of methadone and control or eliminate other drug abuse, the greater the probability that significant life-style changes can be effected. Supporting evidence for this conclusion is suggested by the MMPI profiles of four methadone maintenance patients who have been stabilized in terms of drug use, employment, and familial environment for an extended period of time (9 months t o 15 years). Figure 1 represents the composite profile of four methadone maintenance patients who have been “stabilized.” As is evident, the Pd social deviance elevation following extended contact is much reduced. Although this latter evidence is statistically tenuous (Overall, 1973; Rosen, 1960), the sum of our experience and derived data suggests that (1) the “addictive” personality exists or is identifiable only in terms of the drug acquisition and abusing behaviors and that many differing types of “personalities” are identifiable within the overall term “addictive personality,” and (2) the focus of treatment for the drug-addicted personality should be directed at direct intervention and control of the drug abuse behavior with concommitant substitution of less destruction and socially approved behavior. REFERENCES LIEBSON, I., BIGELOW, G., and FLAMER, R. Alcoholism among methadone patients: A specific treatment method. Am. J. Psychiatry 130(4): 483-485, 1973. OVERALL, J.E. MMPI personality patterns of alcoholics and narcotic addicts. Q.J . Stud. Alcohol 34: 104-1 1 1 , 1973. ROSEN, A, A comparative study of alcoholic and psychiatric patients with the MMPI. Q. J. Stud. A/cohol21: 314-343, 1960.
