The management of relapse in an outpatient program for heroin user by administration of naltrexone

Abstract

Introduction

The Counseling Center for Combating Drug Abuse offers an outpatient drug psychotherapeutic program, on an individual basis. Naltrexone is prescribed to selected heroin addicted users as part of this program.

Objectives

Relapse is one of the most challenging problems.

Aims

Detection of factors which engage in the therapeutic process and hinder successful therapy leads to a better design of the therapeutic plan.

Methods

Administration of naltrexone aims at retention in therapy and avoidance of relapse. The program's design focuses on the right selection of users, and the therapist's suitability. Family or people in the user's environment engage actively in the observation of ingestion. Naltrexone administration continues for several months after stabilization and at least until user changes his attitude towards drug use. Relapse is considered as a stage of the withdrawal procedure. Manipulation focuses on user's rehabilitation in therapy. Therapist, user and family concentrate on factors which fostered relapse (parallel drug use, association with active users, co-morbidity, personal and family difficulties), and set new goals.

Results

Development of a therapeutic alliance between therapist and addicted patient is one of the stronger predictors of treatment retention and success. Effective manipulation of the factors which foster relapse may lead to successful therapy.

Conclusions

Relapse must be seen not as a failure, but as a demanding stage of the procedure. Goal readjustment, and focusing on previously unresolved problems, may lead to an ultimate successful therapeutic outcome, and develop trust in naltrexone programs which are considered as particularly effective in open withdrawal programs.