The differences in Quality of Life between the Heroin Addicts treated in Methadone Program and Addicts treated in the Frame of Therapeutic Community Program

Abstract

IntroductionThe addiction to heroin is a severe disorder and its treatment represents a complicated, long-lasting process, which includes a series of various interventions which have to be constantly adjusted to patients' present state and his abilities to accept the therapy. The addiction is very resistant to treatment and if the program is not at the same time, enough influential and persistent, but also acceptable to the addict to stick to it for months or even years, the expected results will not be achieved. Retention to the program, abstinence from the illicit drugs, reduction of illegal activities and improving the aspects of socially acceptable behaviour are the best indicators of therapeutic efforts [1-5].Already thirty years ago, the most of western-European countries and USA, Canada and Australia have accepted the use of methadone as a recognized method for treatment of opiate addicts and a useful tool in the frame of 'harm-reduction' approach for helping the not-motivated or incurable heroin addicts. Methadone enables those patients to stop or significantly reduce taking heroin. Although methadone does not create the feeling of euphoria similar to the effect of heroin, it replaces the biological lack of endorphins at the opioid receptors in brain and, with its help, the patient can achieve a psychophysical balance and control the pathological addict's craving. The use of methadone is the best way to attract the addicts from the street to the process of treatment and, if it is well organized and spread, can ultimately direct many addicts towards the programs that would help them in stabilizing the permanent abstinence [1-5].In the evaluation study carried out by the American National Institute for Drugs (NIDA) it has been found that the substitution therapy reduces users' heroin intake for 70%, and their criminal activity by 57 %. [6]. It has also been reported that the countries which use methadone attract up to 75% of opiate addicts to their programs, while those that do not use it, achieve less than 20 %, making the mortality of addicts due to overdose very high. A large number of addicts included in substitution programs function better socially, i.e. better fulfill their duties at the workplace and in families and display significantly less dealings with criminal activities, particularly with selling drugs, thus reducing the risk of initial drug abuse among the healthy population. Application of methadone improves the physical and mental health of the addict, his life gets longer and the risk for early sudden death is reduced. By using methadone, physical and mental health of addicts is improved, their lifespan prolonged i.e. the risk of sudden death is reduced. The addicts in substitution programs are less dangerous concerning the spread of HIV infection, hepatitis and encouraging others to take drugs. The use of methadone in pregnancy is absolutely indicated: it reduces the risk of unwanted pregnancy termination and the risk of damaging the fetus. [1]."Drug free" residential treatment of addictions in the frame of therapeutic communities (TZ) started in early sixties as groups of self and mutual help, as an alternative to the existing conventional programs. The mean duration of stay differs from TZ to TZ (18-60 months). The staff consists mostly of former addicts, while the rest of the staff consists of medical professionals from the field of mental health, psychologists, defectologists, and pedagogues and similar. The aim of staying in TZ is a global change of lifestyle, including abstinence from the illegal substances, elimination of anti-social activities, gathering skills for job-finding and the development of pro-social efforts and values. In TZ, detoxification is the condition to enter the treatment and not the goal of it. Most of the patients who enter TZ already have histories of multiple drug abuse, significantly disturbed psychosocial functioning and consequently, significantly lower quality of life. …