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Who are Resistant Patients? Quality of Treatment and Disease Control

Maremmani, Icro MD*,†,‡; Maremmani, Angelo G. I. MD*,‡; Lubrano, Sonia MD§; Nardini, Roberto§; Dell’Osso, Liliana MD; Pacini, Matteo MD*,†,§

Addictive Disorders & Their Treatment: September 2014 - Volume 13 - Issue 3 - p 116–124
doi: 10.1097/ADT.0000000000000034
Original Articles

Background: The correspondence between scientific knowledge and health care practices is essential to grant drug addicts with qualitative improvement in therapeutic units available. The lack of knowledge into effective treatment strategies and poor skills in handling effective instruments may lead to dropping out of apparently resistant patients, whose disease has never been challenged with any potentially effective program.

Methods: We analyzed clinical characteristics and outcomes of standard treatment nonresponder heroin addicts enrolled in the upper-level Pisa University program in 2 subsequent periods, 1993 to 1998 and 1998 to 2004, after their latest relapse.

Results: Period II patients got treatment earlier in their addiction history, but seemed to spend longer time in treatment (successfully or not) before their latest relapse. With regard to outcomes over the years, there has been no decrease in the rate of therapeutic successes and the duration of successfully accomplished treatments. No difference was found either for the duration of treatments with negative outcomes. A worthsome percentage of patients shows a positive outcome (treatment successfully completed or in progress with success). The maximum administered dosage did not differ with respect to outcome in either period.

Conclusions: Although diagnosis and intervention tend to place first in the history of addicts, effective means of treatment are not systematically resorted to, so that symptomatic patients tend to stay for longer periods and miss stabilization. Treatment units seem to stick to their own habits, so that stabilized patients are offered the same treatments they had shown resistance to.

*“Vincent P. Dole” Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital

Department of Clinical and Experimental Medicine, University of Pisa

“G. De Lisio,” Institute of Behavioral Sciences, Pisa

Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta

and §Project Open Community (PCA), Pietrasanta, Lucca, Italy, EU

The authors declare no conflict of interest.

Reprints: Icro Maremmani, MD, “Vincent P. Dole” Dual Diagnosis Unit, UOP1, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, Pisa 67 56100, Italy, EU (e-mail: maremman@med.unipi.it).

© 2014 by Lippincott Williams & Wilkins