Combining Medication and Family Counseling Improves Treatment Outcome for Men Who Abuse Heroin

BUFFALO, N.Y. -- A study led by a University at Buffalo researcher has shown that combining medication and family treatment leads to improved outcomes in male heroin abusers.

A key to the success was family support of the heroin abusers' use of naltrexone, which, while it blocks the "high" associated with heroin use, is prescribed rarely because few patients who abuse heroine have been willing to take it, said William Fals-Stewart, Ph.D., lead researcher on the study. A clinical psychologist, he is a senior research scientist in UB's Research Institute on Addictions and research associate professor in the Department of Psychology in the UB College of Arts and Sciences. His co-investigator was Timothy J. O'Farrell, Ph.D., of Harvard Medical School and Veterans Affairs Boston Healthcare System in Brockton, Mass.

The study was the first to combine family counseling and naltrexone as a treatment for heroin dependence. Heroin abuse is the primary drug problem of people entering treatment programs in the U.S. Results of the National Institute on Drug Abuse-funded study were reported in the August issue of Journal of Consulting and Clinical Psychology.

The research involved 124 men entering treatment for heroin dependence who were then assigned to one of two treatment methods: behavioral family counseling plus use of naltrexone or individual-based treatment plus naltrexone. One of the criteria for participating in the program was that participants live with a family member. Participants in the study averaged 32 years of age, 13 years of education and were predominately white.

Fals-Stewart explained that naltrexone is a medication that blocks the "high" created by taking heroin and other opiates. It makes using these drugs less enjoyable and, in turn, reduces their use. In behavioral family counseling, a family member observed the patient taking the medication; in individual-based treatment, the patient was not observed taking the medication.

The study showed that men in behavioral family counseling were more likely to take naltrexone on a daily basis than were those who received individual counseling only. As a result, these men were heroin-free 81 percent of their days during treatment and, more importantly, were heroin-free for 69 percent of their days during the year following treatment. The men in individual-based treatment were heroin-free 56 percent of their days during treatment and were heroin-free 49 percent of their days during the year after treatment.

"Although use of naltrexone with patients who abuse heroin is effective, few patients are willing to take it. As a result, it is very rarely prescribed in clinical practice," said Fals-Stewart. "However, family members supporting the patients' daily use of naltrexone increases their compliance and leads to better outcomes. This combination of family support with naltrexone therapy appears to be an effective method to increase compliance with this powerful and effective medication."

Fals-Stewart noted, "Our findings are consistent with the broader literature on family-involved treatment of drug abuse and alcoholism. In this study, the behavioral family counseling contract included the patient's daily naltrexone dose being witnessed by the family member who then offered verbal support. It adds to the growing evidence that the use of family observation of medication-taking is a non-coercive way to encourage compliance with pharmacotherapy and commitment to treatment and recovery."

Fals-Stewart has been invited to speak about his research at the American Psychiatric Association and the research was highlighted in a congressional subcommittee as among the "best" of the behavioral interventions for drug abuse.

Future studies will look at whether the findings would generalize to female patients living with a non-substance abusing family member or to patients of either gender living with family members who also have substance abuse problems.

Scientists at UB's Research Institute on Addictions have been advancing the knowledge, prevention, and treatment of addictions since 1970.