Lapse and relapse following inpatient treatment of opiate dependence.

We conducted a prospective follow-up study of consecutive opiate dependent patients admitted to a residential addiction treatment service for detoxification. We measured the rate of relapse following discharge, and sought to identify factors that were associated with early relapse (i.e., a return to daily opiate use). Follow-up interviews were conducted with 109 patients, of whom, 99 (91%) reported a relapse. The initial relapse occurred within one week in 64 (59%) cases. Multivariate survival analysis revealed that earlier relapse was significantly predicted by younger age, greater heroin use prior to treatment, history of injecting, and a failure to enter aftercare. Unexpectedly, those who were in a relationship with an opiate user had significantly delayed relapse. Those who completed the entire six-week inpatient treatment programme also had a significantly delayed relapse. In order to reduce relapse and the associated increased risk of fatal overdose, services providing residential opiate detoxification should prepare people for admission, strive to retain them in treatment for the full admission period and actively support their entry into planned aftercare in order to improve outcome.

Health student regard for substance-using patients as measured by the Medical Condition Regard Scale: a systematic review.

OBJECTIVES: As clinical impartiality is an accepted basic principle of ethical practice, any proactive exercises that may inform selection, training, clinical placements, and other interventions, which promote future positive and equitable professional conduct, thus guarding against future discriminatory attitudes are germane. Within this context, the purpose of this review was to identify trends and patterns in health student, namely future practitioners', regard for substance-using patients using the Medical Condition Regard Scale. METHODS: Six electronic databases were systematically searched for studies that used the Medical Condition Regard Scale as an outcome measure in assessing health student regard for drug-using patients. Academics who had published in this area were also consulted to recommend texts that would complement the above citation sourcing process. Following an elimination of duplicates, the application of inclusion and exclusion criteria, as well as conducting citation searches, 16 studies were incorporated in the final review. Although the quality of all included studies was satisfactory, no study was free from a potential source of bias. RESULTS: This review found that patients with drug-use problems were consistently held in the lowest echelons of regard by trainee health practitioners. The impact of sex, age, year of course, and personal exposure to mental health difficulties in predicting negative regard was unclear. CONCLUSIONS: Unless addressed, patients with drug problems may have a high potential for future treatment marginalisation by tomorrow's health professionals. This scenario needs to be proactively managed by all stakeholders through a greater investment in educational and clinical training placement opportunities.