S-59-01

Heroin assisted treatment of opiate dependence in five European countries

C. Haasen. University Hospital Eppendorf, Hamburg, Germany

Methadone has been established as the “gold standard” of maintenance treatment for opiate dependence in most European countries, with the exception of France, where buprenorphine is the main substance used in maintenance treatment. Despite its established effectivity, there is still a high rate of non-response to maintenance treatment with methadone and buprenorphine, which is characterized by additional drug use and insufficient compliance. A diversification of substances used for maintenance treatment is underway in most countries, including heroin assisted treatment, which has been initiated in five European countries: United Kingdom, Switzerland, the Netherlands, Germany and Spain. In most cases heroin assisted treatment has been initiated in the context of clinical trials, each with different goals and objectives and with different treatment designs. These differences and the potential future of heroin assisted treatment in Europe will be discussed.

S-59-02

Treatment of pregnant drug dependent patients

G. Fischer. Univ-Klinik für Psychiatrie, Wien, Austria

S-59-03

Comorbidity of drug dependence and ADHD syndrome

M. Casas. Unitat de Psychiatria Hospital, Barcelona, Spain

S-59-04

Street work with crack addicted patients in the North of Paris

A.-M. Pezous. ECIMUD Service de Psychiatrie, Paris, France

S-59-05

Resistant patients are not difficult patients• The role of compliance.

A. Gual. Hospital Clinic Institute of Nervous System, Barcelona, Spain

Objective: In Psychiatry in general, and in the addictions field particularly, Resistance to treatment has usually been approached from a simplistic point of view. Instead, compliance is often a key issue to which psychiatrists pay scarce attention. This presentation pretends to underscore the role of compliance in resistance to treatments.

Methods: Review of literature addressing the issue of compliance with treatments in both clinical and psychosocial treatment trials.

Results: Compliance rates are low for many medical diseases, where the average non-adherence rate is 25%. In the field of Psychiatry bad compliance may be higher than 40% in the short term, and reach even higher rates (64%) in the long term management of diseases like bipolar disorders. In the Addictions field, compliance is often at the heart of early drop-outs and bad outcomes. In clinical trials compliance with pharmacological treatment is usually low. Naltrexone trials have reported compliance rates between 78-43%, while in studies with unsupervised disulflram compliance rates may be as low as 18%.

Conclusion: There's strong evidence supporting the fact that better compliance leads to better outcomes. Hence, minimizing drop-outs should always be a priority for clinicians. Ways of improving compliance include patient factors (reactance, selfmanagement), doctor factors (empathy, psycho education), drug factors (dosage, side effects) and family factors (supervision).