Heroin Treatment Reduced Use of Most Drugs Over 18 Months, but Cannabis and Alcohol Use Stayed the Same
An 18-month NHS treatment program for heroin dependence significantly reduced heroin, cocaine, and benzodiazepine use, but cannabis and alcohol consumption remained unchanged throughout.
Quick Facts
What This Study Found
Researchers followed 100 heroin-dependent people in London over 18 months of NHS treatment. Heroin use days in the prior month dropped significantly, as did cocaine, benzodiazepine, and polydrug use. Injecting behavior decreased, employment increased, money spent on drugs fell, criminal activity declined, and suicidal ideation decreased.
However, cannabis and alcohol use remained stubbornly unchanged throughout the 18-month period. This is concerning because these substances can undermine recovery and contribute to their own health problems.
Key Numbers
100 participants followed for 18 months. Significant reductions in heroin (p<.001), cocaine (p<.05), benzodiazepines (p<.001), and polydrug use (p<.001). No significant change in cannabis or alcohol use. Suicidal ideation decreased (p<.05).
How They Did This
Longitudinal prospective cohort study with repeated measures at baseline (T0), 9 months (T1), and 18 months (T2). The CIDI was used for psychiatric evaluation, EuropASI for drug abuse assessment, WHO-DAS II for disability, and UCLA-SSI for social support. 100 heroin users were recruited.
Why This Research Matters
While the overall treatment results are encouraging, the persistence of cannabis and alcohol use raises a red flag. Treatment programs focused on heroin may inadvertently allow other substance use to continue or even increase, potentially compromising long-term recovery.
The Bigger Picture
This study illustrates a common pattern in addiction treatment: successful reduction of the primary substance does not automatically translate to reduced use of other substances. Cannabis and alcohol may serve as substitute coping mechanisms or may simply not be addressed by heroin-focused treatment protocols.
What This Study Doesn't Tell Us
The sample of 100 participants is modest. There was no control group to determine whether improvements were due to treatment versus natural recovery. Attrition over 18 months may have biased results if those doing worst dropped out. The study was conducted in London and may not generalize to other healthcare systems.
Questions This Raises
- ?Should heroin treatment programs explicitly address cannabis and alcohol use?
- ?Does continued cannabis or alcohol use predict relapse to heroin?
- ?Would integrated treatment addressing all substances produce better overall outcomes?
Trust & Context
- Key Stat:
- Cannabis and alcohol use remained unchanged despite 18 months of heroin treatment
- Evidence Grade:
- Longitudinal cohort study without a control group; moderate evidence for treatment outcomes.
- Study Age:
- Published in 2012. Integrated substance use treatment approaches have continued to develop.
- Original Title:
- Impact of an 18-month, NHS-based, treatment exposure for heroin dependence: results from the London Area Treat 2000 Study.
- Published In:
- The American journal on addictions, 21(3), 268-73 (2012)
- Authors:
- Schifano, Fabrizio(5), Martinotti, Giovanni(18), Cunniff, Anna, Reissner, Volker, Scherbaum, Norbert, Ghodse, Hamid
- Database ID:
- RTHC-00617
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Why did cannabis and alcohol use not decrease during heroin treatment?
The treatment program was focused specifically on heroin dependence. Cannabis and alcohol may not have been targeted by the interventions, and patients may have used them as alternative coping strategies. It is also possible that patients and clinicians viewed these substances as less harmful than heroin and did not prioritize reducing them.
Does continued cannabis use affect heroin recovery?
This study did not directly examine that question, but the authors flagged it as a concern. Other research has shown mixed results, with some studies suggesting cannabis may help manage withdrawal symptoms while others indicate it may increase relapse risk.
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Cite This Study
https://rethinkthc.com/research/RTHC-00617APA
Schifano, Fabrizio; Martinotti, Giovanni; Cunniff, Anna; Reissner, Volker; Scherbaum, Norbert; Ghodse, Hamid. (2012). Impact of an 18-month, NHS-based, treatment exposure for heroin dependence: results from the London Area Treat 2000 Study.. The American journal on addictions, 21(3), 268-73. https://doi.org/10.1111/j.1521-0391.2012.00226.x
MLA
Schifano, Fabrizio, et al. "Impact of an 18-month, NHS-based, treatment exposure for heroin dependence: results from the London Area Treat 2000 Study.." The American journal on addictions, 2012. https://doi.org/10.1111/j.1521-0391.2012.00226.x
RethinkTHC
RethinkTHC Research Database. "Impact of an 18-month, NHS-based, treatment exposure for her..." RTHC-00617. Retrieved from https://rethinkthc.com/research/schifano-2012-impact-of-an-18month
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.