Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Cornell University on 12/27/14 For personal use only.
AM. J. DRUG ALCOHOL ABUSE,6(3), pp. 367- 373(1979)
Alcohol Use in Methadone Maintenance Clinics ALVIN M. GELB," M.D. Chief, Division of Gastroenterology Beth Israel Medical Center Associate Professor of Clinical Medicine Mount Sinai School of Medicine of the City University of New York
BEVERLY L. RICHMAN, M.D. Assistant A ttending Physician Beth Israel Medical Center Senior Clinical Instructor, Medicine Mount Sinai School of Medicine of the City University of New York
NINA P. PEYSER, M.B.A. Administrative Coordinator Methadone Maintenance Treatment Program Beth Israel Medical Center New York, New York 10003
*To whom correspondence and requests for reprints should be addressed at Beth Israel Medical Center, 10 Nathan D. Perlman Place, New York, New York 10003. 367
GELB, RICHMAN. AND PEYSER
368
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Cornell University on 12/27/14 For personal use only.
ABSTRACT A study was undertaken to determine the frequency of alcohol use and the amount consumed by methadone maintenance patients. In four clinics of the Beth Israel Medical Center Methadone Maintenance Treatment Program, every fifth patient from an alphabetical clinic list was selected for interview. Among the 101 patients who were interviewed, mean alcohol consumption was 1.2 ounces per day. Among those who drank, there was a continuum in terms of amount consumed. Forty-three percent had totally abstained from alcohol during the prior 3 months, and an additional 30% drank one or less ounces per day. At the other end of the spectrum, 12% consumed 3 or more ounces per day. Independently obtained staff rankings generally approximated interview results, and thus supported the reliability of the interview. Since staff rankings for participants and nonparticipants in the interview were similar, it appears that those who participated were typical of the group selected for study.
INTRODUCTION Alcohol abuse by patients in methadone maintenance treatment programs (MMTP) is an important problem. We have reported previously that it is the major factor in the development of cirrhosis and death from liver failure in narcotic addicts and patients in MMTP [l] , We have also found that daily alcohol consumption in patients admitted for alcohol detoxification is not significantly different in active narcotic addicts or in MMTP patients when compared to alcoholics not so involved [2]. This report concerns itself with the frequency and amount of alcohol consumed by outpatients who attend MMTP clinics.
METHOD The patients studied were from four methadone maintenance clinics of the Beth Israel Medical Center. From an alphabetical patient list of about 250 to 300 names in each clinic, every fifth patient was selected for study. If a patient was unavailable or uncooperative, where possible the next patient on the list was selected. After signing an informed consent which specified voluntary participation and confidentiality, even in regard to clinic staff, patients were asked to complete a questionnaire with the help of a volunteer or a physician’s assistant who was not associated with the clinic. Average alcohol consumption during the 30 days preceeding the interview was recorded. Alcohol quantity was determined by multiplying ounces consumed by a factor of 1 for daily
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Cornell University on 12/27/14 For personal use only.
ALCOHOL USE IN METHADONE MAINTENANCE CLINICS
369
consumption, 0.8 for 5 or 6 days per week, 0.5 for 3 or 5 days per week, 0.2 for 1 or 2 days per week, and 0.05 for less than weekly. Alcohol content was considered 4% for beer, 15% for wine, and 45% for whiskey. The concept of “abuse” was avoided, and only the quantity of alcohol consumed was pursued. To determine reliability of the patients’ responses to the questionnaire, and whether the patients who cooperated were in any way different in alcohol consumption from those who did not participate, staff members in two clinics were asked to estimate alcohol use by all patients selected for the study. Rankings were on a 0 to 4 scale. Zero indicated no alcohol use; 1 to 4 indicated progressively larger involvement with alcohol. Clinic staff who did the ranking had no knowledge of patients’ responses or whether they had completed the questionnaire. The rankings were compared to the questionnaire results.
RESULTS In total, 101 patients were interviewed in the four clinics. Although the clinics were comparable in regard to age, they differed in other patient characteristics (Table 1). In Clinic D there was a higher proportion of females and Blacks, and a shorter continuous time in treatment. In Clinic B, Hispanics were in the majority and the proportion of females was the smallest. The patients interviewed reflected the demographic characteristics of the clinics in regard to age (median age 30), sex (male:female ratio 2), and ethnicity. Duration in treatment of the interviewed patients was less, however, 70% having been in continuous treatment less than 5 years. Among the total group of 101 patients, mean alcohol consumption was 1.2 ounces per day (Table 2). Forty-three percent stated that in the 3 months prior to the interview, they had totally abstained from alcohol. Twelve percent stated that they consumed 3 or more ounces of alcohol per day (equivalent to more than 6 ounces whiskey/day). When the entire group that consumed any alcohol at all was considered, there was no sharp division separating mild, moderate, and heavy drinkers, but rather there was a continuum of the quantity consumed. The selection of 3 or more ounces of alcohol per day as an index of heavy drinking was arbitrary. In two clinics, A and D, we studied the reliability of interview responses and whether the responders were different from nonresponders regarding alcohol use. The nonresponders consisted of both patients who could not be reached by the interviewer and those who refused tocooperate. In
31
31
32
319
294
307
C
D
33
296
A B
age
Median
patients
Clinic
Number of
1.7
3.1
4.7
3.2
Male:female ratio
Table 1. Some Characteristics of the Clinics Studied
83
27 2
37
30
51%
24% 14
White
Bh&
14
33
51
19%
Hisuanic
Ethnicity
1
3
6
6%
Other
15
5
8
3%
lyerr
46
35
25% 33
1to5years
39
60
59
72%
5years
Continuous time in treatment Less than More than
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Cornell University on 12/27/14 For personal use only.
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AM. J. DRUG ALCOHOL ABUSE,6(3), pp. 367- 373(1979)
Alcohol Use in Methadone Maintenance Clinics ALVIN M. GELB," M.D. Chief, Division of Gastroenterology Beth Israel Medical Center Associate Professor of Clinical Medicine Mount Sinai School of Medicine of the City University of New York
BEVERLY L. RICHMAN, M.D. Assistant A ttending Physician Beth Israel Medical Center Senior Clinical Instructor, Medicine Mount Sinai School of Medicine of the City University of New York
NINA P. PEYSER, M.B.A. Administrative Coordinator Methadone Maintenance Treatment Program Beth Israel Medical Center New York, New York 10003
*To whom correspondence and requests for reprints should be addressed at Beth Israel Medical Center, 10 Nathan D. Perlman Place, New York, New York 10003. 367
GELB, RICHMAN. AND PEYSER
368
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Cornell University on 12/27/14 For personal use only.
ABSTRACT A study was undertaken to determine the frequency of alcohol use and the amount consumed by methadone maintenance patients. In four clinics of the Beth Israel Medical Center Methadone Maintenance Treatment Program, every fifth patient from an alphabetical clinic list was selected for interview. Among the 101 patients who were interviewed, mean alcohol consumption was 1.2 ounces per day. Among those who drank, there was a continuum in terms of amount consumed. Forty-three percent had totally abstained from alcohol during the prior 3 months, and an additional 30% drank one or less ounces per day. At the other end of the spectrum, 12% consumed 3 or more ounces per day. Independently obtained staff rankings generally approximated interview results, and thus supported the reliability of the interview. Since staff rankings for participants and nonparticipants in the interview were similar, it appears that those who participated were typical of the group selected for study.
INTRODUCTION Alcohol abuse by patients in methadone maintenance treatment programs (MMTP) is an important problem. We have reported previously that it is the major factor in the development of cirrhosis and death from liver failure in narcotic addicts and patients in MMTP [l] , We have also found that daily alcohol consumption in patients admitted for alcohol detoxification is not significantly different in active narcotic addicts or in MMTP patients when compared to alcoholics not so involved [2]. This report concerns itself with the frequency and amount of alcohol consumed by outpatients who attend MMTP clinics.
METHOD The patients studied were from four methadone maintenance clinics of the Beth Israel Medical Center. From an alphabetical patient list of about 250 to 300 names in each clinic, every fifth patient was selected for study. If a patient was unavailable or uncooperative, where possible the next patient on the list was selected. After signing an informed consent which specified voluntary participation and confidentiality, even in regard to clinic staff, patients were asked to complete a questionnaire with the help of a volunteer or a physician’s assistant who was not associated with the clinic. Average alcohol consumption during the 30 days preceeding the interview was recorded. Alcohol quantity was determined by multiplying ounces consumed by a factor of 1 for daily
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Cornell University on 12/27/14 For personal use only.
ALCOHOL USE IN METHADONE MAINTENANCE CLINICS
369
consumption, 0.8 for 5 or 6 days per week, 0.5 for 3 or 5 days per week, 0.2 for 1 or 2 days per week, and 0.05 for less than weekly. Alcohol content was considered 4% for beer, 15% for wine, and 45% for whiskey. The concept of “abuse” was avoided, and only the quantity of alcohol consumed was pursued. To determine reliability of the patients’ responses to the questionnaire, and whether the patients who cooperated were in any way different in alcohol consumption from those who did not participate, staff members in two clinics were asked to estimate alcohol use by all patients selected for the study. Rankings were on a 0 to 4 scale. Zero indicated no alcohol use; 1 to 4 indicated progressively larger involvement with alcohol. Clinic staff who did the ranking had no knowledge of patients’ responses or whether they had completed the questionnaire. The rankings were compared to the questionnaire results.
RESULTS In total, 101 patients were interviewed in the four clinics. Although the clinics were comparable in regard to age, they differed in other patient characteristics (Table 1). In Clinic D there was a higher proportion of females and Blacks, and a shorter continuous time in treatment. In Clinic B, Hispanics were in the majority and the proportion of females was the smallest. The patients interviewed reflected the demographic characteristics of the clinics in regard to age (median age 30), sex (male:female ratio 2), and ethnicity. Duration in treatment of the interviewed patients was less, however, 70% having been in continuous treatment less than 5 years. Among the total group of 101 patients, mean alcohol consumption was 1.2 ounces per day (Table 2). Forty-three percent stated that in the 3 months prior to the interview, they had totally abstained from alcohol. Twelve percent stated that they consumed 3 or more ounces of alcohol per day (equivalent to more than 6 ounces whiskey/day). When the entire group that consumed any alcohol at all was considered, there was no sharp division separating mild, moderate, and heavy drinkers, but rather there was a continuum of the quantity consumed. The selection of 3 or more ounces of alcohol per day as an index of heavy drinking was arbitrary. In two clinics, A and D, we studied the reliability of interview responses and whether the responders were different from nonresponders regarding alcohol use. The nonresponders consisted of both patients who could not be reached by the interviewer and those who refused tocooperate. In
31
31
32
319
294
307
C
D
33
296
A B
age
Median
patients
Clinic
Number of
1.7
3.1
4.7
3.2
Male:female ratio
Table 1. Some Characteristics of the Clinics Studied
83
27 2
37
30
51%
24% 14
White
Bh&
14
33
51
19%
Hisuanic
Ethnicity
1
3
6
6%
Other
15
5
8
3%
lyerr
46
35
25% 33
1to5years
39
60
59
72%
5years
Continuous time in treatment Less than More than
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Cornell University on 12/27/14 For personal use only.
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