IMPULSIVE BEHAVIORS IN OPIATE-DEPENDENT SUBJECTS TREATED WITH NALTREXONE

Thirty three heroin dependents (DSM-III-R) attending a naltrexone clinic were assessed to see if their histories of bulimic and non-suicidal self-agressive behaviours would allow to predict the therapeutic response of the opioid antagonist. Neither these impulsive behaviours non previous suicide attempts or over-doses could predict such a response, wich was evaluated according to the time spent under treatment with naltrexone. Before the administration of naltrexone, one or more of the studied impulsive conducts were detected in 87.8% of the sample (n = 29). None of the patients combined enough criteria in to be diagnosed of bulimia (DSM-III-R). In 32 patients the occurrence of changes in the impulsive behaviours studied during the treatment period with the opioid antagonist were determined. These variations were not related to the determinations of abuse drugs in urine with intake of psychoactive drugs. During the treatment with naltrexone, 15 patients ceased to present self-injuries without suicidal purposes and none of the patients began these behaviours for the first time. However, some patients without a previous history of bulimic behaviour developed this condition during the administration of the opioid antagonist. In this sense, four subgroups of patients can be differentiated according to the moment in wich the bulimic behaviour appeared: subgroup A includes 7 individuals (21.7%) who discontinued this behaviour upon receiving the antagonist, while subgroup B (n = 3; 9.3%) is made up of those who presented this behaviour during both heroin consumption and the administration of naltrexone. Subgroup C (n = 7) includes those individuals who initiated bulimic behaviour for the first rime during the administration of naltrexone, while subgroup D (n = 15; 46.8%) is composed of the subjects who did not present bulimic behaviour at any time. Bulimic behaviour registered in subgroup A included binges but not purges; however, in subgroup C 42.9% of subjects carried out significantly more purges (p = 0.0253). Patients in subgroup B had the most overaloaded history of suicide attempts and also of self-injury episodes without a suicide intention.