There is generally consistent evidence supporting the importance of family history in the development of substance use disorders. The published evidence suggests that those with a family history of substance abuse are more vulnerable towards alcohol abuse and dependence; however, it has also been shown for other drugs, particularly for opioids . Thus, it is not surprising that more than 50% of our patients reported a family history of substance use problems. Our data are consistent with previous studies that have shown that substance abusers were also significantly more likely to have an alcoholic father than controls.


There are no clear guidelines on how to treat patients severely dependent on prescription opioids. Each individual is evaluated extensively, and often a combination of pharmacological and nonpharmacological interventions is used . The most common practice is to taper the medication(s) slowly under careful monitoring . This approach seems to be adequate for most patients. However in severe cases (such as some of our patients) a long acting opioid such as methadone can be used to minimize withdrawal symptoms . Adjunct therapy to either treat additional substance use problems (eg, benzodiazepine tapering) or treat opioid withdrawal symptomatically (eg, antidiarrheal agents) is also common. Similar to the treatment for patients who are severely dependent on multiple drugs, a variety of nonpharmacological interventions is needed. Despite these efforts, long term outcome in these patients is often poor, and better strategies are needed.