Petry N M, Bickel W K
Substance Abuse Treatment Center and Department of Psychology, University of Vermont, Burlington, USA.
Psychiatr Serv. 1999 Feb;50(2):219-27. doi: 10.1176/ps.50.2.219.
The role of patient characteristics and the strength of the therapeutic alliance in predicting completion of treatment by opioid-dependent patients was examined.
Information about patient characteristics and scores on subscales of the Addiction Severity Index (ASI) were obtained for 114 patients at intake to a buprenorphine treatment program lasting three to four months. The strength of the therapeutic alliance was assessed by the Helping Alliance Questionnaire (HAQ). Patients were classified as treatment completers or noncompleters, and logistical regression examined predictors of treatment completion.
Only two variables significantly predicted treatment completion: severity of psychiatric symptoms and interaction between HAQ scores and psychiatric severity. Patients with fewer psychiatric symptoms were more likely to complete treatment. The strength of the therapeutic alliance was not related to treatment completion among patients with few psychiatric symptoms, and 62 percent of these patients completed treatment. In contrast, among patients with moderate to severe psychiatric problems, less than 25 percent with weak therapeutic alliances completed treatment, while more than 75 percent with strong therapeutic alliances completed treatment.
The results underscore the importance of early identification of opioid-dependent patients with moderate to severe levels of psychopathology. In this patient subgroup, a strong therapeutic alliance may be an essential condition for successful treatment.
研究患者特征及治疗联盟强度对阿片类药物依赖患者治疗完成情况的预测作用。
获取了114名进入为期三至四个月的丁丙诺啡治疗项目的患者的患者特征信息及成瘾严重程度指数（ASI）各分量表得分。通过帮助联盟问卷（HAQ）评估治疗联盟强度。将患者分为治疗完成者和未完成者，并采用逻辑回归分析治疗完成的预测因素。
仅有两个变量显著预测治疗完成情况：精神症状严重程度以及HAQ得分与精神症状严重程度之间的相互作用。精神症状较少的患者更有可能完成治疗。在精神症状较少的患者中，治疗联盟强度与治疗完成情况无关，这些患者中有62%完成了治疗。相比之下，在有中度至重度精神问题的患者中，治疗联盟较弱的患者中不到25%完成了治疗，而治疗联盟较强的患者中有超过75%完成了治疗。
研究结果强调了早期识别有中度至重度精神病理学水平的阿片类药物依赖患者的重要性。在这个患者亚组中，强大的治疗联盟可能是成功治疗的必要条件。
