Keen J, Oliver P, Rowse G, Mathers N
Institute of General Practice and Primary Care, Community Sciences Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
Fam Pract. 2001 Oct;18(5):545-8. doi: 10.1093/fampra/18.5.545.
Residential rehabilitation based on 'therapeutic community' treatment for drug users is a treatment option which is attractive to GPs and others referring drug users for treatment. Whilst there is evidence that maintenance-based programmes for drug users are effective, there have been fewer attempts to evaluate the effectiveness of abstinence-based programmes which are relatively more intensive and expensive interventions.
This paper reports and evaluates the outcomes for 13 months' intake of 138 drug users to a residential community.
We carried out a retrospective cohort study using existing clinical and residential record data. The setting is a residential rehabilitation centre run by the charity Phoenix House in Sheffield, UK, offering a 1-year programme for heroin addicts including community detoxification overseen by primary care specialist doctors and residential rehabilitation. Participants were all patients who entered treatment between 1 February 1998 and 28 February 1999 inclusive. An analysis was carried out of clinical records and other records kept by clinicians and staff at the centre. Outcome measures were numbers of days of retention in treatment and reasons for departure, categorized as completed treatment, planned or unplanned departure and expulsion from the programme. For patients who underwent in-house detoxification, a further outcome measure was whether or not detoxification was complete at discharge.
Heroin was the main drug of abuse in 85% of admissions. Mean length of time for which individuals had been drug dependent was 8 years (range 1.3-20.1 years). The mean length of stay was 80.2 days (range 1-394, 95% confidence interval 61.8-98.6). Thirty-four individuals (25%) completed 90 days or more. No association was found between length of stay and age, sex, route of administration, polydrug use, length of time addicted or age of first addiction. Sixty-five per cent of those who received in-house detoxification completed the detoxification period. When patients were classified as 'successes' or 'failures' by reason for departure from the programme, 94 (68.1%) were classified as failures and 18 (13.0%) as successes. Data were unavailable for 26 patients. Success was not associated with any characteristic at entry apart from being drug free as opposed to requiring detoxification (P = 0.048, chi-square = 6.06, df = 2).
This study shows overall low levels of programme completion and high levels of unplanned departure and eviction from the programme amongst these long-term drug users. On the other hand, the importance of abstinence for those who achieve it in residential rehabilitation should not be underestimated, nor should the possibility that long-term outcomes are influenced by the learning process involved in the intervention. It may be possible to operate better selection procedures in order to optimize outcomes.
基于“治疗社区”模式的戒毒者住院康复治疗，对全科医生及其他为戒毒者转诊治疗的人员来说是一种颇具吸引力的治疗选择。虽然有证据表明针对吸毒者的维持治疗方案是有效的，但相对而言更为密集且昂贵的戒断治疗方案的效果评估尝试较少。
本文报告并评估了138名吸毒者进入一个住院社区接受为期13个月治疗的结果。
我们利用现有的临床和住院记录数据进行了一项回顾性队列研究。研究地点是英国谢菲尔德由慈善机构凤凰之家运营的一家住院康复中心，为海洛因成瘾者提供为期1年的项目，包括由初级保健专科医生监督的社区戒毒及住院康复治疗。参与者为1998年2月1日至1999年2月28日期间（含这两个日期）开始接受治疗的所有患者。对该中心临床医生和工作人员保存的临床记录及其他记录进行了分析。结果指标包括治疗留存天数及出院原因，出院原因分为完成治疗、计划内或计划外出院以及被开除出项目。对于在机构内进行戒毒的患者，另一个结果指标是出院时戒毒是否完成。
85%的入院者主要滥用药物为海洛因。个体药物依赖的平均时长为8年（范围1.3 - 20.1年）。平均住院时长为80.2天（范围1 - 394天，95%置信区间61.8 - 98.6）。34人（25%）完成了90天或更长时间的治疗。未发现住院时长与年龄、性别、给药途径、多药滥用、成瘾时长或首次成瘾年龄之间存在关联。接受机构内戒毒的患者中有65%完成了戒毒期。当根据出院原因将患者分为“成功”或“失败”时，94人（68.1%）被归为失败，18人（13.0%）被归为成功。26名患者的数据缺失。成功与入院时的任何特征均无关联，除了无需戒毒而是已戒毒（P = 0.048，卡方 = 6.06，自由度 = 2）。
本研究表明，在这些长期吸毒者中，项目完成率总体较低，计划外出院和被开除出项目的比例较高。另一方面，对于在住院康复治疗中实现戒断的人来说，戒断的重要性不应被低估，干预过程中学习过程对长期结果的影响可能性也不应被低估。或许可以采用更好的筛选程序以优化治疗结果。
