Teichner Gordon, Horner Michael D, Roitzsch John C, Herron Janice, Thevos Angelica
Department of Neurology, Medical University of South Carolina, Charleston 29425, USA.
Addict Behav. 2002 Sep-Oct;27(5):751-63. doi: 10.1016/s0306-4603(01)00207-6.
The purpose of this research was to examine the effects of cognitive impairment on the efficacy of substance abuse treatment outcome. Alcohol, drug, medical, legal, psychological, employment, and family functioning related treatment outcomes were examined for 26 cognitively impaired and 68 cognitively intact abusing outpatients. Subjects were enrolled in an intensive, 3-week, outpatient program for the treatment of their substance abuse. Subjects were administered a battery of neuropsychological tests prior to treatment onset, and outcome data were obtained at 1, 3, 6, and 12 months posttreatment entry. No significant between-group differences were found on any of the outcome measures, and significant treatment gains were observed across all problem domains in both groups. Subjects' largest improvements were made in the first month of treatment for alcohol, drug, legal, family, and psychological problems. Improvements for employment and medical problems were not observed until 6 months posttreatment. Success across domains was maintained through 12 months follow-up, with the exception of psychological problems; 12-month data indicated a return to thelevel observed at 30 days posttreatment for psychological problems, a level that reflected significant improvement from baseline functioning. A greater proportion of treatment dropouts (i.e., no follow-up data obtained after 30 days) were cognitively impaired as compared to treatment completers. These results suggest that this method of intensive substance abuse outpatient treatment is effective for cognitively impaired patients, an important finding given that research evaluating the efficacy of interventions for such patients is limited. Additionally, neuropsychological evaluation may be important in reducing treatment dropouts, as the present findings indicated that greater cognitive impairment was related to an increased likelihood of treatment dropout.
本研究的目的是检验认知障碍对药物滥用治疗效果的影响。对26名认知障碍和68名认知正常的药物滥用门诊患者的酒精、药物、医疗、法律、心理、就业及家庭功能相关治疗效果进行了检查。受试者参加了一个为期3周的强化门诊项目以治疗其药物滥用问题。在治疗开始前，对受试者进行了一系列神经心理学测试，并在治疗开始后的1、3、6和12个月获取了结果数据。在任何一项结果指标上均未发现显著的组间差异，且两组在所有问题领域均观察到显著的治疗进展。受试者在治疗的第一个月，在酒精、药物、法律、家庭和心理问题方面取得了最大改善。就业和医疗问题直到治疗后6个月才出现改善。除心理问题外，各领域的成功在12个月的随访中得以维持；12个月的数据表明心理问题恢复到了治疗后30天观察到的水平，该水平反映出与基线功能相比有显著改善。与完成治疗者相比，认知障碍者中治疗退出者（即30天后未获得随访数据者）的比例更高。这些结果表明，这种强化药物滥用门诊治疗方法对认知障碍患者有效，鉴于评估此类患者干预措施效果的研究有限，这是一项重要发现。此外，神经心理学评估在减少治疗退出方面可能很重要，因为目前的研究结果表明，认知障碍程度越高，治疗退出的可能性就越大。
