Patkar Ashwin A, Thornton Charles C, Mannelli Paolo, Hill Kevin P, Gottheil Edward, Vergare Michael J, Weinstein Stephen P
Division of Substance Abuse Programs, Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA 19107, USA.
J Addict Dis. 2004;23(1):93-109. doi: 10.1300/J069v23n01_08.
We investigated whether pretreatment characteristics and measures of outcome differed for alcohol-, cocaine-, and multisubstance-dependent patients receiving outpatient substance abuse treatment. One hundred and forty substance dependent individuals (32 alcohol, 76 cocaine, and 32 multisubstance) enrolled in a 12-week outpatient treatment program were compared across measures of addiction severity, personality, and treatment-readiness at admission. In-treatment, end-of-treatment and 9-month follow-up assessments of treatment outcome were then compared across the three groups. Outcome measures included reduction in problem severity, abstinence, retention, number of sessions attended, dropout, and counselor and patient ratings of treatment benefit. At admission, the multisubstance group had a higher proportion of positive urines, reported more severe drug, alcohol and psychiatric problems, and displayed higher impulsivity and anxiety scores than one or both of the other groups. However, multisubstance patients were more treatment ready in terms of adopting a total abstinence orientation than alcohol or cocaine patients. While a significant reduction in symptoms occurred for the total sample during treatment as well as at follow-up, comparisons of outcomes did not consistently favor any particular group. The three groups had equivalent improvements in eleven of fourteen during-treatment and five of seven follow-up measures. Despite pretreatment differences, in severity and treatment-readiness, outcomes were more similar than different for alcohol-, cocaine-, and multisubstance-dependent patients. Clinicians should be cautious about forecasting treatment-outcomes for addicted patients based on their primary substances of abuse.
我们调查了接受门诊药物滥用治疗的酒精依赖、可卡因依赖和多物质依赖患者的治疗前特征及治疗结果指标是否存在差异。对140名药物依赖个体（32名酒精依赖者、76名可卡因依赖者和32名多物质依赖者）进行了比较，这些个体参加了一个为期12周的门诊治疗项目，比较内容包括入院时的成瘾严重程度、人格和治疗准备情况。然后对三组患者治疗期间、治疗结束时及9个月随访期的治疗结果评估进行比较。结果指标包括问题严重程度的降低、戒断情况、留存率、参加治疗的疗程数、退出率以及咨询师和患者对治疗效果的评分。入院时，多物质依赖组尿样呈阳性的比例更高，报告的药物、酒精和精神问题更严重，且冲动性和焦虑得分高于其他两组中的一组或两组。然而，在采取完全戒断取向方面，多物质依赖患者比酒精或可卡因依赖患者更愿意接受治疗。虽然在治疗期间及随访时整个样本的症状都有显著减轻，但结果比较并未始终有利于任何特定组。在14项治疗期间指标中的11项以及7项随访指标中的5项上，三组的改善情况相当。尽管在治疗前的严重程度和治疗准备情况方面存在差异，但酒精依赖、可卡因依赖和多物质依赖患者的治疗结果更相似而非不同。临床医生在根据成瘾患者的主要滥用物质预测治疗结果时应谨慎。
