Amato L, Minozzi S, Davoli M, Vecchi S, Ferri M, Mayet S
Dep of epidemiology, ASL RM/E, via di S. Costanza 53, Rome, 00198, Lazio, Italy.
Cochrane Database Syst Rev. 2004 Oct 18(4):CD005031. doi: 10.1002/14651858.CD005031.
Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the rehabilitation of dependent heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological symptoms rather than physiological symptoms associated with the withdrawal syndrome.
To evaluate the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the treatment, reduce the use of substances and improve health and social status.
We searched the Cochrane Central Register of Trials (CENTRAL) issue 3, 2003; MEDLINE 1966-2003; EMBASE 1980-2003; PsycINFO 1985-2003; relevant web sites; scan of reference list of relevant articles. There were no language or publication restrictions.
Randomised controlled trials which focus on any psychosocial associated with any pharmacological intervention aimed at opioid detoxification. People less than 18 years of age and pregnant women were excluded.
The trials were independently assessed for inclusion and methodological quality by three reviewers. Data were extracted independently and double checked.
The searching process resulted in the identification of 77 different studies: 8 studies met inclusion criteria. These studies considered 5 different psychosocial interventions and 2 substitution detoxification treatments: Methadone and Buprenorphine. The results show promising benefit from adding any psychosocial treatment to any substitution detoxification treatment in terms of completion of treatment RR 1.68 (95% CI 1.11-2.55), results at follow-up RR 2.43 (95% CI 1.61-3.66), and compliance RR 0.48 (95% CI 0.38-0.59). In respect of the use of heroin during the treatment, the differences were not statistically significant but favoured the combined treatments.
REVIEWERS' CONCLUSIONS: Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, results at follow-up and compliance. Although a treatment, like detoxification, that exclusively attenuates the severity of opiate withdrawal symptoms can be at best partially effective for a chronic relapsing disorder like opiate dependence, this type of treatment is an essential step prior to longer-term drug-free treatment and it is desirable to develop adjunct psychosocial approaches that might make detoxification more effective. Limitations to this review are imposed by the heterogeneity of the assessment of outcomes. Because of lack of detailed information no meta analysis could be performed to analyse the results related to several outcomes.
针对阿片类药物脱毒的不同药理学方法是有效的。然而，大多数患者会复吸海洛因，而复吸是依赖海洛因使用者康复过程中的一个重大问题。一些研究表明，在脱毒过程中，让成瘾者最痛苦的症状类型是心理症状，而非与戒断综合征相关的生理症状。
评估任何心理社会干预加任何药理学干预与单纯任何药理学干预相比，在阿片类药物脱毒中帮助患者完成治疗、减少物质使用并改善健康和社会状况方面的有效性。
我们检索了《考克兰系统评价数据库》2003年第3期；《医学索引》1966年至2003年；《荷兰医学文摘数据库》1980年至2003年；《心理学文摘数据库》1985年至2003年；相关网站；对相关文章参考文献列表进行筛选。没有语言或出版限制。
聚焦于任何与旨在阿片类药物脱毒的药理学干预相关的心理社会干预的随机对照试验。排除18岁以下人群和孕妇。
由三位评价者独立评估试验是否符合纳入标准及方法学质量。数据独立提取并进行二次核对。
检索过程共识别出77项不同研究：8项研究符合纳入标准。这些研究考虑了5种不同的心理社会干预和2种替代脱毒治疗：美沙酮和丁丙诺啡。结果显示，在任何替代脱毒治疗中添加任何心理社会治疗在治疗完成率（相对危险度RR 1.68，95%可信区间1.11 - 2.55）、随访结果（RR 2.43，95%可信区间1.61 - 3.66）和依从性（RR 0.48，95%可信区间0.38 - 0.59）方面都有显著益处。在治疗期间海洛因使用方面，差异无统计学意义，但联合治疗更具优势。
除药理学脱毒治疗外提供的心理社会治疗在治疗完成、随访结果和依从性方面是有效的。尽管像脱毒这样仅减轻阿片类药物戒断症状严重程度的治疗，对于像阿片类药物依赖这样的慢性复发性疾病充其量只能部分有效，但这种治疗是长期戒毒治疗之前的关键一步，开发可能使脱毒更有效的辅助心理社会方法是很有必要的。本综述的局限性在于结局评估的异质性。由于缺乏详细信息，无法进行荟萃分析来分析与多个结局相关的结果。
