Chi Felicia W, Satre Derek D, Weisner Constance
Division of Research, Kaiser Permanente Northern California, Oakland 94612-2403, USA.
Alcohol Clin Exp Res. 2006 May;30(5):851-9. doi: 10.1111/j.1530-0277.2006.00100.x.
Improving services and treatment outcomes for individuals with cooccurring alcohol and drug use disorders and psychiatric conditions has been a critical challenge to clinicians and policy makers. This study examined 1-year outcomes for individuals entering chemical dependency (CD) treatment with and without cooccurring psychiatric diagnoses targeted by California parity legislation. Among those with cooccurring conditions (i.e., dual-diagnosis patients), we examined a model including individual characteristics, treatment services, and extratreatment characteristics to understand CD outcome predictors in this population. We hypothesized that longer CD treatment duration and receiving psychiatric services would predict higher abstinence levels. In particular,patterns of psychiatric services (amount of services, receiving a critical dose, or receiving services concurrently with CD treatment) were assessed in relation to outcome.
We examined abstinence rates 1 year after intake for 747 adults with and without cooccurring conditions. Among dual-diagnosis patients, logistic regression was used to examine predictors of abstinence.
At baseline, dual-diagnosis patients (N=104) had higher levels of medical, family, and employment problems than others. They had similar CD retention and received more psychiatric services during the year after intake and had comparable CD outcomes at 1 year. Length of stay in CD treatment, hours of psychiatric services, number of months with concurrent CD and psychiatric services, and number of 12-step meetings attended were independent predictors of abstinence for dual diagnosis patients.
Chemical dependency outcomes in patients with cooccurring psychiatric conditions were positively associated with the number and patterning of services. Receiving psychiatric services concurrently with CD treatment may be beneficial for dual-diagnosis patients. Future studies should examine how best to integrate services to optimize treatment outcomes.
改善同时患有酒精和药物使用障碍及精神疾病的个体的服务和治疗效果，一直是临床医生和政策制定者面临的重大挑战。本研究调查了根据加利福尼亚平价立法确定的、伴有或不伴有精神疾病诊断而进入化学依赖（CD）治疗的个体的1年治疗效果。在那些患有共病的个体（即双重诊断患者）中，我们研究了一个包括个体特征、治疗服务和治疗外特征的模型，以了解该人群中CD治疗效果的预测因素。我们假设CD治疗时间越长和接受精神科服务能预测更高的戒酒水平。特别是，评估了精神科服务模式（服务量、接受关键剂量或与CD治疗同时接受服务）与治疗效果的关系。
我们调查了747名有或无共病的成年人入院1年后的戒酒率。在双重诊断患者中，使用逻辑回归分析来研究戒酒的预测因素。
在基线时，双重诊断患者（N = 104）在医疗、家庭和就业问题方面比其他人更严重。他们在CD治疗中的留存率相似，入院后一年内接受了更多的精神科服务，且1年后的CD治疗效果相当。CD治疗的住院时间、精神科服务时长、CD治疗与精神科服务同时进行的月数以及参加12步会议的次数是双重诊断患者戒酒的独立预测因素。
患有共病精神疾病的患者的化学依赖治疗效果与服务的数量和模式呈正相关。与CD治疗同时接受精神科服务可能对双重诊断患者有益。未来的研究应探讨如何最好地整合服务以优化治疗效果。
