Trafton Jodie A, Tracy Stephen W, Oliva Elizabeth M, Humphreys Keith
Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System and Stanford University Medical School, 795 Willow Road (152-MPD), Menlo Park, California 94025, USA.
J Stud Alcohol Drugs. 2007 Mar;68(2):165-72. doi: 10.15288/jsad.2007.68.165.
The aim of this study was to determine how the treatment needs and outcomes of polysubstance-using patients entering opioid-substitution treatment (OST) may be affected if the patient had a parent with substance-use problems.
This prospective observational study examined outcomes of 255 patients (97% male) entering OST at eight clinics in the Veterans Health Administration. Self-reported substance-use outcomes in the first year of treatment were compared between patients with (n = 121) and without (n = 134) a parent with substance-use problems. The association between receipt of practice guideline-recommended elements of care and treatment outcome was examined.
Parent history-positive patients had greater drug use at 6 months, but by 12 months they had reduced their drug use to the same extent as parent history-negative patients. Ongoing methadone (Dolophine, Methadose) maintenance was associated with improved outcomes of drug use in parent history-negative patients; however, parent history-positive patients who ended methadone maintenance reduced drug use as much as those who continued treatment. The association between treatment received and outcome differed in these populations. In parent history-negative patients, reduced severity of substance use at 1 year was predicted solely by receiving methadone for a greater number of days. In parent history-positive patients, reduced severity of substance use was predicted by receiving methadone for fewer days, by greater satisfaction with and receipt of counseling services, and by lesser tendency for providers to encourage a reduction in methadone use.
The importance of counseling and medication components of OST may differ depending on family history. For parent history-negative patients, medication maintenance may be more therapeutically necessary.
本研究旨在确定，如果进入阿片类药物替代治疗（OST）的多物质使用患者有一位患有物质使用问题的父母，那么其治疗需求和治疗结果会受到怎样的影响。
这项前瞻性观察性研究考察了退伍军人健康管理局8家诊所中255名进入OST的患者（97%为男性）的治疗结果。比较了有（n = 121）和没有（n = 134）患有物质使用问题父母的患者在治疗第一年自我报告的物质使用结果。研究了接受实践指南推荐的护理要素与治疗结果之间的关联。
有父母物质使用问题史的患者在6个月时药物使用量更大，但到12个月时，他们的药物使用量减少程度与无父母物质使用问题史的患者相同。持续进行美沙酮（多罗啡、美沙酮）维持治疗与无父母物质使用问题史患者的药物使用治疗结果改善相关；然而，结束美沙酮维持治疗的有父母物质使用问题史患者与继续治疗的患者减少药物使用的程度相同。这些人群中接受的治疗与结果之间的关联有所不同。在无父母物质使用问题史的患者中，仅通过接受更多天数的美沙酮治疗就能预测1年时物质使用严重程度的降低。在有父母物质使用问题史的患者中，物质使用严重程度的降低可通过接受更少天数的美沙酮治疗、对咨询服务更高的满意度和接受度以及提供者鼓励减少美沙酮使用的倾向较低来预测。
OST的咨询和药物治疗成分的重要性可能因家族史而异。对于无父母物质使用问题史的患者，药物维持治疗在治疗上可能更有必要。
