Bowser Benjamin P, Ryan Lisa, Smith Carla Dillard, Lockett Gloria
Department of Sociology and Social Services, California State University, East Bay, Hayward, CA 94542, USA.
Int J Drug Policy. 2008 Dec;19(6):492-5. doi: 10.1016/j.drugpo.2007.07.007. Epub 2008 Mar 28.
California Prevention Education Program (Cal-Pep) provides street outreach services to injection drugs users and sex traders in Oakland and San Francisco, CA, to reduce their chances of contracting HIV/AIDS. Drug treatment is an effective barrier to HIV infections, but only clients who are ready for total abstinence from drug use can be referred to traditional treatment. Drug treatment readiness is currently defined by funding policies in the U.S. as a client's willingness to totally abstain from alcohol and illegal drug use. This policy and practice eliminates a major harm reduction opportunity to reach drug users who are just contemplating recovery with treatment. With a CSAT grant to demonstrate an effective innovation in treatment, Cal-Pep started a harm reduction outpatient program for women who were active drug users. Over the course of 1 year, actively drug-using clients came to the program house during the day for meals, for risk-reduction education sessions, group discussions, and one-on-one psychological counselling.
From April 2001 to March 2006, 37 clients per year were interviewed at program entry and after 6 and 12 months to see if the intervention activities had an impact on their drug use and readiness for abstinence drug treatment.
By the 6th and 12th month of clients' progression through the risk-reduction program, they reported a statistically significant reduction in their poly-drug use (cocaine, cannabis, heroin, PCP) in the 30 days prior to their interviews (p<.000). There were also significant reductions in poly-drug use with alcohol (p<.000) and use of crack cocaine alone (p<.003). There was also an added benefit: clients significantly improved their living circumstances from the streets and shelters to rooms and apartments while in the program (p<.034). There was no significant improvement in employment.
This intervention shows that a harm reduction intermediate treatment program for actively using drug users can significantly reduce their drug use and improve readiness for full recovery.
加利福尼亚预防教育项目（Cal-Pep）为加利福尼亚州奥克兰市和旧金山市的注射吸毒者及性交易者提供街头外展服务，以降低他们感染艾滋病毒/艾滋病的几率。药物治疗是预防艾滋病毒感染的有效屏障，但只有那些准备好完全戒毒的客户才能被转介到传统治疗机构。目前，美国的资助政策将药物治疗准备状态定义为客户完全戒酒和停止使用非法药物的意愿。这一政策和做法消除了一个重要的减少伤害机会，即无法为那些刚刚开始考虑通过治疗实现康复的吸毒者提供帮助。通过药物滥用和精神健康服务管理局（CSAT）的一项拨款，旨在展示一种有效的治疗创新方法，Cal-Pep启动了一项针对活跃吸毒女性的减少伤害门诊项目。在一年的时间里，活跃吸毒的客户白天来到项目场所用餐、参加降低风险教育课程、小组讨论和一对一心理咨询。
从2001年4月到2006年3月，每年有37名客户在项目开始时以及6个月和12个月后接受访谈，以了解干预活动是否对他们的药物使用和戒毒准备状态产生影响。
在客户参与降低风险项目的第6个月和第12个月时，他们报告称在接受访谈前30天内，多种药物使用（可卡因、大麻、海洛因、苯环己哌啶）有统计学意义的显著减少（p<0.0（此处原文有误，推测应为p<0.000））。同时，与酒精一起使用多种药物的情况（p<0.000）以及单独使用快克可卡因的情况（p<0.003）也有显著减少。此外还有一个额外的好处：客户在参与项目期间，生活环境从街头和收容所显著改善到了房间和公寓（p<0.034）。就业情况没有显著改善。
这项干预措施表明，针对活跃吸毒者的减少伤害中级治疗项目可以显著减少他们的药物使用，并提高完全康复的准备状态。
