King Van Lewis, Brooner Robert K
Department of Psychiatry, Johns Hopkins School of Medicine, Balitmore, USA.
Jt Comm J Qual Patient Saf. 2008 Apr;34(4):209-13. doi: 10.1016/s1553-7250(08)34027-6.
Substance abuse treatment programs that provide long term care that includes methadone routinely treat patients with both the chronic and severe form of opioid dependence disorder. In the early 1990s the Addiction Treatment Services clinic at Johns Hopkins Bayview Medical Center began experiencing a growing problem with poor counseling attendance and high rates of continuing opioid and other drug use, primarily cocaine.
A comprehensive and adaptive treatment model was developed that adjusts the amount of individual counseling and group therapy, medication dose, and overall monitoring, and integrates them with clinic-based behavioral reinforcement procedures to increase patients' attendance. This model of care (Motivated Stepped Care [MSC]), an adaptive stepped-care treatment approach, was implemented in 1995.
The MSC model has demonstrated large improvements in counseling attendance and rates of urine specimens testing negative for drug use. Additional work has extended the model's evaluation to other common problems-continuing unemployment and limited access to and participation in drug-free social support.
The MSC adaptive treatment model is a viable and effective alternative to standard treatment approaches. It is integrated with performance improvement monitoring to inform and adjust the amount of services necessary to achieve and sustain good clinical response to treatment during months and years of care.
提供包括美沙酮在内的长期护理的药物滥用治疗项目通常会治疗患有慢性和严重形式阿片类物质使用障碍的患者。20世纪90年代初，约翰霍普金斯湾景医疗中心的成瘾治疗服务诊所开始面临一个日益严重的问题，即咨询出勤率低，以及持续使用阿片类药物和其他药物（主要是可卡因）的比例很高。
开发了一种全面且适应性的治疗模式，该模式会调整个体咨询和团体治疗的量、药物剂量以及整体监测，并将它们与基于诊所的行为强化程序相结合以提高患者的出勤率。这种护理模式（动机逐步护理[MSC]），一种适应性逐步护理治疗方法，于1995年实施。
MSC模式在咨询出勤率和药物使用尿液标本检测呈阴性的比例方面有了大幅改善。进一步的工作将该模式的评估扩展到了其他常见问题——持续失业以及获得和参与无毒品社会支持的机会有限。
MSC适应性治疗模式是标准治疗方法的一种可行且有效的替代方案。它与绩效改进监测相结合，以便在数月乃至数年的护理过程中，为实现并维持对治疗的良好临床反应所需的服务量提供信息并进行调整。
