Hoque M Monjurul, Hossain Kazi Jahangir, Kamal M Mustafa, Akhtaruzzaman M
Department of Psychiatry, Sir Salimullah Medical College (SSMC), Mitford, Dhaka, Bangladesh.
Mymensingh Med J. 2009 Jan;18(1 Suppl):S56-65.
The primary aim of this study was to investigate significance of the naltrexone in the management of drug addiction. A total of 108 opiate dependent drug abusers were included in this study. The study period was May 2004 to March 2008. They were selected consecutively on the basis of defined criteria. Of 108 drug abusers, 81.48% were literate and rest was illiterate. In current profession, majority of them (81.48%) had no work; rests were businessmen (13.89%) or service holders (4.63%). Nearly 72.22% drug abusers were young adult had age 20-30 years and 71.30% were married. About 94.00% of them were using heroin. In lifetime, sixty percent of them had been using heroin or phensedyl for 3-5 years, 25.93% for 6-10 years and 13.89% for 11-16 years. Hundred percent of the studied drug abusers had habit of smoking cigarettes. Most of them were heterosexual having sex with multiple partners. Nocturnal insomnia, difficulty falling asleep or hypersomnia, antisocial and/or irritable behaviors were found among them. About 75.00% of them had altered food habit and 45.37% had sexual dysfunction. Eighty-four percent wives of the participant drug abusers were found to be literate and 84.42% had only household works in their profession. Illiteracy was found to be higher in mother (26.85%) than that of father (24.07%). Majority of the father were found to be businessmen and mothers had household works only. Their family income was Tk.10,000-20,000 monthly. In addition, disharmony among family members, illicit drug users and mental illness were found in 81.48%, 23.15% and 21.30% families respectively. About 95.00% of the participant drug abusers were completed treatment schedule with naltrexone successfully and rest were dropout. Only 45.37% of them were developed adverse effects; of which, insomnia, nausea vomiting, headache, abdominal cramps and nervousness were found to be notable. Finally, 75.93% participant drug abusers were relapsed and rest (25.49%) was remained abstinent from illicit drug use. Multiple factors were found to be liable to use illicit drugs once more. Of them, unpleasant emotional state, sexual dysfunction, friend's incitement, family disharmony and interpersonal conflict were found to be crucial important. All of the participants were acknowledged essentiality of the Naltrexone in the treatment of drug addiction. They expressed their satisfaction during treatment including abstinent period. Most of them had not physical or mental craving for illicit drugs as before treatment and did not mention sleep disturbance or other mental troubles. They had normal food habit, increased appetite and taste preference in abstinent period. However, naltrexone could play important role in demand reduction but has no effect to enhance self-efficacy. In combination with self-efficacy enhancement therapies, it would be effective in the treatment of opioids dependence.
本研究的主要目的是探讨纳曲酮在药物成瘾治疗中的意义。本研究共纳入108名阿片类药物依赖的吸毒者。研究时间为2004年5月至2008年3月。他们是根据既定标准连续入选的。在108名吸毒者中，81.48%识字，其余为文盲。在当前职业方面，他们中的大多数（81.48%）无业；其余为商人（13.89%）或服务业从业者（4.63%）。近72.22%的吸毒者为20至30岁的青年成年人，71.30%已婚。其中约94.00%的人使用海洛因。在其吸毒生涯中，60%的人使用海洛因或苯环己哌啶3至5年，25.93%的人使用6至10年，13.89%的人使用11至16年。100%的受试吸毒者有吸烟习惯。他们中的大多数是与多个性伴侣发生性行为的异性恋者。他们中存在夜间失眠、入睡困难或睡眠过多、反社会和/或易怒行为。约75.00%的人饮食习惯改变，45.37%的人存在性功能障碍。发现受试吸毒者的妻子中84%识字，84.42%在职业上仅有家务工作。发现母亲的文盲率（26.85%）高于父亲（24.07%）。发现大多数父亲为商人，母亲仅有家务工作。他们的家庭月收入为10,000至20,000塔卡。此外，分别在81.48%、23.15%和21.30%的家庭中发现家庭成员之间关系不和谐、有非法吸毒者和精神疾病。约95.00%的受试吸毒者成功完成了纳曲酮治疗方案，其余为退出者。其中只有45.37%出现不良反应；其中，失眠、恶心呕吐、头痛、腹部绞痛和紧张较为明显。最后，75.93%的受试吸毒者复发，其余（25.49%）保持对非法药物的戒断状态。发现多种因素易导致再次使用非法药物。其中，不愉快的情绪状态、性功能障碍、朋友的煽动、家庭不和谐和人际冲突被认为至关重要。所有参与者都认可纳曲酮在药物成瘾治疗中的必要性。他们在治疗期间包括戒断期都表示满意。他们中的大多数人不像治疗前那样对非法药物有身体或精神上的渴望，也没有提及睡眠障碍或其他精神问题。他们在戒断期饮食习惯正常，食欲增加，味觉偏好改善。然而，纳曲酮在减少需求方面可发挥重要作用，但对增强自我效能没有效果。与增强自我效能的疗法相结合，它在治疗阿片类药物依赖方面将是有效的。
