Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.
Exp Clin Psychopharmacol. 2011 Apr;19(2):116-22. doi: 10.1037/a0022795.
Concurrent alcohol dependence (AD) among polysubstance abusers has been associated with negative consequences, although it may not necessarily lead to poor treatment outcomes. One of the most efficacious treatments for cocaine abuse is contingency management (CM), but little research has explored the impact of AD on abstinence outcomes, particularly among patients in methadone maintenance. Using data from three trials of CM for cocaine use, we compared baseline characteristics and posttreatment and follow-up cocaine outcomes between methadone-maintained, cocaine-dependent patients (N = 193) with and without concurrent AD, randomized to standard care (SC) with or without CM. Patients with and without concurrent AD had similar baseline characteristics, with the exception that AD patients reported more alcohol use. AD patients achieved longer durations of cocaine abstinence and were more likely to submit a cocaine-negative sample at follow-up than non-AD patients. Patients randomized to CM achieved better outcomes than those randomized to SC, but there was no interaction between treatment condition and AD status. These findings suggest that cocaine-using methadone patients with AD achieve greater cocaine abstinence than their non-AD counterparts and should not necessarily be viewed as more difficult to treat.
同时患有酒精依赖(AD)和多种物质滥用的患者会面临更多负面后果,但这并不一定导致较差的治疗结果。针对可卡因滥用,最有效的治疗方法之一是依情况而定的管理(CM),但很少有研究探讨 AD 对戒断结果的影响,特别是在美沙酮维持治疗的患者中。我们使用了三项 CM 治疗可卡因使用的试验数据,比较了同时患有 AD 和不患有 AD、随机分配至标准治疗(SC)加或不加 CM 的美沙酮维持治疗、可卡因依赖患者(N = 193)的基线特征以及治疗后的可卡因结局和随访结果。同时患有 AD 和不患有 AD 的患者具有相似的基线特征,除了 AD 患者报告的酒精使用量更多。AD 患者的可卡因戒断时间更长,在随访时更有可能提交可卡因阴性样本。与随机分配至 SC 的患者相比,随机分配至 CM 的患者获得了更好的结果,但治疗条件和 AD 状态之间没有交互作用。这些发现表明,同时患有 AD 的可卡因使用美沙酮维持治疗患者比没有 AD 的患者实现了更长时间的可卡因戒断,不应将他们视为更难治疗的患者。
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