Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454, USA.
Subst Abuse Treat Prev Policy. 2011 Oct 18;6:28. doi: 10.1186/1747-597X-6-28.
Chronic medical diseases require regular and longitudinal care and self-management for effective treatment. When chronic diseases include substance use disorders, care and treatment of both the medical and addiction disorders may affect access to care and the ability to focus on both conditions. The objective of this paper is to evaluate the association between the presence of chronic medical disease and recent addiction treatment utilization among adults with substance dependence.
Cross-sectional secondary data analysis of self-reported baseline data from alcohol and/or drug-dependent adults enrolled in a randomized clinical trial of a disease management program for substance dependence in primary care. The main independent variable was chronic medical disease status, categorized using the Katz Comorbidity Score as none, single condition of lower severity, or higher severity (multiple conditions or single higher severity condition), based on comorbidity scores determined from self-report. Asthma was also examined in secondary analyses. The primary outcome was any self-reported addiction treatment utilization (excluding detoxification) in the 3 months prior to study entry, including receipt of any addiction-focused counseling or addiction medication from any healthcare provider. Logistic regression models were adjusted for sociodemographics, type of substance dependence, recruitment site, current smoking, and recent anxiety severity.
Of 563 subjects, 184 (33%) reported any chronic disease (20% low severity; 13% higher severity) and 111 (20%) reported asthma; 157 (28%) reported any addiction treatment utilization in the past 3 months. In multivariate regression analyses, no significant effect was detected for chronic disease on addiction treatment utilization (adjusted odds ratio [AOR] 0.88 lower severity vs. none, 95% confidence interval (CI): 0.60, 1.28; AOR 1.29 higher severity vs. none, 95% CI: 0.89, 1.88) nor for asthma.
In this cohort of alcohol and drug dependent persons, there was no significant effect of chronic medical disease on recent addiction treatment utilization. Chronic disease may not hinder or facilitate connection to addiction treatment.
慢性病需要定期进行纵向护理和自我管理，以实现有效治疗。当慢性病包括物质使用障碍时，对医疗和成瘾障碍的护理和治疗可能会影响获得护理的机会，并影响对两种病症的关注能力。本文的目的是评估患有物质依赖的成年人中存在慢性内科疾病与近期成瘾治疗利用之间的关联。
对初级保健中物质依赖疾病管理计划的随机临床试验中纳入的酒精和/或药物依赖成年人的自我报告基线数据进行横断面二次数据分析。主要的独立变量是慢性内科疾病状态，根据自报告确定的共病评分，使用 Katz 合并症评分将其分为无、单一轻度严重程度或更严重程度（多种疾病或单一严重程度更高的疾病）。在二次分析中还检查了哮喘。主要结局是在研究入组前的 3 个月内，任何自我报告的成瘾治疗利用（不包括戒毒），包括从任何医疗保健提供者处获得任何成瘾相关咨询或成瘾药物。逻辑回归模型根据社会人口统计学、物质依赖类型、招募地点、当前吸烟情况和近期焦虑严重程度进行了调整。
在 563 名受试者中，184 名（33%）报告了任何慢性疾病（20%为轻度严重程度；13%为更严重程度），111 名（20%）报告了哮喘；157 名（28%）报告了过去 3 个月内任何成瘾治疗利用。在多变量回归分析中，慢性疾病对成瘾治疗利用没有显著影响（调整后的优势比 [AOR] 轻度严重程度较无疾病者低 0.88，95%置信区间 [CI]：0.60，1.28；严重程度较高者较无疾病者高 1.29，95%CI：0.89，1.88），哮喘也没有显著影响。
在这个酒精和药物依赖人群队列中，慢性内科疾病对近期成瘾治疗的利用没有显著影响。慢性疾病可能不会阻碍或促进与成瘾治疗的联系。
