Magura Stephen, Spybrook Jessaca, Rosenblum Andrew, Fong Chunki, Villano Cherie, Vogel Howard S, Betzler Thomas
Open Addict J. 2010;3:102-108. doi: 10.2174/1874941001003010102.
A challenge for psychiatric treatment programs is to accurately identify individuals with drug misuse problems at admission to treatment. Consecutive new admissions to an urban continuing day treatment (n=229) during 2003-2005 were recruited and their treatment status was determined after one year. At admission, 34% were diagnosed with drug dependence/abuse based on a DSM-IV clinical interview, whereas 69% were found to be misusing drugs based on a research protocol consisting of self-reports of use within the past 30 days and drug toxicologies. Drug misuse as identified by the research protocol predicted a clinically meaningful outcome - early exit from treatment (relative risk = 2.7, p < .01), but DSM-IV diagnosis of drug use disorder was not predictive. These results suggest that psychiatric outpatient programs should consider adding an assessment for drug misuse to a comprehensive clinical assessment at admission to treatment.
精神治疗项目面临的一项挑战是在治疗入院时准确识别有药物滥用问题的个体。招募了2003年至2005年期间城市日间持续治疗中心连续的新入院患者（n = 229），并在一年后确定他们的治疗状况。入院时，根据《精神疾病诊断与统计手册》第四版（DSM-IV）临床访谈，34%的患者被诊断为药物依赖/滥用，而根据一项研究方案，即过去30天内自我报告的用药情况和药物毒理学检测，发现69%的患者存在药物滥用。研究方案所确定的药物滥用可预测一个具有临床意义的结果——提前退出治疗（相对风险 = 2.7，p < 0.01），但DSM-IV对药物使用障碍的诊断并无预测作用。这些结果表明，精神科门诊项目应考虑在治疗入院时的综合临床评估中增加对药物滥用的评估。
