University of California, Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA 90025, USA.
Am J Epidemiol. 2013 Apr 1;177(7):675-82. doi: 10.1093/aje/kws284. Epub 2013 Feb 27.
In accordance with the chronic disease model of opioid dependence, cessation is often observed as a longitudinal process rather than a discrete endpoint. We aimed to characterize and identify predictors of periods of heroin abstinence in the natural history of recovery from opioid dependence. Data were collected on participants from California who were enrolled in the Civil Addict Program from 1962 onward by use of a natural history interview. Multivariate regression using proportional hazards frailty models was applied to identify independent predictors and correlates of repeated abstinence episode durations. Among 471 heroin-dependent males, 387 (82.2%) reported 932 abstinence episodes, 60.3% of which lasted at least 1 year. Multivariate analysis revealed several important findings. First, demographic factors such as age and ethnicity did not explain variation in durations of abstinence episodes. However, employment and lower drug use severity predicted longer episodes. Second, abstinence durations were longer following sustained treatment versus incarceration. Third, individuals with multiple abstinence episodes remained abstinent for longer durations in successive episodes. Finally, abstinence episodes initiated >10 and ≤20 years after first use lasted longer than others. Public policy facilitating engagement of opioid-dependent individuals in maintenance-oriented drug treatment and employment is recommended to achieve and sustain opioid abstinence.
根据阿片类药物依赖的慢性病模式，停止使用阿片类药物通常被视为一个纵向过程，而不是一个离散的终点。我们旨在描述和确定从阿片类药物依赖中恢复的自然史中，海洛因戒除期的特征，并确定其预测因素。数据来自于加利福尼亚州的参与者，他们于 1962 年起通过自然历史访谈被纳入民事成瘾者项目。使用比例风险脆弱性模型的多变量回归分析用于确定重复禁欲期持续时间的独立预测因素和相关性。在 471 名男性海洛因依赖者中，387 名（82.2%）报告了 932 次禁欲期，其中 60.3%至少持续了 1 年。多变量分析揭示了一些重要发现。首先，年龄和种族等人口统计学因素并不能解释禁欲期持续时间的变化。然而，就业和较低的药物使用严重程度预示着更长的禁欲期。其次，与监禁相比，持续治疗后禁欲期更长。第三，有多次禁欲期的个体在随后的禁欲期内保持禁欲的时间更长。最后，首次使用后 10 年至 20 年开始的禁欲期比其他禁欲期持续时间更长。建议采取公共政策，促使阿片类药物依赖者参与以维持为导向的药物治疗和就业，以实现和维持阿片类药物的禁欲。
