Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Addiction. 2013 Nov;108(11):1942-51. doi: 10.1111/add.12269. Epub 2013 Jul 19.
Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of on-site and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes.
Participants at the Addiction Treatment Services (ATS) were assigned randomly to receive on-site and integrated substance abuse and psychiatric care (on-site: n = 160) versus off-site and non-integrated substance abuse and psychiatric care (off-site: n = 156), and observed for 1 year. On-site participants received all psychiatric care within the substance abuse program by the same group of treatment providers. The same type and schedule of psychiatric services were available to off-site participants at a community psychiatry program.
All participants received routine methadone maintenance at the ATS program in Baltimore, Maryland, USA.
Participants were opioid-dependent men and women with at least one comorbid psychiatric disorder, as assessed by the Structured Clinical Interview for DSM-IV and confirmed by expert clinical reappraisal.
Outcomes included psychiatric service utilization and retention, Hopkins Symptom Checklist Global Severity Index (GSI) change scores and urinalysis test results.
On-site participants were more likely to initiate psychiatric care 96.9 to 79.5%; P < 0.001), remain in treatment longer (195.9 versus 101.9 days; P < 0.001), attend more psychiatrist appointments (12.9 versus 2.7; P < 0.001) and have greater reductions in GSI scores (4.2 versus 1.7; P = 0.003) than off-site participants; no differences were observed for drug use.
On-site and integrated psychiatric and substance misuse services in a methadone treatment setting might improve psychiatric outcomes compared with off-site and non-integrated substance misuse and psychiatric care. However, this might not translate into improved substance misuse outcomes.
将精神科服务融入物质滥用治疗环境是一种很有前途的服务提供模式，但尚未通过随机分配精神科治疗环境和控制精神科护理来评估。本研究评估了在阿片类药物治疗计划中提供现场和综合精神科服务对精神和物质使用结果的疗效。
在 Addiction Treatment Services（ATS）的参与者被随机分配接受现场和综合物质滥用和精神保健（现场组：n=160）或非现场和非综合物质滥用和精神保健（非现场组：n=156），并观察了 1 年。现场组参与者通过同一组治疗提供者在物质滥用计划内接受所有精神科护理。非现场组参与者可在社区精神病学计划中获得相同类型和时间表的精神科服务。
所有参与者均在美国马里兰州巴尔的摩的 ATS 计划中接受常规美沙酮维持治疗。
参与者为患有至少一种共病精神障碍的阿片类药物依赖男性和女性，通过 DSM-IV 结构化临床访谈进行评估，并通过专家临床重新评估得到确认。
结果包括精神科服务的利用和保留、Hopkins 症状清单全球严重程度指数（GSI）变化评分和尿液分析测试结果。
现场组参与者更有可能开始接受精神科护理 96.9%到 79.5%；P<0.001），治疗时间更长（195.9 天比 101.9 天；P<0.001），就诊次数更多（12.9 次比 2.7 次；P<0.001），GSI 评分降低幅度更大（4.2 分比 1.7 分；P=0.003），而非现场组参与者则没有观察到差异；在药物使用方面没有差异。
与非现场和非综合物质滥用和精神保健相比，在美沙酮治疗环境中提供现场和综合精神科和物质滥用服务可能会改善精神科结果。然而，这可能不会转化为改善物质滥用结果。
