From the Department of Psychiatry (ANCC, EVN), New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York; Department of Psychiatry and Behavioral Health (ANCC), St Luke's Roosevelt Hospital Center, New York, NY; Department of Psychiatry and Behavioral Sciences (EAM), Medical University of South Carolina, Clinical Neuroscience Division, Charleston; Department of Psychiatry (MCH), Columbia University College of Physicians and Surgeons, New York, NY; New York State Psychiatric Institute (ET), New York; Northshore-Long Island Jewish Health System (BG), Glen Oaks, NY; and HARBEL Prevention and Recovery Center (PQS), Baltimore, MD.
J Addict Med. 2013 Sep-Oct;7(5):363-71. doi: 10.1097/ADM.0b013e31829e3971.
This study examines sociodemographic and clinical characteristics, as a function of primary substance of abuse, among clients approached, screened, and assessed for eligibility in a 10-site effectiveness trial of a Web-based psychosocial intervention for substance use disorders. Consistent with the design of effectiveness trials, eligibility criteria were broad and exclusion criteria minimal; thus, the recruited sample may be viewed as relatively representative of patients seeking treatment throughout the United States.
χ tests for categorical variables and F tests for continuous variables were used to analyze demographic, substance use, physical and mental health, and sexual risk data collected at screening and baseline; pairwise comparisons between primary substance subgroups for baseline data were conducted if the test statistic P value was 0.01 or less.
Few participants expressed disinterest in the study at screening because of the computer-assisted intervention. A diverse sample of substance users completed baseline and were enrolled: 22.9% marijuana; 21.7% opiates; 20.9% alcohol; 20.5% cocaine; and 13.9% stimulants users. Marijuana users demonstrated the greatest differences across primary substances: they were younger, less likely to be married or attend 12-step meetings, and more likely to be in treatment as a result of criminal justice involvement. All patients, even marijuana users, reported comparable rates of co-occurring mental health disorders and sexual risk and substantial rates of polysubstance use disorders.
Primary substance of abuse may be a less important indicator of overall severity compared with co-occurring disorders and other factors common across treatment seekers, further demonstrating the need for integrated treatment services and care and comprehensive pretreatment assessment.
本研究考察了社会人口学和临床特征,这些特征与通过网络进行的基于心理的物质使用障碍干预的 10 个地点有效性试验中被接触、筛选和评估的患者的主要滥用物质有关。与有效性试验的设计一致,纳入标准广泛,排除标准最小;因此,招募的样本可以被视为在美国各地寻求治疗的患者的相对代表性样本。
使用卡方检验进行分类变量分析,使用 F 检验进行连续变量分析,对筛选和基线时收集的人口统计学、物质使用、身体和心理健康以及性风险数据进行分析;如果检验统计量 P 值为 0.01 或更小,则对主要物质亚组的基线数据进行两两比较。
由于计算机辅助干预,很少有参与者在筛选时对研究表示不感兴趣。完成基线并被纳入的是一个多样化的物质使用者样本:22.9%的大麻使用者;21.7%的阿片类药物使用者;20.9%的酒精使用者;20.5%的可卡因使用者;13.9%的兴奋剂使用者。大麻使用者在主要物质之间表现出最大的差异:他们更年轻,已婚或参加 12 步会议的可能性较小,并且更有可能因刑事司法介入而接受治疗。所有患者,甚至大麻使用者,都报告了类似的共病精神健康障碍和性风险发生率,以及大量的多物质使用障碍发生率。
与共病障碍和其他常见于治疗寻求者的因素相比,主要滥用物质可能是总体严重程度的一个不太重要的指标,进一步证明了需要综合治疗服务和护理以及全面的治疗前评估。