Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street, Vancouver, B,C, V6Z 1Y6, Canada.
Harm Reduct J. 2013 Dec 10;10:38. doi: 10.1186/1477-7517-10-38.
Addiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals. In this study we examined characteristic differences between Aboriginal and non-Aboriginal clients accessing an inpatient medical withdrawal management program, and identified risk factors associated with the probabilities of pretreatment and treatment dropouts, respectively.
2231 unique clients (Aboriginal = 451; 20%) referred to Vancouver Detox over a two-year period were assessed. For both Aboriginal and non-Aboriginal groups, multivariate logistic regression analyses were conducted with pretreatment dropout and treatment dropout as dependent variables, respectively.
Aboriginal clients had higher pretreatment and treatment dropout rates compared to non-Aboriginal clients (41.0% vs. 32.7% and 25.9% vs. 20.0%, respectively). For Aboriginal people, no fixed address (NFA) was the only predictor of pretreatment dropout. For treatment dropout, significant predictors were: being female, having HCV infection, and being discharged on welfare check issue days or weekends. For non-Aboriginal clients, being male, NFA, alcohol as a preferred substance, and being on methadone maintenance treatment (MMT) at referral were associated with pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on weekends.
Our results highlight the importance of social factors for the Aboriginal population compared to substance-specific factors for the non-Aboriginal population. These findings should help clinicians and decision-makers to recognize the importance of social supports especially housing and initiate appropriate services to improve treatment intake and subsequent retention, physical and mental health outcomes and the cost-effectiveness of treatment.
成瘾治疗面临着高的治疗前和治疗脱落率，尤其是在原住民中。在这项研究中，我们检查了接受住院医疗戒断管理项目的原住民和非原住民患者之间的特征差异，并确定了与治疗前和治疗脱落率分别相关的风险因素。
在两年期间，对 2231 名（原住民=451；20%）被转介到温哥华戒毒所的独特患者进行了评估。对于原住民和非原住民组，分别将治疗前脱落和治疗脱落作为因变量进行多变量逻辑回归分析。
与非原住民患者相比，原住民患者的治疗前和治疗脱落率更高（分别为 41.0%比 32.7%和 25.9%比 20.0%）。对于原住民来说，没有固定地址（NFA）是治疗前脱落的唯一预测因素。对于治疗脱落，有意义的预测因素包括：女性、HCV 感染、以及在福利检查日或周末出院。对于非原住民患者，男性、NFA、首选酒精作为物质以及转诊时正在接受美沙酮维持治疗（MMT）与治疗前脱落有关。治疗脱落的显著风险因素包括：年龄较小、首选物质不是酒精、首选物质是阿片类药物以及在周末出院。
与非原住民患者的物质特异性因素相比，我们的结果突出了社会因素对原住民患者的重要性。这些发现应该有助于临床医生和决策者认识到社会支持的重要性，特别是住房，并启动适当的服务，以提高治疗参与度和随后的保留率、身心健康结果以及治疗的成本效益。
