Brecht Mary-Lynn, Herbeck Diane
Integrated Substance Abuse Programs, Department of Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 100, Los Angeles, CA 90025, United States; School of Nursing, University of California, Los Angeles, Factor 5-151, 700 Tiverton Ave., Los Angeles, CA 90095, United States.
Integrated Substance Abuse Programs, Department of Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 100, Los Angeles, CA 90025, United States.
Drug Alcohol Depend. 2014 Jun 1;139:18-25. doi: 10.1016/j.drugalcdep.2014.02.702. Epub 2014 Mar 12.
This paper describes methamphetamine (MA) use patterns, specifically the duration of continuing abstinence ("time to relapse") for periods averaging 5 years post-discharge from treatment for MA use, and the relationship with selected user and treatment characteristics.
A sample of 350 treatment admissions from a large county substance use disorder (SUD) treatment system was randomly selected (within gender, race/ethnicity, treatment modality strata). Retrospective self-report data are from natural history interviews (NHI) conducted approximately 3 years after treatment and a follow-up of 2-3 years later. Relapse is defined as any use of MA with time as the number of months of continuous MA abstinence after treatment discharge until relapse. This outcome was constructed from a monthly MA use timeline using NHI data. A Cox model was used to examine time to relapse and predictors.
Sixty-one percent of the sample relapsed to MA use within 1 year after treatment discharge and 14% during years 2-5. Significant protective factors predicting longer time to relapse included having experienced serious MA-related psychiatric/behavioral problems (hazard ratio [HR]=0.75, p=0.027), longer duration of the index treatment episode (HR=0.93, p=0.001), and participating in self-help or other treatment during the post-treatment abstinence period (HR=0.29, p<0.001); risk factors for shorter time to relapse included having a parent with alcohol and/or drug use problems (HR=1.35, p=0.020) and involvement in MA sales (HR=1.48, p=0.002).
Results contribute a long-term perspective on patterns of MA use following treatment and support a need for early post-treatment and long-term continuing care and relapse-prevention services.
本文描述了甲基苯丙胺（MA）的使用模式，特别是从MA使用治疗出院后平均5年期间持续戒断的时长（“复发时间”），以及与选定的使用者和治疗特征之间的关系。
从一个大县物质使用障碍（SUD）治疗系统的350例治疗入院病例样本中（在性别、种族/民族、治疗方式分层内）随机选取。回顾性自我报告数据来自治疗后约3年进行的自然病史访谈（NHI）以及2 - 3年后的随访。复发定义为MA的任何使用，时间为治疗出院后直至复发的持续MA戒断月数。该结果是根据NHI数据从每月MA使用时间线构建的。使用Cox模型检查复发时间和预测因素。
61%的样本在治疗出院后1年内复发使用MA，14%在第2 - 5年复发。预测复发时间较长的显著保护因素包括经历过与MA相关的严重精神/行为问题（风险比[HR]=0.75，p = 0.027）、索引治疗疗程持续时间较长（HR = 0.93，p = 0.001）以及在治疗后戒断期参与自助或其他治疗（HR = 0.29，p < 0.001）；复发时间较短的风险因素包括有父母存在酒精和/或药物使用问题（HR = 1.35，p = 0.02）以及参与MA销售（HR = 1.48，p = 0.002）。
研究结果为治疗后MA使用模式提供了长期视角，并支持了治疗后早期和长期持续护理及预防复发服务的必要性。
