King Van L, Brooner Robert K, Peirce Jessica, Kolodner Ken, Kidorf Michael
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Dual Diagn. 2014;10(2):60-7. doi: 10.1080/15504263.2014.906132.
Most opioid users seeking treatment in community-based substance abuse treatment programs have at least one co-occurring psychiatric disorder, and the presence of psychiatric comorbidity in this population is associated with increased psychological distress, poorer quality of life, and reduced response to substance abuse treatment. This observational study describes clinical outcomes of referring patients receiving methadone maintenance with at least one co-occurring psychiatric disorder to a community psychiatry program located on the same hospital campus.
Participants (n = 156) were offered priority referrals to a community psychiatry program that included regularly scheduled psychiatrist appointments, individual and group therapy, and enhanced access to psychiatric medications for 1 year. Psychiatric distress was measured with the Symptom Checklist (SCL-90-R), which participants completed monthly.
While about 80% of the sample (n = 124) initiated psychiatric care, the average length of treatment was only 128.2 days (SD = 122.8), participants attended only 33% of all scheduled appointments (M = 14.9 sessions, SD = 14.1), and 84% (n = 104) did not complete a full year of care. Of those who did not complete a full year, over half (55%, n = 68) left psychiatric care while still receiving substance abuse treatment. Exploratory negative binomial regression showed that baseline cocaine and alcohol use disorder (p = .002 and .022, respectively) and current employment (p = .034) were associated with worse psychiatric treatment retention. Modest reductions in psychiatric distress over time were observed (SCL-90-R Global Severity Index change score = 2.5; paired t = 3.54, df = 121, p = .001).
Referral of patients with co-occurring psychiatric disorders receiving methadone maintenance to a community psychiatry program is often ineffective, even after reducing common barriers to care. Service delivery models designed to improve attendance and retention, such as integrated care models, should be evaluated. This study is part of a larger clinical trial, registered at www.clinicaltrials.gov under #NCT00787735.
在社区药物滥用治疗项目中寻求治疗的大多数阿片类药物使用者至少患有一种共病精神障碍，该人群中精神疾病共病与心理困扰增加、生活质量较差以及药物滥用治疗反应降低有关。这项观察性研究描述了将接受美沙酮维持治疗且至少患有一种共病精神障碍的患者转介至位于同一医院院区的社区精神病学项目后的临床结果。
为156名参与者提供了转介至社区精神病学项目的优先机会，该项目包括定期安排精神科医生问诊、个体和团体治疗以及为期1年的增加精神科药物获取途径。使用症状清单（SCL - 90 - R）测量精神困扰，参与者每月完成一次。
虽然约80%的样本（n = 124）开始接受精神科护理，但平均治疗时长仅为128.2天（标准差 = 122.8），参与者仅参加了所有预定问诊的33%（中位数 = 14.9次问诊，标准差 = 14.1），且84%（n = 104）未完成一整年的护理。在未完成一整年护理的人群中，超过一半（55%，n = 68）在仍接受药物滥用治疗时就停止了精神科护理。探索性负二项回归显示，基线可卡因和酒精使用障碍（分别为p = .002和.022）以及当前就业情况（p = .034）与较差的精神科治疗留存率相关。随着时间推移观察到精神困扰有适度减轻（SCL - 90 - R全球严重程度指数变化得分 = 2.5；配对t检验 = 3.54，自由度 = 121，p = .001）。
将接受美沙酮维持治疗的共病精神障碍患者转介至社区精神病学项目通常效果不佳，即使在减少常见护理障碍之后。应评估旨在提高就诊率和留存率的服务提供模式，如综合护理模式。本研究是一项更大规模临床试验的一部分，已在www.clinicaltrials.gov上注册，注册号为#NCT00787735。
