Kidorf Michael, King Van L, Peirce Jessica, Gandotra Neeraj, Ghazarian Sharon, Brooner Robert K
Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, USA.
Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, USA.
J Subst Abuse Treat. 2015 Apr;51:64-9. doi: 10.1016/j.jsat.2014.10.012. Epub 2014 Nov 5.
The psychiatric care of opioid users receiving agonist therapies is often complicated by high rates of illicit drug use (Brooner et al., 2013). The present study evaluates if illicit drug use (i.e., opioids, cocaine, sedatives) detected at the start of psychiatric care affects treatment response. Methadone maintenance patients (n = 125) with at least one current psychiatric disorder completed a 3-month randomized clinical trial evaluating the efficacy of financial incentives on attendance to on-site integrated substance abuse and psychiatric services (Kidorf et al., 2013). The present study re-analyzes the data set by grouping participants into one of two conditions based on the 4-week baseline observation: (1) no illicit drug use (baseline negative; n = 50), or (2) any illicit drug use (baseline positive; n = 75). All participants received a similar schedule of psychiatric services, and had good access to prescribed psychiatric medications. The Global Severity Index (GSI) of the Hopkins Symptom Checklist-Revised was administered monthly to evaluate changes in psychiatric distress. Results showed that while both conditions evidenced similar utilization of on-site psychiatric services, baseline negative participants remained in treatment somewhat longer (80.7 vs. 74.8 days, p = .04) and demonstrated greater reductions in GSI scores than baseline positive participants at month 3 (p = .004). These results have implications for interpreting previous studies that have shown inconsistent efficacy of pharmacotherapy and other psychiatric treatments, and for providing clinical care for patients with co-occurring substance use and psychiatric disorders.
接受激动剂治疗的阿片类药物使用者的精神科护理常常因非法药物使用率高而变得复杂（布鲁纳等人，2013年）。本研究评估在精神科护理开始时检测到的非法药物使用（即阿片类药物、可卡因、镇静剂）是否会影响治疗反应。125名患有至少一种当前精神疾病的美沙酮维持治疗患者完成了一项为期3个月的随机临床试验，评估经济激励措施对参加现场综合药物滥用和精神科服务的效果（基多夫等人，2013年）。本研究根据4周的基线观察将参与者分为两种情况之一，对数据集进行重新分析：（1）无非法药物使用（基线阴性；n = 50），或（2）有任何非法药物使用（基线阳性；n = 75）。所有参与者都接受了类似的精神科服务安排，并且能够很好地获得处方精神科药物。每月使用修订后的霍普金斯症状清单的全球严重指数（GSI）来评估精神痛苦的变化。结果显示，虽然两种情况在现场精神科服务的利用方面表现相似，但基线阴性的参与者在治疗中停留的时间略长（80.7天对74.8天，p = .04），并且在第3个月时，与基线阳性的参与者相比，GSI得分的降低幅度更大（p = .004）。这些结果对于解释先前显示药物治疗和其他精神科治疗效果不一致的研究，以及为同时患有物质使用和精神疾病的患者提供临床护理具有启示意义。
