丁丙诺啡维持治疗项目结合工作/教育合同以及对非处方药物使用的低容忍度：一项针对男性和女性七年后结局的队列研究
Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.
作者信息
Öhlin Leif, Fridell Mats, Nyhlén Anna
机构信息
Department of Psychiatry, Lund University Hospital, SE, 221 85, Lund, Sweden.
Department of Psychology, Lund University, SE, 221 01, Lund, Sweden.
出版信息
BMC Psychiatry. 2015 Mar 24;15:56. doi: 10.1186/s12888-015-0415-z.
BACKGROUND
A seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed.
METHODS
A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions.
RESULTS
148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children. At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year. More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years. Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year).
CONCLUSIONS
After seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group. Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men. The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use.
背景
对接受丁丙诺啡维持治疗项目的海洛因依赖患者进行了为期七年的随访，该项目结合了合同制工作/教育以及对非处方药物使用的低容忍度。分析了结局的性别差异。
方法
连续纳入135名男性和35名女性组成队列，平均有八年海洛因滥用/依赖史，接受强化丁丙诺啡维持治疗。在入院时和随访时进行标准化访谈、精神疾病诊断评估和社会心理状况评估。报告了与性别相关的在戒断、留存率、精神症状、就业和刑事定罪方面的结局。
结果
148名患者开始治疗。七年后，148名患者中有94名（64%）留在项目中，有工作且戒除了毒品和酒精。女性在持续戒断、留存率和就业方面比男性更好（76%对60%）。一年后，高风险饮酒患者不再大量饮酒，且在整个研究期间一直保持这种状态（p <.001）。所有女性都重新获得了孩子的监护权。入院时，因精神疾病入院的女性比男性更多（70%/44%），因药物滥用接受强制治疗的女性也更多（30%/18%）。精神共病的初始性别差异在一年后减小且不再显著。曾被监禁的男性比女性更多（62%对27%），在非机构照料中的男性也更多（80%对49%）。刑事定罪从入院时的1751次减少到七年后的74次（58%）。整个队列中有8名患者在7年中死亡（每年0.7%）。一名患者在完成治疗组仍在项目期间死亡（每年0.1%）。
结论
七年后，项目中三分之二的患者戒除了毒品且有工作。完成治疗组不再有定罪情况。完成治疗组中有一名患者死亡。与男性相比，女性有更好的长期结局：持续戒断更多、就业情况更好且定罪更少。女性与孩子共同生活的比例也比男性更高。积极的结局凸显了在将药物治疗与注重就业和心理治疗以及对非处方药物使用的低容忍度相结合时保持高度结构化的重要性。
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