Teesson Maree, Marel Christina, Darke Shane, Ross Joanne, Slade Tim, Burns Lucy, Lynskey Michael, Memedovic Sonja, White Joanne, Mills Katherine L
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use, University of New South Wales, Australia.
Addiction. 2017 Jun;112(6):1056-1068. doi: 10.1111/add.13747. Epub 2017 Feb 13.
To identify trajectories of heroin use in Australia, predictors of trajectory group membership and subsequent outcomes among people with heroin dependence over 10-11 years.
Longitudinal cohort study.
Sydney, Australia.
A total of 615 participants were recruited between 2001 and 2002 as part of the Australian Treatment Outcome Study (66.2% male; mean age 29 years). The predominance of the cohort (87.0%) was recruited upon entry to treatment (maintenance therapies, detoxification and residential rehabilitation), and the remainder from non-treatment settings (e.g. needle and syringe programmes). This analysis focused upon 428 participants for whom data on heroin use were available over 10-11 years following study entry.
Structured interviews assessed demographics, treatment history, heroin and other drug use, overdose, criminal involvement, physical health and psychopathology. Group-based trajectory modelling was used to: (i) identify trajectory groups based on use of heroin in each year, (ii) examine predictors of group membership and (iii) examine associations between trajectory group membership and 10-11-year outcomes.
Six trajectory groups were identified [Bayesian Information Criterion (BIC) = -1927.44 (n = 4708); -1901.07 (n = 428)]. One in five (22.1%) were classified as having 'no decrease' in heroin use, with the probability of using remaining high during the 10-11 years (> 0.98 probability of use in each year). One in six (16.1%) were classified as demonstrating a 'rapid decrease to maintained abstinence'. The probability of heroin use among this group declined steeply in the first 2-3 years and continued to be low (< 0.01). The remaining trajectories represented other fluctuating patterns of use. Few baseline variables were found to predict trajectory group membership, but group membership was predictive of demographic, substance use and physical and mental health outcomes at 10-11 years.
Long-term trajectories of heroin use in Australia appear to show considerable heterogeneity during a decade of follow-up, with few risk factors predicting group membership. Just more than a fifth continued to use at high levels, while fewer than a fifth become abstinent early on and remained abstinent. The remainder showed fluctuating patterns.
确定澳大利亚海洛因使用轨迹、轨迹组成员的预测因素以及海洛因依赖者在10至11年期间的后续结果。
纵向队列研究。
澳大利亚悉尼。
2001年至2002年期间，共有615名参与者作为澳大利亚治疗结果研究的一部分被招募（男性占66.2%；平均年龄29岁）。队列中的大多数（87.0%）是在进入治疗时（维持治疗、戒毒和住院康复）被招募的，其余的来自非治疗环境（如针头和注射器项目）。本分析聚焦于428名参与者，他们在研究进入后的10至11年期间有海洛因使用数据。
结构化访谈评估了人口统计学、治疗史、海洛因和其他药物使用、过量用药、犯罪参与、身体健康和精神病理学情况。基于群体的轨迹模型用于：（i）根据每年的海洛因使用情况确定轨迹组，（ii）检查轨迹组成员的预测因素，以及（iii）检查轨迹组成员与10至11年结果之间的关联。
确定了六个轨迹组[贝叶斯信息准则（BIC）=-1927.44（n = 4708）；-1901.07（n = 428）]。五分之一（22.1%）的人被归类为海洛因使用“无减少”，在10至11年期间使用的可能性仍然很高（每年使用的概率>0.98）。六分之一（16.1%）的人被归类为表现出“迅速减少至持续戒断”。该组中海洛因使用的可能性在前2至3年急剧下降，并持续处于低水平（<0.01）。其余轨迹代表了其他波动的使用模式。几乎没有发现基线变量可预测轨迹组成员，但轨迹组成员可预测10至11年时的人口统计学、物质使用以及身心健康结果。
在十年的随访期间，澳大利亚海洛因使用的长期轨迹似乎显示出相当大的异质性，几乎没有风险因素可预测轨迹组成员。略多于五分之一的人继续大量使用，而不到五分之一的人早期就实现并保持了戒断。其余的人表现出波动模式。
