Lauritzen Grethe, Nordfjærn Trond
Department of Drug Policy, Norwegian Institute of Public Health, Oslo, Norway.
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
PLoS One. 2018 Jan 25;13(1):e0190381. doi: 10.1371/journal.pone.0190381. eCollection 2018.
To examine temporal changes in opiate and stimulant use among patients in substance abuse treatment over a ten-year observation period and to explore the role of contextual factors, mental health disorders and psychosocial factors on these changes.
A cohort of 481 patients was prospectively interviewed at admission to treatment and after 1, 2, 7 and 10 years. The sample was recruited from 20 facilities in the Greater Oslo region, Norway.
The majority of patients were poly-drug users and 80% had used both opiates and stimulants the last 30 days prior to treatment admission. Last-month use of heroin, other opiates, cocaine and amphetamines declined from 80% to 34% at the end of the observation period. The most substantial reduction was observed between baseline and one-year follow-up. Use of heroin decreased the most from 62% to 16% after 10 years (a reduction of 74%), and the reduction continued from one-year follow-up throughout the observation period. The most important multivariate risk factors for sustained use of these drugs were male gender, having one or both biological parents with severe alcohol or drug problems, having an antisocial personality disorder, and living together with a person who abuses alcohol or drugs. Employment was associated with reduced risk of drug use at 7-year follow-up.
There was a substantial reduction in opiate and stimulant use from baseline to all follow-up assessments, most greatly for heroin. Findings regarding sustained use could suggest familial transmission and the challenges of preventive strategies and treatment efforts in an intergenerational context. Co-occurrence between drug abuse and mental health problems highlights the need of highly specialized competence in SUD treatment.
研究在为期十年的观察期内，药物滥用治疗患者中阿片类药物和兴奋剂使用情况的时间变化，并探讨背景因素、心理健康障碍和社会心理因素在这些变化中的作用。
对481名患者组成的队列在入院治疗时以及治疗后1年、2年、7年和10年进行前瞻性访谈。样本来自挪威大奥斯陆地区的20家机构。
大多数患者为多药使用者，80%在治疗入院前的最后30天内同时使用过阿片类药物和兴奋剂。观察期结束时，上个月海洛因、其他阿片类药物、可卡因和苯丙胺的使用率从80%降至34%。在基线和一年随访之间观察到最大幅度的下降。海洛因的使用下降最为显著，10年后从62%降至16%（下降了74%），且从一年随访至整个观察期使用率持续下降。持续使用这些药物的最重要多变量风险因素包括男性、父母一方或双方有严重酒精或药物问题、患有反社会人格障碍以及与酗酒或吸毒者同居。在7年随访时，就业与药物使用风险降低相关。
从基线到所有随访评估，阿片类药物和兴奋剂的使用大幅减少，海洛因减少最为明显。关于持续使用的研究结果可能表明存在家族传播以及在代际背景下预防策略和治疗工作面临的挑战。药物滥用与心理健康问题并存凸显了药物使用障碍治疗中高度专业化能力的必要性。
