Geneva University Hospitals, Geneva, Switzerland,
Geneva University Hospitals, Geneva, Switzerland.
Eur Addict Res. 2019;25(2):56-67. doi: 10.1159/000496742. Epub 2019 Jan 30.
Substance use disorders (SUD) are an important health issue internationally. Traditional outpatient programmes often do not adequately address the substantial medical and social needs and in addition many patients have difficulties accessing the care needed. The assertive community treatment (ACT) model was originally developed for patients with a severe mental illness but has been adapted for patients with SUD by integrating specific SUD treatments into the traditional ACT model. This paper aims to assess the effectiveness of ACT for patients with SUD on a number of measures.
We performed a systematic review of ACT interventions for patients with SUD by analyzing randomized controlled studies published before June 2017 found on the electronic databases PsychINFO, MEDLINE, PsychARTICLES. Eleven publications using 5 datasets were included in the analysis. Quality of studies was analyzed using the JADAD scale or Oxford quality scoring system. Outcome measures used were substance use, treatment engagement, hospitalization rates, quality of life, housing status, medication compliance and legal problems. Patients included in the studies had a diagnosis of SUD. Two datasets included homeless patients and 2 datasets included patients with high service use.
The results of the very few existing randomized control studies are mixed. Treatment engagement was higher for ACT in 4 datasets. One dataset reported higher service contact rates for the ACT group than for controls. In 2 datasets a positive effect on hospitalization rates was found. Higher fidelity to the ACT model appears to improve outcomes. Substance use reduced only in half of the datasets, of which only one showed a significant reduction in the ACT group. Overall, ACT is a promising approach that may be useful for promoting treatment engagement for patients with SUD. According to earlier studies on patients with severe mental illness, patients with high inpatient service use benefit most from this assertive approach. We hypothesize that a similar high need user group among patients with SUD might benefit most from ACT. Further research is needed to examine which types of clinical interventions might help difficult-to-engage patients with addictions.
物质使用障碍（SUD）是国际上一个重要的健康问题。传统的门诊项目通常不能充分满足大量的医疗和社会需求，此外，许多患者难以获得所需的护理。积极社区治疗（ACT）模式最初是为患有严重精神疾病的患者开发的，但通过将特定的 SUD 治疗方法整合到传统的 ACT 模式中，已经适应了 SUD 患者。本文旨在评估 ACT 对 SUD 患者在多个方面的疗效。
我们通过分析在电子数据库 PsychINFO、MEDLINE 和 PsychARTICLES 上找到的 2017 年 6 月之前发表的随机对照研究，对 SUD 患者的 ACT 干预进行了系统评价。纳入分析的有 11 项使用 5 个数据集的出版物。使用 JADAD 量表或牛津质量评分系统分析研究质量。使用的结果测量指标包括物质使用、治疗参与度、住院率、生活质量、住房状况、药物依从性和法律问题。研究纳入的患者均有 SUD 诊断。两个数据集纳入了无家可归的患者，两个数据集纳入了高服务利用的患者。
为数不多的现有随机对照研究的结果参差不齐。在 4 个数据集中，ACT 的治疗参与度更高。一个数据集报告说 ACT 组的服务接触率高于对照组。在 2 个数据集中，ACT 组的住院率呈积极影响。更高的 ACT 模型保真度似乎改善了结果。仅在一半的数据集观察到物质使用减少，其中只有一个数据集显示 ACT 组的物质使用减少具有统计学意义。总的来说，ACT 是一种很有前途的方法，可能有助于提高 SUD 患者的治疗参与度。根据先前对严重精神疾病患者的研究，高住院服务利用的患者最受益于这种积极的方法。我们假设 SUD 患者中有类似高需求的用户群体可能最受益于 ACT。需要进一步研究来检验哪种类型的临床干预可能有助于治疗难以参与的成瘾患者。
