Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA.
Johns Hopkins Bayview Medical Center, Baltimore, MD, 21224, USA.
Drug Alcohol Depend. 2019 Sep 1;202:200-208. doi: 10.1016/j.drugalcdep.2019.05.026. Epub 2019 Jul 16.
Treatment with opioid agonists is effective for opioid use disorder, but early discontinuation of treatment is a major obstacle to success. Intensive longitudinal methods - which take many repeated measurements over time, usually in the field- have provided unique insight into the effects of stress, mood and craving on drug use while people are being treated; these methods might also be useful for studying the processes that lead people to drop out of treatment.
Ecological momentary assessment (EMA) was conducted for up to 17 weeks by obtaining multiple electronic diary entries per day from 238 participants being treated with methadone or buprenorphine-naloxone. Survival analysis was used to study two outcomes: dropping out of treatment and noncompliance with EMA self-report requirements. Self-reports of stress, craving, and mood were used as time-varying predictors. Demographic and psychosocial variables measured with the Addiction Severity Index at the start of treatment were used as time-invariant predictors.
Dropping out of treatment was more likely in participants with more reported hassles (a measure of stress), higher levels of cocaine craving, lower levels of positive mood, a recent history of emotional abuse, a recent history of being bothered frequently by psychological problems, and with buprenorphine rather than methadone as their medication. In contrast, study noncompliance was not significantly associated with any of the variables analyzed.
Assessment of stress, craving and mood during treatment might identify people who are at greater risk of dropping out, and therapeutic interventions targeting these processes might increase retention.
阿片类药物激动剂治疗对于阿片类药物使用障碍是有效的，但治疗早期的停药是成功的主要障碍。密集的纵向方法——通常在现场进行多次重复测量，随着时间的推移——为研究压力、情绪和渴望对药物使用的影响提供了独特的见解，而这些方法也可能有助于研究导致人们退出治疗的过程。
对 238 名接受美沙酮或丁丙诺啡-纳洛酮治疗的参与者进行了长达 17 周的生态瞬时评估（EMA），每天获得多次电子日记条目。生存分析用于研究两个结果：退出治疗和不遵守 EMA 自我报告要求。压力、渴望和情绪的自我报告被用作时变预测因子。在治疗开始时使用成瘾严重程度指数测量的人口统计学和心理社会变量被用作时不变预测因子。
报告的麻烦（压力测量）越多、可卡因渴望程度越高、积极情绪水平越低、近期有情感虐待史、近期经常因心理问题而烦恼、以及使用丁丙诺啡而非美沙酮作为药物的参与者，退出治疗的可能性更大。相比之下，研究不遵守情况与分析的任何变量都没有显著关联。
在治疗期间评估压力、渴望和情绪可能会识别出更有可能退出治疗的人，针对这些过程的治疗干预可能会增加保留率。
