Pear Therapeutics, Boston, MA, United States of America.
Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, Center City, MN 55012, United States of America.
J Subst Abuse Treat. 2019 Sep;104:51-63. doi: 10.1016/j.jsat.2019.06.009. Epub 2019 Jun 12.
Opioid overdose deaths and healthcare costs associated with opioid use disorder (OUD) continue to escalate while the majority of addiction treatment providers in the United States do not use medication-assisted treatment (MAT) in spite of proven efficacy. The primary resistance to the use of MAT has been associated with the philosophical conflict many 12-step based treatment programs have with the use of these medications.
This study sought to determine whether patients self-selecting into a treatment program based upon the 12-step philosophy would elect to use MAT and, if so, what initial outcomes might result.
This naturalistic, prospective study of patients (N = 253) with OUD included a combination of OUD-specific group therapy and the use of buprenorphine-naloxone, oral naltrexone, injectable naltrexone, or no medication with standard 12-step treatment initiated in a residential or day treatment setting with outpatient follow-up. Baseline assessment of subjects with OUD included level of craving and opioid withdrawal symptom severity. Post-residential treatment outcomes at 1- and 6-months included craving, opioid withdrawal, residential treatment completion, continuing care compliance, medication compliance, substance use frequency and 12-step meeting attendance.
Irrespective of medication condition, nearly all patients successfully completed residential treatment and the majority attended additional programming afterward. Among those who elected to take a medication (71%), differences were associated with medication compliance. Patients who reported compliance with their medication at 1 and 6 months following residential treatment had significantly higher abstinence rates than patients who reported noncompliance. Among those who relapsed post-discharge, neither medication use nor compliance was significantly related to a change in the frequency of alcohol use days or drug use days at 6 months.
These preliminary results suggest that it is feasible to administer medications, including partial opioid agonists like buprenorphine, within the context of 12-step based treatment and taking these medications as prescribed is associated with favorable outcomes.
尽管有循证疗效，美国大多数成瘾治疗提供者仍不使用药物辅助治疗（MAT），而阿片类药物过量死亡和与阿片类药物使用障碍（OUD）相关的医疗保健费用持续上升。对 MAT 使用的主要抵制与许多 12 步治疗计划与这些药物使用相关的哲学冲突有关。
本研究旨在确定基于 12 步哲学自行选择治疗计划的患者是否会选择使用 MAT，如果是，可能会产生哪些初始结果。
本研究对 253 名 OUD 患者进行了自然主义、前瞻性研究，包括 OUD 特定的小组治疗和丁丙诺啡-纳洛酮、口服纳曲酮、注射用纳曲酮或无药物治疗的组合，标准 12 步治疗在住院或日间治疗环境中启动，并进行门诊随访。OUD 患者的基线评估包括成瘾程度和阿片类药物戒断症状严重程度。住院治疗后 1 个月和 6 个月的治疗结果包括成瘾、阿片类药物戒断、住院治疗完成、继续治疗依从性、药物依从性、物质使用频率和 12 步会议出席情况。
无论药物状况如何，几乎所有患者都成功完成了住院治疗，大多数患者在之后还参加了其他治疗项目。在选择服用药物的患者中（71%），差异与药物依从性有关。在住院治疗后 1 个月和 6 个月报告药物依从性的患者，与报告不依从性的患者相比，具有更高的禁欲率。在出院后复发的患者中，药物使用和依从性与 6 个月时酒精使用天数或药物使用天数的变化均无显著相关性。
这些初步结果表明，在 12 步治疗的背景下管理药物（包括丁丙诺啡等部分阿片类激动剂）是可行的，按规定服用这些药物与良好的结果相关。
