Marel Christina, Mills Katherine L, Slade Tim, Darke Shane, Ross Joanne, Teesson Maree
The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia.
National Drug and Alcohol Research Centre, University of New South Wales, Australia.
EClinicalMedicine. 2019 Aug 8;14:71-79. doi: 10.1016/j.eclinm.2019.07.013. eCollection 2019 Sep.
Heroin is currently contributing to the worst drug addiction epidemic in United States history; recent rates of use, dependence and death have also increased dramatically in parts of Europe. An improved understanding of the long-term relationship between heroin use and treatment utilisation is essential to inform both clinical and public health responses. We aimed to identify i) joint trajectories of heroin use and treatment utilisation, ii) predictors of joint group membership, and iii) outcomes associated with joint group membership; over 10-11 years among a cohort of Australians with heroin dependence.
A total of 615 people with heroin dependence were recruited as part of a prospective longitudinal cohort study between 2001 and 02. This analysis focuses on 428 participants (70.1% of the original cohort) for whom complete data were available over 10-11 years.
Five joint trajectory groups were identified: i) 'long-term stable' (17%: decrease in probability of heroin use alongside high treatment utilisation); ii) 'long-term success' (13%: decrease in heroin use alongside decreased treatment utilisation, until there was maintained abstinence from heroin with no treatment utilisation); iii) 'treatment failure' (12%: no decrease in heroin use alongside high treatment utilisation); iv) 'late success' (9%: gradual decrease in heroin use alongside increased treatment utilisation); and v) 'relapsed' (9%: relapse in heroin use alongside an increase and decrease in treatment utilisation). Few variables were found to predict joint group membership, but group membership was predictive of demographic, substance use and physical and mental health outcomes at 10-11 years.
The role of treatment in recovery from heroin dependence is undeniable; however, a considerable proportion of people are able achieve and maintain abstinence without the need for ongoing treatment. An equally significant proportion will continue to use heroin despite being in long-term treatment.
Australian National Health and Medical Research Council.
海洛因目前正导致美国历史上最严重的药物成瘾流行；欧洲部分地区近期的使用、依赖和死亡率也急剧上升。更好地理解海洛因使用与治疗利用之间的长期关系对于指导临床和公共卫生应对措施至关重要。我们旨在确定：i）海洛因使用和治疗利用的联合轨迹；ii）联合组成员的预测因素；iii）与联合组成员相关的结果；在一组有海洛因依赖的澳大利亚人中进行为期10 - 11年的研究。
2001年至2002年期间，共有615名海洛因依赖者被招募参加一项前瞻性纵向队列研究。本分析聚焦于428名参与者（占原始队列的70.1%），他们在10 - 11年期间有完整的数据。
确定了五个联合轨迹组：i）“长期稳定”（17%：海洛因使用概率下降，同时治疗利用率高）；ii）“长期成功”（13%：海洛因使用减少，同时治疗利用率下降，直至保持海洛因戒断且无需治疗）；iii）“治疗失败”（12%：海洛因使用无减少，同时治疗利用率高）；iv）“后期成功”（9%：海洛因使用逐渐减少，同时治疗利用率增加）；v）“复发”（9%：海洛因使用复发，同时治疗利用率有增减）。几乎没有发现变量可预测联合组成员身份，但组成员身份可预测10 - 11年时的人口统计学、物质使用以及身心健康结果。
治疗在海洛因依赖康复中的作用不可否认；然而，相当一部分人能够在无需持续治疗的情况下实现并保持戒断。同样有相当比例的人尽管接受长期治疗仍会继续使用海洛因。
澳大利亚国家卫生与医学研究委员会。
