Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States.
Department of Epidemiology, Florida International University, 11200 SW 8th St AHC5, Miami, FL 33199, United States.
J Subst Abuse Treat. 2020 May;112:68-75. doi: 10.1016/j.jsat.2020.01.016. Epub 2020 Jan 25.
There are several relatively safe and effective FDA-approved medications for Opioid Use Disorder (OUD). Despite the existence of these medications, the rate of returning to opioid use after treatment is relatively high, underscoring the need for continued enhancement of treatments. Adjunctive psychosocial interventions paired with medication have been shown to improve OUD treatment outcomes. However, studies have yet to conclusively examine the distinct effects of the most widely utilized psychosocial treatment modalities. The current study will investigate the relationship between individual counseling, group therapy, and 12-Step participation and illicit opioid abstinence at the end of treatment, 1 and 3 months after treatment.
A secondary analysis was conducted with data from a sample of 570 individuals diagnosed with OUD who were recruited from eight substance abuse treatment centers in the United States. Participants were enrolled in a two-group randomized, controlled trial testing buprenorphine-naloxone versus extended-release naltrexone for OUD. A two-level hierarchical linear growth model was used to examine the effects of individual counseling, group therapy, and 12-Step participation on illicit opioid abstinence (urinanalyses) 1- and 3-months post-treatment.
Hours of individual counseling and 12-Step participation significantly predicted abstinence at follow-up (p < .001, b = -0.59, 95% CI [0.42, 0.74]; p < .01, b = -0.05, 95% CI [0.92, 0.98]). There was a significant interaction between individual counseling and 12-Step participation (p < .01, b = -0.06, 95% CI [1.02, 1.10]). Additionally, participant age and employment status were significant predictors of illicit opioid abstinence (p < .01, b = -0.02, 95% CI [0.97, 0.99]; p < .01, b = -0.38, 95% CI [0.52, 0.90]). Hours of group therapy was not found to significantly predict illicit opioid abstinence.
Findings suggest that greater levels of individual therapy and 12-Step participation may be beneficial for individuals receiving medication treatment for OUD.
目前有几种相对安全且有效的经美国食品药品监督管理局批准的阿片类药物使用障碍（OUD）治疗药物。尽管存在这些药物，但治疗后重新使用阿片类药物的比率仍然相对较高，这突出表明需要不断加强治疗。药物治疗联合辅助心理社会干预已被证明可以改善 OUD 的治疗效果。然而，研究尚未明确检验最广泛应用的心理社会治疗方式的独特效果。本研究将调查个体咨询、小组治疗和 12 步治疗参与度与治疗结束时、治疗结束后 1 个月和 3 个月时非法阿片类药物戒断之间的关系。
对来自美国 8 个药物滥用治疗中心的 570 名 OUD 患者的样本进行二次分析。参与者被纳入一项两臂随机对照试验，比较丁丙诺啡-纳洛酮与纳曲酮缓释片治疗 OUD。采用两层层次线性增长模型，检验个体咨询、小组治疗和 12 步治疗参与度对治疗结束后 1 个月和 3 个月时非法阿片类药物戒断（尿液分析）的影响。
个体咨询时长和 12 步治疗参与度显著预测随访时的戒断情况（p<.001，b=-0.59，95%CI[0.42，0.74]；p<.01，b=-0.05，95%CI[0.92，0.98]）。个体咨询和 12 步治疗参与度之间存在显著的交互作用（p<.01，b=-0.06，95%CI[1.02，1.10]）。此外，参与者年龄和就业状况也是非法阿片类药物戒断的显著预测因素（p<.01，b=-0.02，95%CI[0.97，0.99]；p<.01，b=-0.38，95%CI[0.52，0.90]）。小组治疗时长并未显著预测非法阿片类药物戒断。
研究结果表明，对于接受 OUD 药物治疗的个体，增加个体治疗和 12 步治疗的参与度可能是有益的。
