Epidemiol Rev. 2020 Jan 31;42(1):57-78. doi: 10.1093/epirev/mxaa005.
This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.
本系统评价描述了共病物质使用对阿片类药物治疗计划效果的影响。从数据库建立到 2018 年 11 月 28 日，我们在 MEDLINE/PubMed、Embase、PsychINFO 和 Cumulative Index to Nursing and Allied Health Literature 上进行了搜索，以确定在美国评估共病物质使用与治疗结果（即阿片类药物戒除和治疗保留）之间关系的合格阿片类药物治疗研究。共纳入 34 项合格研究。总体而言，无论干预类型如何，共病物质使用与不良治疗结局相关。然而，模式因物质和干预类型而异。特别是，阿片类药物与可卡因或大麻共病使用与治疗保留和阿片类药物戒除率降低有关，无论干预类型如何。与不使用或减少使用安非他命相比，安非他命共病使用会降低治疗保留率。与酒精共病使用与治疗结果呈正相关和负相关。一项研究报告称，镇静剂使用与阿片类药物戒除之间存在显著正相关。一般来说，这些发现表明，与单独使用药理学或行为干预研究相比，联合干预报告的健康结果更好。本综述的结果强调需要全面研究和解决共病物质使用问题，以改善阿片类药物治疗计划。
