Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
Am J Drug Alcohol Abuse. 2021 Jan 2;47(1):127-138. doi: 10.1080/00952990.2020.1833340. Epub 2020 Nov 7.
Anecdotal evidence suggests a substantial proportion of individuals with cocaine use disorder do not report craving during inpatient detoxification.
To examine prevalence and clinical correlates of consistent absence of cocaine craving among inpatients during detoxification. We hypothesized that craving absence would be associated with less severity of cocaine use, depression, and anxiety. Alternative explanations were also explored.
Craving absence (i.e., non-cravers) was defined as a daily score of zero across two separate craving visual analogue scales in each of the inpatient days. Participants scoring ≥1 on ≥1 day were considered cravers. Severity of cocaine use disorder as well as in-treatment depression and anxiety were assessed. Alternative contributors included presence of cocaine and other substances in urine at admission, in-treatment prescription of psychotropic medications, treatment motivation, executive function, interoception, and social desirability.
Eighty-seven participants (78.2% males) met criteria as either non-cravers ( = 29; 33.3%) or cravers ( = 58; 66.7%). Mean length of admission in non-cravers and cravers was, respectively, 10.83 and 13.16 days. Binary logistic regression model showed that non-cravers scored significantly lower than cravers on cocaine use during last month before treatment (OR, 95% CI; 0.902, 0.839-0.970), in-treatment depression (OR, 95% CI; 0.794, 0.659-0.956), and in-treatment prescribing of antipsychotics (OR, 95% CI; 0.109, 0.014-0.823). Model prediction accuracy was 88.9%.
One in three patients undergoing inpatient detoxification experienced absence of craving, linked to less pretreatment cocaine use, better mood, and decreased administration of antipsychotics. Findings may inform pretreatment strategies and improve treatment cost-effectiveness.
一些传闻证据表明，在住院戒毒期间，相当一部分可卡因使用障碍患者报告没有出现渴求。
研究在住院戒毒期间可卡因渴求持续缺失的发生率和临床相关性。我们假设渴求缺失与可卡因使用严重程度较低、抑郁和焦虑程度较低有关。同时还探讨了其他解释。
渴求缺失（即非渴求者）的定义是在住院期间的每一天，两个单独的渴求视觉模拟量表的每日评分均为零。每天至少有 1 分的患者被认为是渴求者。评估可卡因使用障碍严重程度、治疗期间的抑郁和焦虑程度。其他可能的因素包括入院时尿液中可卡因和其他物质的存在、治疗期间开的精神药物处方、治疗动机、执行功能、内脏感知和社会期望。
87 名参与者（78.2%为男性）符合非渴求者（n=29；33.3%）或渴求者（n=58；66.7%）的标准。非渴求者和渴求者的平均住院时间分别为 10.83 天和 13.16 天。二元逻辑回归模型显示，非渴求者在治疗前一个月的可卡因使用量（比值比，95%置信区间；0.902，0.839-0.970）、治疗期间的抑郁（比值比，95%置信区间；0.794，0.659-0.956）和治疗期间抗精神病药物的处方（比值比，95%置信区间；0.109，0.014-0.823）显著低于渴求者。模型预测准确率为 88.9%。
在接受住院戒毒治疗的患者中，有三分之一的患者出现渴求缺失，与治疗前可卡因使用量较少、情绪较好和抗精神病药物使用减少有关。这些发现可能为治疗前的策略提供信息，并提高治疗的成本效益。
