Independent Researcher, 2232 University Drive, Naperville, IL 60565, USA.
University of Chicago, Crown Family School of Social Work, Policy and Practice, 969 E. 60th Street, Chicago, IL 60637, USA.
Eval Program Plann. 2022 Jun;92:102060. doi: 10.1016/j.evalprogplan.2022.102060. Epub 2022 Feb 23.
The purpose of this study is to identify the relative strengths of association of medication and health and social services in comprehensive substance use disorder (SUD) treatment.
The study uses a novel variance decomposition method to assess the relative strength of association of six active ingredients of comprehensive SUD treatment: methadone medication, access services, SUD counseling, matched service ratio, client-provider relationship, and treatment duration.
The study uses data from the National Treatment Improvement Evaluation Study (1992-1997), a dataset with an unusual number of services and service strategies measured. The data include 3012 clients from 45 SUD treatment programs. Linear mixed models are used to assess the relation of service variables to the outcome of posttreatment substance use. Variance decomposition methods are used to assess the relative importance of the ingredients in the treatment model.
Along with a random intercept and background variables, receipt of methadone accounted for the greatest relative strength of association at 35.4%, compared with 23.8% for treatment duration, 15.4% for client-provider relationship, and 11.2% for matched service ratio. Access and SUD counseling accounted for modest strengths of association at 1% and 3% each.
Findings indicate somewhat greater strength of association of methadone compared with other services and service strategies and overall, reinforce the importance of both medication and services and service strategies in the design and development of effective models of service delivery.
This study, among the first to evaluate the relative importance of specific services and service strategies of comprehensive SUD treatment, provides insights relevant to the development of effective models of service delivery.
本研究旨在确定药物治疗与健康和社会服务在综合物质使用障碍（SUD）治疗中的关联相对强度。
本研究采用一种新颖的方差分解方法，评估综合 SUD 治疗的六种有效成分（美沙酮药物治疗、获取服务、SUD 咨询、匹配服务比例、医患关系和治疗持续时间）的关联相对强度。
本研究使用了国家治疗改进评估研究（1992-1997 年）的数据，该数据集测量了异常数量的服务和服务策略。数据包括来自 45 个 SUD 治疗计划的 3012 名患者。线性混合模型用于评估服务变量与治疗后物质使用结果的关系。方差分解方法用于评估治疗模型中成分的相对重要性。
除了随机截距和背景变量外，美沙酮治疗的接受程度与关联的相对强度最大，为 35.4%，而治疗持续时间为 23.8%，医患关系为 15.4%，匹配服务比例为 11.2%。获取和 SUD 咨询的关联强度稍大，分别为 1%和 3%。
研究结果表明，美沙酮治疗与其他服务和服务策略的关联强度稍高，总体上强调了药物治疗和服务及服务策略在有效服务提供模式设计和开发中的重要性。
本研究是评估综合 SUD 治疗中特定服务和服务策略的相对重要性的首批研究之一，为有效服务提供模式的开发提供了相关见解。
