海洛因依赖者中海洛因使用、缓解及精神健康的模式与预测因素：澳大利亚治疗结果研究（ATOS）18 - 20年随访的关键发现

Patterns and Predictors of Heroin Use, Remission, and Psychiatric Health Among People with Heroin Dependence: Key Findings from the 18-20-Year Follow-Up of the Australian Treatment Outcome Study (ATOS).

作者信息

Marel Christina, Wilson Jack, Darke Shane, Ross Joanne, Slade Tim, Haber Paul S, Haasnoot Katherine, Visontay Rachel, Keaveny Madeleine, Tremonti Chris, Mills Katherine L, Teesson Maree

机构信息

University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia.

National Drug and Alcohol Research Centre, UNSW Australia, Kensington, NSW Australia.

出版信息

Int J Ment Health Addict. 2023 Jan 18:1-18. doi: 10.1007/s11469-022-01006-6.

DOI:10.1007/s11469-022-01006-6

PMID:36688114

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9847452/

Abstract

UNLABELLED

This study aimed to investigate the long-term patterns and predictors of heroin use, dependence, and psychiatric health over 18-20 years among a cohort of Australians with heroin dependence, using a prospective longitudinal cohort study conducted in Sydney, Australia. The original cohort consisted of 615 participants, who were followed up at 3 months and 1, 2, 3, 11, and 18-20 years post-baseline; 401 (65.2%) were re-interviewed at 18-20 years. The Australian Treatment Outcome Study structured interview with established psychometric properties was administered to participants at each follow-up, addressing demographics, treatment and drug use history, overdose, crime, and physical and mental health. Overall, 96.7% completed at least one follow-up interview. At 18-20 years, 109 participants (17.7%) were deceased. Past-month heroin use decreased significantly over the study period (from 98.7 to 24.4%), with one in four using heroin at 18-20 years. Just under half were receiving treatment. Reductions in heroin use were accompanied by reductions in heroin dependence, other substance use, needle sharing, injection-related health, overdose, crime, and improvements in general physical and mental health. Major depression and borderline personality disorder (BPD) were consistently associated with poorer outcome. At 18-20 years, there is strong evidence that clinically significant levels of improvement can be maintained over the long term. The mortality rate over 18-20 years was devastating, with over one in six participants deceased. More sustained and targeted efforts are needed in relation to major depression and BPD to ensure evidence-based treatments are delivered to people with heroin dependence.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-022-01006-6.

摘要

未标注

本研究旨在通过在澳大利亚悉尼进行的一项前瞻性纵向队列研究，调查一组有海洛因依赖的澳大利亚人在18至20年期间海洛因使用、依赖及精神健康的长期模式和预测因素。原始队列由615名参与者组成，在基线后3个月以及1、2、3、11和18至20年进行随访；401名（65.2%）参与者在18至20年时接受了再次访谈。在每次随访时，对参与者进行具有既定心理测量特性的澳大利亚治疗结果研究结构化访谈，内容涉及人口统计学、治疗和药物使用史、过量用药、犯罪以及身心健康。总体而言，96.7%的参与者完成了至少一次随访访谈。在18至20年时，109名参与者（17.7%）已死亡。在研究期间，过去一个月内使用海洛因的情况显著下降（从98.7%降至24.4%），四分之一的人在18至20年时使用海洛因。略少于一半的人正在接受治疗。海洛因使用的减少伴随着海洛因依赖、其他物质使用、共用针头、注射相关健康问题、过量用药、犯罪的减少，以及总体身心健康的改善。重度抑郁症和边缘型人格障碍（BPD）始终与较差的结果相关。在18至20年时，有强有力的证据表明，临床上显著的改善水平可以长期维持。18至20年期间的死亡率令人震惊，超过六分之一的参与者死亡。对于重度抑郁症和BPD，需要做出更持续和有针对性的努力，以确保为有海洛因依赖的人提供循证治疗。