Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, USA.
Drug Alcohol Depend. 2024 Mar 1;256:111092. doi: 10.1016/j.drugalcdep.2024.111092. Epub 2024 Jan 18.
Translational research demonstrates that drug use is inversely associated with availability and engagement with meaningful non-drug reinforcers. Evaluation of non-drug reinforcement in treatment-receiving clinical populations is limited, likely owing to the time intensive nature of existing measures. This study explores the association of non-drug reinforcers with treatment outcomes using a novel, brief measure of past month non-drug reinforcement quantifying three elements: relative frequency, access, and enjoyability.
Respondents enrolled in substance use treatment (residential, intensive outpatient, and medically managed withdrawal) in clinics across the United States (N = 5481) completed standardized assessments of non-drug reinforcement and treatment outcomes (i.e., return to use and life satisfaction) one-month after treatment discharge. Non-drug reinforcement measures (availability, engagement, enjoyability) were used as predictors of return to use and life satisfaction using generalized linear models.
Non-drug reinforcement indices were associated with return to use and life satisfaction in unadjusted models (e.g., 12.4 % versus 58.3 % return to use for those with the highest and lowest availability, respectively). Consistent results were observed in models adjusted for sociodemographic variables and risk factors (i.e., sleep disturbance, anhedonia, stress). Comparisons by drug class generally showed lower non-drug reinforcement among patients reporting heroin or methamphetamine as their primary drug.
Results highlight the importance of non-drug reinforcement during the first month following treatment. Rapid measurement of non-drug reinforcement in stepped care settings may illuminate critical deficits in early stages of behavior change, identify those at greatest risk for return to use, and provide targets for treatment to improve recovery trajectories.
转化研究表明，药物使用与获得和参与有意义的非药物强化物呈反比关系。对接受治疗的临床人群中非药物强化物的评估受到限制，这可能是由于现有措施的时间密集性质。本研究使用一种新的、简短的过去一个月非药物强化物测量方法，该方法量化了三个要素：相对频率、可及性和享受度，探讨了非药物强化物与治疗结果的关系。
在美国各地的诊所中接受药物使用治疗（住院、强化门诊和医疗管理戒断）的受访者（N=5481）在治疗出院后一个月完成了非药物强化物和治疗结果（即重新使用和生活满意度）的标准化评估。使用广义线性模型，将非药物强化物测量（可用性、参与度、享受度）作为重新使用和生活满意度的预测指标。
在未调整的模型中，非药物强化物指标与重新使用和生活满意度相关（例如，可用性最高和最低的患者中分别有 12.4%和 58.3%重新使用）。在调整了社会人口统计学变量和风险因素（即睡眠障碍、快感缺失、压力）的模型中观察到了一致的结果。按药物类别进行比较时，报告海洛因或甲基苯丙胺为主要药物的患者的非药物强化物较低。
结果强调了治疗后第一个月非药物强化物的重要性。在阶梯式护理环境中快速测量非药物强化物可能会阐明行为改变早期阶段的关键缺陷，识别那些重新使用风险最大的患者，并为改善康复轨迹提供治疗目标。
