Singleton E G, Sherman M F, Bigelow G E
Am J Drug Alcohol Abuse. 1984;10(2):209-21. doi: 10.3109/00952998409002781.
Self-report inventories from 35 male methadone patients were examined for possible indicators of intent to choose naltrexone treatment. The index of choice, a composite score derived from the analysis, was developed for each patient and compared to naltrexone treatment status at 6-month follow-up. There was a highly significant relationship between scores on the index of choice and the actual process of naltrexone selection. Patients who elected to detoxify from methadone, who were less confident of their ability to remain opiate-free, and who also expressed greater fear of losing the security that maintenance had helped them attain, intended to choose, exhibited greater interest in, and actually selected naltrexone treatment more often. A significant number of maintenance patients who had been prescribed methadone at higher doses and for longer periods of time rejected naltrexone. Failure is the factor that seems to motivate methadone patients to respond to the selection process. Although perceptions of "failure to remain free of illicit opiates" may have enhanced interest in naltrexone, perceptions of "failure to detoxify from methadone" diminished naltrexone's appeal, and actual "failure to remain free of illicit opiates" following methadone detoxification precluded patient participation. Thus, dilemmas appeared to exist. The index of choice may prove to be effective in the evaluation of these dilemmas encountered by patients throughout the selection process, and recommendations for intervention are made. Cautious application of the index of choice is advised until the relationships with retention and success in naltrexone treatment are more clearly demonstrated in future research.
对35名男性美沙酮患者的自我报告量表进行了检查，以寻找可能表明选择纳曲酮治疗意向的指标。为每位患者制定了一个选择指数，这是从分析中得出的综合得分，并将其与6个月随访时的纳曲酮治疗状态进行比较。选择指数得分与纳曲酮选择的实际过程之间存在高度显著的关系。选择从美沙酮脱毒的患者、对自己保持无阿片状态的能力缺乏信心的患者，以及对失去维持治疗所帮助他们获得的安全感表达出更大恐惧的患者，更倾向于选择、对纳曲酮治疗表现出更大兴趣，并且实际上更频繁地选择了纳曲酮治疗。大量长期服用高剂量美沙酮的维持治疗患者拒绝了纳曲酮。失败似乎是促使美沙酮患者对选择过程做出反应的因素。虽然“未能保持无非法阿片类药物状态”的认知可能增强了对纳曲酮的兴趣，但“未能从美沙酮脱毒”的认知降低了纳曲酮的吸引力，并且美沙酮脱毒后实际“未能保持无非法阿片类药物状态”使患者无法参与。因此，困境似乎存在。选择指数可能被证明在评估患者在整个选择过程中遇到的这些困境时是有效的，并提出了干预建议。在未来的研究更清楚地证明其与纳曲酮治疗的留存率和成功率之间的关系之前，建议谨慎应用选择指数。
