Greenstein R A, Resnick R B, Resnick E
Psychiatr Clin North Am. 1984 Dec;7(4):671-9.
Over the past 20 years, methadone maintenance has been shown to be a safe, effective treatment for large numbers of heroin addicts. The majority of patients derive major benefits while in treatment, most measurably in the areas of decreased use of illicit opiates, diminished criminality, increased levels of employment and more stable interpersonal relationships. An advantage of methadone maintenance over other treatments is that it attracts and retains a relatively large segment of the addict population and is reasonably cost-effective. Naltrexone is well suited as a transitional treatment for individuals who have progressed using methadone maintenance. Patients completing a course of methadone maintenance should be encouraged to use naltrexone during the postmethadone period, when symptoms of protracted abstinence often lead them to reinitiate use of heroin. Those with stable family relationships, good jobs, minimal antisocial behavior, and low drug-craving before beginning a course of naltrexone appear to benefit most from the treatment. Rates of retention improve when naltrexone is used within a comprehensive rehabilitation program. Although addicted individuals are often stereotyped, they are, in fact, a heterogeneous group representing a range of psychopathologies and life situations. Thus, within any one facility, a variety of modalities should be available to allow treatment to be tailored to the individual. No single treatment is best for all patients, and, moreover, the preferred modality for any one individual may change over time as a result of progress in treatment or varying life circumstances. Multimodality programs that include methadone and naltrexone enable the maximal number of individuals to benefit from treatment.
在过去20年里，美沙酮维持治疗已被证明是一种针对大量海洛因成瘾者的安全、有效治疗方法。大多数患者在治疗期间能获得主要益处，最显著的体现在非法阿片类药物使用减少、犯罪行为减少、就业水平提高以及人际关系更稳定等方面。美沙酮维持治疗相对于其他治疗方法的一个优势在于，它能吸引并留住相对较大比例的成瘾者群体，且具有合理的成本效益。纳曲酮非常适合作为已完成美沙酮维持治疗的个体的过渡治疗。应鼓励完成美沙酮维持治疗疗程的患者在美沙酮治疗后阶段使用纳曲酮，此时长期戒断症状往往会导致他们重新开始使用海洛因。那些在开始纳曲酮治疗疗程前家庭关系稳定、工作良好、反社会行为极少且药物渴望程度低的人似乎从治疗中获益最大。在综合康复项目中使用纳曲酮时，留存率会提高。尽管成瘾个体常常被刻板化，但实际上他们是一个异质性群体，代表着一系列精神病理学情况和生活状况。因此，在任何一个机构内，都应提供多种治疗方式，以便使治疗能够根据个体情况进行调整。没有一种单一的治疗方法对所有患者都是最好的，而且，由于治疗进展或生活状况变化，任何一个个体首选的治疗方式可能会随时间而改变。包括美沙酮和纳曲酮的多模式项目能使最大数量的个体从治疗中获益。
