Galanter M, Egelko S, De Leon G, Rohrs C
Division of Alcoholism and Drug Abuse, New York University School of Medicine, New York 10016.
Hosp Community Psychiatry. 1993 Jul;44(7):644-9. doi: 10.1176/ps.44.7.644.
Cocaine abuse, particularly in crack form, is highly prevalent among patients with severe socioeconomic disadvantages who are treated in municipal general hospitals. The authors describe and evaluate a day treatment program for 30 such patients that combines peer-led self-help and professional care provided by a general hospital psychiatric service.
Treatment outcomes at one year for 92 patients referred to the day program from the hospital's psychiatric services and 58 perinatal patients referred from the obstetric services were examined using chi square and regression analyses to determine whether certain variables, especially referral source, were related to outcome. An acceptable treatment outcome was defined as three successive negative urinalyses before termination or at the end of one year of treatment.
Almost all the patients were unemployed members of ethnic minorities, and most abused at least one substance in addition to cocaine. The 150 patients attended the program an average of 44 times during the year, and 39 percent had an acceptable treatment outcome. Patients referred from psychiatric services had a better outcome than perinatal patients.
Peer-led milieu treatment and professional services can be combined in the general hospital to provide intensive ambulatory care for socioeconomically disadvantaged substance abusers. Techniques and services for engaging perinatal patients in treatment should be developed.
可卡因滥用，尤其是快克可卡因形式的滥用，在市政综合医院接受治疗的严重社会经济弱势群体患者中极为普遍。作者描述并评估了一个针对30名此类患者的日间治疗项目，该项目将同伴主导的自助与综合医院精神科服务提供的专业护理相结合。
使用卡方检验和回归分析，对从医院精神科服务转介到日间项目的92名患者以及从产科服务转介的58名围产期患者的一年治疗结果进行检查，以确定某些变量，特别是转介来源，是否与治疗结果相关。可接受的治疗结果定义为在治疗终止前或治疗一年结束时连续三次尿液分析呈阴性。
几乎所有患者都是少数民族的失业人员，并且大多数除了可卡因之外还滥用至少一种物质。这150名患者一年中平均参加该项目44次，39%的患者获得了可接受的治疗结果。从精神科服务转介的患者比围产期患者治疗效果更好。
同伴主导的环境治疗和专业服务可以在综合医院中结合起来，为社会经济弱势的药物滥用者提供强化门诊护理。应开发吸引围产期患者接受治疗的技术和服务。
