Milby J B, Schumacher J E, Raczynski J M, Caldwell E, Engle M, Michael M, Carr J
University of Alabama at Birmingham School of Medicine 35233, USA.
Drug Alcohol Depend. 1996 Dec 2;43(1-2):39-47. doi: 10.1016/s0376-8716(96)01286-0.
Treatment efficacy for homeless substance abusers (primarily crack cocaine) was studied in a randomized control design with subjects (n = 176) assigned to usual care (UC) or an enhanced day treatment program plus abstinent contingent work therapy and housing (EC). Subjects met DSM-III-R criteria for Substance Use Disorder and McKinny Act criteria for homelessness. UC involved weekly individual and group counseling. EC involved a day treatment program consisting of daily attendance, transportation, lunch, manualized psychoeducational groups, and individual counseling. A total of 131 (74.4%) subjects (62 UC and 69 EC) were treated and followed. UC subjects attended 28.5% and EC attended 48.4% of expected treatment during the first 2 months. After 2 months, EC subjects experienced up to 4 months of abstinent contingent work therapy (44.9% of EC subjects) and housing (37.7% of EC subjects), with day treatment available two afternoons per week. Longitudinal Wei-Lachin analyses of medians (reported alcohol use, days homeless and employed) and proportions (cocaine toxicologies) were conducted across 2-, 6-, and 12-month follow-up points. EC had 36% fewer positive cocaine toxicologies at 2-months and 18% fewer at 6-months than UC with regression toward baseline at 12-months. EC had 8 days fewer days of reported alcohol use in the past 30 days, 52 fewer days homeless in the past 60 days, and 10 more days employed in the past 30 days from baseline to the 12-months. UC showed no changes except a temporary increase in employment at 6-months. This is one of the first demonstrations that homeless cocaine abusers can be retained and effectively treated.
在一项随机对照设计中，研究了针对无家可归的药物滥用者（主要是快克可卡因滥用者）的治疗效果，研究对象（n = 176）被分配到常规护理组（UC）或强化日间治疗项目组，后者还包括禁欲应急工作疗法和住房（EC）。研究对象符合《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）中物质使用障碍的标准以及《麦金尼法案》中无家可归的标准。常规护理组包括每周一次的个体和团体咨询。强化日间治疗项目组包括一个日间治疗项目，内容有每日出勤、交通、午餐、手册化的心理教育团体以及个体咨询。共有131名（74.4%）研究对象（62名常规护理组和69名强化日间治疗项目组）接受了治疗并进行了随访。在最初的两个月里，常规护理组研究对象的预期治疗参与率为28.5%，强化日间治疗项目组为48.4%。两个月后，强化日间治疗项目组的研究对象接受了长达4个月的禁欲应急工作疗法（占强化日间治疗项目组研究对象的44.9%）和住房安置（占强化日间治疗项目组研究对象的37.7%），每周有两个下午提供日间治疗。在2个月、6个月和12个月的随访点，对中位数（报告的酒精使用情况、无家可归天数和就业天数）和比例（可卡因毒理学检测结果）进行了纵向的魏-拉钦分析。与常规护理组相比，强化日间治疗项目组在2个月时可卡因毒理学检测呈阳性的比例少36%，在6个月时少18%，在12个月时回归基线水平。从基线到12个月，强化日间治疗项目组在过去30天内报告的酒精使用天数少8天，在过去60天内无家可归天数少52天，在过去30天内就业天数多10天。常规护理组除了在6个月时就业情况有短暂增加外，没有其他变化。这是首批证明无家可归的可卡因滥用者能够被留住并得到有效治疗的研究之一。
