Simpson D D, Joe G W, Rowan-Szal G A, Greener J M
Institue of Behavioral Research, Texas Christian University, Fort Worth 76129, USA.
J Subst Abuse Treat. 1997 Nov-Dec;14(6):565-72. doi: 10.1016/s0740-5472(97)00181-5.
Longer retention has been the most consistent predictor of favorable drug abuse treatment outcomes, but key therapeutic and patient engagement indicators of treatment process need to be more clearly established.
An integrative model representing treatment dynamics was tested for explaining long-term program retention. It was based on a multisite sample of 527 daily opioid users who remained in methadone maintenance a minimum of 3 months. All had been assigned randomly to a counseling condition at admission (i.e., cognitively enhanced or standard), and information obtained from patient files, as well as periodic assessments completed by patients and their counselors in the first 90 days after admission were the sources of predictors.
Counseling enhancements (using node-link mapping, a visual representation tool for improving communication and problem solving) contributed to stronger therapeutic relationships between counselor and patient, which in turn had a positive reciprocal relationship with patient engagement (session attendance). Pretreatment motivation measured at intake was also related to higher engagement. More positive therapeutic relationships (in months 1 and 2) led to lower levels of during-treatment drug use (defined from urinalysis results in months 2 and 3), and better session attendance and therapeutic relationships both predicted longer retention. In addition, lower drug use during treatment was related to longer retention.
Major conceptual domains of drug abuse treatment process were identified in community-based programs and their interrelationships with retention specified. As intermediate (during treatment) criteria, they can help guide functional improvements in program effectiveness as illustrated with our counseling enhancements.
更长的治疗保留期一直是药物滥用治疗取得良好效果最一致的预测指标，但治疗过程中的关键治疗和患者参与指标需要更明确地确定。
对一个代表治疗动态的综合模型进行了测试，以解释长期项目保留率。该模型基于527名每日使用阿片类药物的多地点样本，这些患者接受美沙酮维持治疗至少3个月。所有患者在入院时均被随机分配到一种咨询条件（即认知增强或标准咨询），从患者档案中获取的信息以及患者及其咨询师在入院后前90天完成的定期评估是预测指标的来源。
咨询增强措施（使用节点-链接映射，一种用于改善沟通和解决问题的可视化工具）有助于咨询师与患者之间建立更强的治疗关系，而这反过来又与患者参与度（出席治疗 sessions）呈正相关。入院时测量的治疗前动机也与更高的参与度相关。更积极的治疗关系（在第1和第2个月）导致治疗期间药物使用水平较低（根据第2和第3个月的尿液分析结果确定），更好的出席治疗 sessions 和治疗关系都预测了更长的保留期。此外，治疗期间较低的药物使用与更长的保留期相关。
在基于社区的项目中确定了药物滥用治疗过程的主要概念领域，并明确了它们与保留期的相互关系。作为中间（治疗期间）标准，它们可以帮助指导项目有效性的功能改进，正如我们的咨询增强措施所示。
