McCusker J, Bigelow C, Vickers-Lahti M, Spotts D, Garfield F, Frost R
School of Public Health, University of Massachusetts, Amherst, USA.
Addiction. 1997 Nov;92(11):1467-78.
Two randomized controlled trials of residential drug abuse treatment programs found the programs to be equally effective, based on outcomes among those assigned to the treatments. This study aimed to compare the relative efficacy of the programs, based on outcomes among those who received the specific treatment program as planned.
Secondary analyses of data from two concurrent randomized controlled trials, with stratification by actual length of stay.
Two residential drug abuse treatment facilities in the United States.
Six hundred and twenty-eight clients were enrolled over a 2-year period, representing 85% of all clients admitted, 91% of all eligible clients, and 95% of those asked to participate.
At one facility, clients were randomized to 3-month or 6-month versions of a traditional therapeutic community program. At the second facility, clients were randomized to 3-month or 6-month versions of a modified therapeutic community program that emphasized relapse prevention and health education.
Time from admission to first drug use (except alcohol); and Addiction Severity Index (ASI) composite scores for severity of drug, alcohol, legal, and employment problems.
Five hundred and thirty-nine clients (86%) completed a follow-up interview at least 16.5 months after admission. In the relapse prevention trial, benefits of the 6-month program were generally limited to those who stayed at least 40 days. In the therapeutic community trial, among those who stayed at least 171 days, the 12-month program had a beneficial effect on employment. Otherwise, there were inconsistent differences between the 6- and 12-month programs.
On average, clients who stayed in treatment at least 80 days benefited from continuing in treatment for up to 6 months, but not beyond. Conversely, those admitted to programs of longer planned duration who dropped out of treatment early had worse outcomes than those who dropped out of shorter programs. Thus, although longer planned duration of treatment may be efficacious, it is not effective.
两项关于住院药物滥用治疗项目的随机对照试验发现，基于分配到治疗组的患者的治疗结果，这些项目的效果相同。本研究旨在根据按计划接受特定治疗项目的患者的治疗结果，比较这些项目的相对疗效。
对两项同期随机对照试验的数据进行二次分析，并按实际住院时间分层。
美国的两家住院药物滥用治疗机构。
在两年期间招募了628名患者，占所有入院患者的85%、所有符合条件患者的91%以及所有被邀请参与患者的95%。
在一家机构，患者被随机分配到传统治疗社区项目的3个月或6个月版本。在第二家机构，患者被随机分配到强调预防复发和健康教育的改良治疗社区项目的3个月或6个月版本。
从入院到首次使用毒品（酒精除外）的时间；以及药物、酒精、法律和就业问题严重程度的成瘾严重程度指数（ASI）综合评分。
539名患者（86%）在入院至少16.5个月后完成了随访访谈。在预防复发试验中，6个月项目的益处通常仅限于住院至少40天的患者。在治疗社区试验中，在住院至少171天的患者中，12个月项目对就业有有益影响。否则，6个月和12个月项目之间存在不一致的差异。
平均而言，住院治疗至少80天的患者从持续治疗长达6个月中受益，但超过6个月则不然。相反，那些被纳入计划治疗时间较长的项目但提前退出治疗的患者，其结果比那些退出计划治疗时间较短项目的患者更差。因此，虽然计划治疗时间较长可能有效，但并不高效。
