Booth R E, Kwiatkowski C, Iguchi M Y, Pinto F, John D
Department of Psychiatry, University of Colorado School of Medicine, Denver 80211, USA.
Public Health Rep. 1998 Jun;113 Suppl 1(Suppl 1):116-28.
High risk injection practices are common among injecting drug users (IDUs), even following intervention efforts. Moreover, relapse to risk behaviors has been reported among those who initiate risk reduction. Substance abuse treatment offers the potential to reduce or eliminate injecting risk behaviors through drug cessation. We report on the effectiveness of two intervention strategies in facilitating treatment entry among out-of-treatment IDUs: motivational interviewing (MI), and intervention developed to help individuals resolve their ambivalence about behavior change, and free treatment for 90 days. These conditions were compared with an intervention focusing on a hierarchy of safer injecting practice, referred to here as risk reduction (RR), and no free treatment.
Nearly 200 out-of-treatment IDUs were randomly assigned to one of four experimental conditions: MI/free treatment, MI/no free treatment, RR/free treatment, and RR/no free treatment. Regardless of assignment, we assisted anyone desiring treatment by calling to schedule the appointment, providing transportation, and waiving the intake fee.
Overall, 42% of study participants entered treatment. No significant differences were found between MI and RR; however, 52% of those assigned free treatment entered compare with 32% for those who had to pay. Other predictors of treatment entry included prior treatment experiences, perceived chance of contracting acquired immunodeficiency syndrome (AIDS) greater than 50%, "determination" stage of change, greater frequency of heroin injecting, and fewer drug-using friends.
These findings support the importance of removing barriers to treatment entry.
即使在采取干预措施之后，高风险注射行为在注射吸毒者（IDU）中仍然很常见。此外，在开始减少风险行为的人群中也有复吸风险行为的报告。药物滥用治疗有可能通过戒毒来减少或消除注射风险行为。我们报告了两种干预策略在促进未接受治疗的注射吸毒者接受治疗方面的有效性：动机性访谈（MI），以及为帮助个体解决行为改变的矛盾心理而开发的干预措施，还有90天的免费治疗。将这些条件与一种侧重于更安全注射实践层级的干预措施（在此称为风险降低（RR））以及不提供免费治疗的情况进行了比较。
近200名未接受治疗的注射吸毒者被随机分配到四个实验条件之一：MI/免费治疗、MI/无免费治疗、RR/免费治疗和RR/无免费治疗。无论分配情况如何，我们通过打电话安排预约、提供交通以及免除入院费用来协助任何想要接受治疗的人。
总体而言，42%的研究参与者接受了治疗。在MI和RR之间未发现显著差异；然而，被分配到免费治疗的人中有52%接受了治疗，而必须付费的人这一比例为32%。接受治疗的其他预测因素包括先前的治疗经历、认为感染获得性免疫缺陷综合征（艾滋病）的几率大于50%、“决心”改变阶段、海洛因注射频率更高以及吸毒朋友更少。
这些发现支持了消除治疗障碍的重要性。
