THE EFFECTS OF PSYCHOSOCIAL SERVICES IN SUBSTANCE-ABUSE TREATMENT
THE EFFECTS OF PSYCHOSOCIAL SERVICES IN SUBSTANCE-ABUSE TREATMENT
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DOI：
10.1001/jama.269.15.1953
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发表时间：
1993-04-21
影响因子：
120.7
通讯作者：
OBRIEN, CP
中科院分区：
文献类型：
--
作者：
MCLELLAN, AT;ARNDT, IO;OBRIEN, CP
客观。-检查是否增加咨询，医疗保健和心理社会服务提高了盐酸美沙酮治疗在阿片类药物依赖患者康复中的疗效。随机分配到三个治疗组之一，进行为期6个月的临床试验：（1）最低美沙酮服务（MMS）-美沙酮单独治疗（最低60毫克/天），没有其他服务;（2）标准美沙酮服务（SMS）-相同剂量的美沙酮加咨询;或（3）加强美沙酮服务（EMS）-相同剂量的美沙酮加上咨询和现场医疗/精神病，就业和家庭治疗。费城（宾夕法尼亚州）退伍军人事务医疗中心的美沙酮维持计划。92例接受美沙酮维持治疗的男性静脉注射阿片类药物使用者。虽然美沙酮单独治疗（MMS）与阿片类药物使用减少有关，但由于持续使用阿片类药物或可卡因，或医疗/精神紧急情况，这些受试者中有69%不得不从试验中“保护性转移”。这与41%的SMS受试者和19%的EMS受试者符合标准有显著差异。治疗结束数据（24周时）显示，完成试验的10名MMS患者的改善极小。SMS组比MMS组表现出明显更多和更大的改善; EMS组比SMS组表现出明显更好的结果。最低限度的美沙酮服务受试者已被“保护性转移”到标准护理显示显着减少阿片类药物和可卡因的使用在4周内。单独使用美沙酮（即使是大剂量）可能只对少数符合条件的患者有效。基本咨询的增加与有效性的大幅提高有关;而现场专业服务的增加则更为有效。
Objective.-To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients.Design.-Random assignment to one of three treatment groups for a 6-month clinical trial: (1) minimum methadone services (MMS)-methadone alone (a minimum of 60 mg/d) with no other services; (2) standard methadone services (SMS) -same dose of methadone plus counseling; or (3) enhanced methadone services (EMS)-same dose of methadone plus counseling and on-site medical/psychiatric, employment, and family therapy.Setting.-The methadone maintenance program of the Philadelphia (Pa) Veterans Affairs Medical Center.Subjects.-Ninety-two male intravenous opiate users in methadone maintenance treatment.Results.-While methadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be ''protectively transferred'' from the trial because of unremitting use of opiates or cocaine, or medical/psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than did the SMS group. Minimum methadone services subjects who had been ''protectively transferred'' to standard care showed significant reductions in opiate and cocaine use within 4 weeks.Conclusions.-Methadone alone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective.