Do drug treatment facilities increase clients' exposure to potential neighborhood-level triggers for relapse? A small-area assessment of a large, public treatment system
Do drug treatment facilities increase clients' exposure to potential neighborhood-level triggers for relapse? A small-area assessment of a large, public treatment system
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DOI：
10.1007/s11524-005-9013-6
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发表时间：
2006-03-01
影响因子：
6.6
通讯作者：
Jacobson, JO
中科院分区：
文献类型：
--
作者：
Jacobson, JO
对药物治疗设施选址的研究一直狭隘地集中在地理上与客户接近的问题上。我们认为，周边条件也应该成为设施选址决策的一部分，并说明对大城市地区设施的社区条件的正式评估，同时考虑到客户在家中已经面临的条件。我们讨论了与药物治疗环境相关的小区域措施的选择和构建，包括毒品活动、劣势和暴力，以及与这些措施相关的当事人住所和治疗地点的统计比较。对洛杉矶县1998-2000年间接受公共资金的494家社区门诊和住宅治疗机构出院的22,707名患者进行的分析显示，家庭和治疗社区之间的平均水平没有显著差异。然而，高达20%的客户在接受治疗的地方面临的不利因素、暴力或毒品活动水平明显高于他们居住的地方，这表明治疗地点增加客户对潜在环境触发因素的暴露并不少见。虽然平均而言，家庭和治疗地点的这些措施水平都高于普通人群的家庭地点，但公共治疗客户家庭社区的巨大差异让他们只从贫穷、毒品活动频繁的地区逃脱的想法受到质疑。此外，还讨论了可用于治疗地点邻里评估的措施的不足，以及研究结果对其他治疗研究领域的影响。
Research on drug treatment facility locations has focused narrowly on the issue of geographic proximity to clients. We argue that neighborhood conditions should also enter into the facility location decision and illustrate a formal assessment of neighborhood conditions at facilities in a large, metropolitan area, taking into account conditions clients already face at home. We discuss choice and construction of small-area measures relevant to the drug treatment context, including drug activity; disadvantage, and violence as well as statistical comparisons of clients' home and treatment locations with respect to these measures. Analysis of 22,707 clients discharged from 494 community-based outpatient and residential treatment facilities that received public funds during 1998-2000 in Los Angeles County revealed no significant mean differences between home and treatment neighborhoods. However, up to 20% of clients are exposed to markedly higher levels of disadvantage, violence, or drug activity where they attend treatment than where they live, suggesting that it is not uncommon for treatment locations to increase clients' exposure to potential environmental triggers for relapse. Whereas on average both home and treatment locations exhibit higher levels of these measures than the household locations of the general population, substantial variability in public treatment clients' home neighborhoods calls into question the notion that they bail exclusively from poor, high drug activity areas. Shortcomings of measures available for neighborhood assessment of treatment locations and implications of the findings for other areas of treatment research are also discussed.