Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People With Alcohol Dependence
Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People With Alcohol Dependence
复制标题
DOI：
10.1080/08897077.2014.904838
复制
发表时间：
2015-01-02
期刊：
影响因子：
3.5
通讯作者：
Ries, Richard K.
中科院分区：
文献类型：
--
作者：
Collins, Susan E.;Duncan, Mark H.;Ries, Richard K.
背景：对于患有多种疾病、公共资助服务利用率和相关成本高的长期无家可归的酒精依赖者来说，基于戒断的酒精干预措施是最低限度的，也是最有效的。低障碍、以患者为中心的联合药物行为干预可能更有效地治疗这一人群。减少伤害咨询包括一种非评判的、移情的风格和病人驱动的目标设定，既不需要戒断也不需要减少使用。缓释纳曲酮（XR-NTX）是一种阿片受体拮抗剂的每月注射制剂，可减少渴望，对活跃饮酒者安全有效，因此可能支持减少危害的目标设定。这项为期12周的单臂试验的目的是初步记录XR-NTX治疗的可行性、可接受性和酒精结果，并为长期无家可归的酒精依赖者提供减少危害的咨询。方法：参与者是目前/以前长期无家可归、酒精依赖的个人（N = 31），来自美国太平洋西北地区的2个社区机构。测量包括自我报告的酒精渴望、数量/频率、问题和生物标志物（葡萄糖醛酸乙酯[EtG]、肝转氨酶）。在3个月的治疗过程中，每月给予XR-NTX和减少危害咨询。结果：在接触的45个人中，有43个人对参与感兴趣。31名参与者接受了第一次注射，24名参与者遵守了所有研究程序。参与者报告治疗是可以接受的。从基线到12周随访，参与者的酒精渴望（33%）、典型（25%）和峰值（34%）使用、频率（17%）、问题（60%）和EtG （p < 0.05）均有所下降。结论：XR-NTX和减少危害咨询是支持减少长期无家可归、酒精依赖者的酒精使用和酒精相关危害的有希望的手段。
Background: Abstinence-based alcohol interventions are minimally desirable to and effective for chronically homeless individuals with alcohol dependence who have multimorbidity and high publicly funded service utilization and associated costs. Lower-barrier, patient-centered combined pharmacobehavioral interventions may more effectively treat this population. Harm reduction counseling involves a nonjudgmental, empathic style and patient-driven goal setting that requires neither abstinence nor use reduction. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving, is safe and effective for active drinkers, and may thereby support harm reduction goal setting. The aims of this 12-week, single-arm pilot were to initially document some aspects of feasibility, acceptability, and alcohol outcomes following XR-NTX administration and harm reduction counseling for chronically homeless individuals with alcohol dependence. Methods: Participants were currently/formerly chronically homeless, alcohol-dependent individuals (N = 31) from 2 community-based agencies in the US Pacific Northwest. Measures included self-reported alcohol craving, quantity/frequency, problems, and biomarkers (ethyl glucuronide [EtG], liver transaminases). XR-NTX and harm reduction counseling were administered monthly over the 3-month treatment course. Results: Of the 45 individuals approached, 43 were interested in participation. The first injection was received by 31 participants, and 24 complied with all study procedures. Participants reported the treatment was acceptable. Participants evinced decreases in alcohol craving (33%), typical (25%) and peak (34%) use, frequency (17%), problems (60%), and EtG from the baseline to the 12-week follow-up (Ps < .05). Conclusions: XR-NTX and harm reduction counseling are promising means of supporting reductions in alcohol use and alcohol-related harm among chronically homeless, alcohol-dependent individuals.