Multidimensionality and prediction of treatment outcome in opioid addicts: 2.5-year follow-up.
Multidimensionality and prediction of treatment outcome in opioid addicts: 2.5-year follow-up.
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阿片类药物成瘾者治疗结果的多维性和预测：2.5 年随访。
DOI：
10.1016/0010-440x(87)90038-1
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发表时间：
1987
影响因子：
7.3
通讯作者：
Kleber,HD
中科院分区：
文献类型：
--
作者：
Kosten,TR;Rounsaville,BJ;Kleber,HD
药物滥用者的治疗结果可能几乎完全取决于药物戒断（单维观点），也可能涉及几个相对独立的维度的复合体。在一个为期2.5年的后续行动的150阿片类药物成瘾者，我们发现，他们的医疗，社会，心理，法律的，和就业问题，评估成瘾严重程度指数（ASI），大大改善。临床医生的评分比自我报告的医疗，就业和家庭问题的复合材料表现出更多的改善。使用因素分析，由ASI涵盖的七个结果领域形成两个因素，占约50%的方差在摄入评估和后续行动。第一个因素包括就业，医疗，心理，家庭和酒精问题量表的强负荷，而第二个因素主要包括药物和法律的问题量表。在2.5年的随访中，药物戒断与更好的药物滥用和法律的结果相关，戒断者比继续滥用者表现出更多的改善。然而，在大多数非药物滥用地区，戒断者和滥用者之间的差异相对较小。随访结果只有弱预测的摄入临床医生的评级问题，和摄入评级没有很高的特异性，在预测相应的结果领域。因此，一个单维的观点侧重于禁欲描述了药物滥用治疗结果的一个重要组成部分，但心理社会因素，不包括药物滥用，占很大一部分的结果差异。
Treatment outcome for drug abusers may be almost entirely dependent on drug abstinence (unidimensional view) or may involve a complex of several relatively independent dimensions. In a 2.5-year follow-up of 150 opiate addicts, we found that their medical, social, psychological, legal, and employment problems, as assessed by the Addiction Severity Index (ASI), improved substantially. Clinician ratings demonstrated more improvement than self-report composites of medical, employment, and family problems. Using factor analysis, the seven outcome areas covered by the ASI formed two factors that accounted for about 50% of the variance at both intake assessment and follow-up. The first factor included strong loadings from the employment, medical, psychological, family, and alcohol problem scales, while the second factor included the drug and legal problem scales primarily. Drug abstinence was correlated with better drug abuse and legal outcome at the 2.5-year follow-up, and abstainers showed more improvement than continued abusers. However, in most non-drug abuse areas the differences between abstainers and abusers were relatively small. Follow-up outcomes were only weakly predicted by the intake clinician ratings of problems, and the intake ratings did not have high specificity in predicting corresponding outcome areas. Thus, a unidimensional view focusing on abstinence described an important part of drug abuse treatment outcome, but a psychosocial factor, that did not include drug abuse, accounted for a large part of outcome variance.