Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work.
Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work.
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DOI：
10.1186/s40359-014-0026-3
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发表时间：
2014
期刊：
影响因子：
3.6
通讯作者：
Davison C
中科院分区：
文献类型：
--
作者：
Jackson LA;Buxton JA;Dingwell J;Dykeman M;Gahagan J;Gallant K;Karabanow J;Kirkland S;LeVangie D;Sketris I;Gossop M;Davison C
50多年来，美沙酮一直作为缓解阿片类药物戒断症状的药理学方法处方给阿片类药物依赖者。然而，个人处方美沙酮有时需要额外的干预（例如，咨询），以进一步改善他们的健康状况。这项研究进行了一个现实主义的综合评价干预措施，旨在改善美沙酮治疗的个人的心理和就业结果，以确定什么干预措施的工作（或不），为什么。之所以采用现实主义综合方法，是因为它揭示了导致特定结果的过程（或机制），以及发生这种情况的背景。全面的检索过程共检索到31篇文献进行综述。从文章中提取数据，并放置在四个模板中以协助分析。数据分析是一个反复的过程，涉及比较和对比每个模板内的数据，并与原始文章进行交叉检查，以确定数据中的关键模式。对于美沙酮的个人，参与干预似乎对改善心理和/或就业结果很重要。参与过程包括参加干预措施以及对所提供的服务进行投资。三种干预背景（通常以某种组合）支持参与过程：a）以客户为中心的背景（或客户的心理社会和/或就业需求/问题/技能得到承认和/或解决的背景）; B）解决客户社会经济条件和需求的背景;以及c）存在积极的客户-顾问和/或同伴关系的背景。有一些证据表明，有时持续的接触对于保持积极成果是必要的。还有一些证据表明完全戒除毒品（例如，可卡因，海洛因）不是订婚所必需的。必须考虑干预措施的背景如何可能引起和/或支持客户的参与。需要进一步的研究来探索个人的背景（例如，长期参与不同的干预措施）可能会影响参与。长期参与可能是维持一些积极成果所必需的，但持续多久尚不清楚，需要进一步研究。即使没有完全戒除可卡因或海洛因等毒品，也可能发生参与，但需要进行更多的研究，因为参与可能受到吸毒程度和类型的影响。本文的在线版本（doi：10.1186/s40359-014-0026-3）包含补充材料，可供授权用户使用。
For over 50 years, methadone has been prescribed to opioid-dependent individuals as a pharmacological approach for alleviating the symptoms of opioid withdrawal. However, individuals prescribed methadone sometimes require additional interventions (e.g., counseling) to further improve their health. This study undertook a realist synthesis of evaluations of interventions aimed at improving the psychosocial and employment outcomes of individuals on methadone treatment, to determine what interventions work (or not) and why. The realist synthesis method was utilized because it uncovers the processes (or mechanisms) that lead to particular outcomes, and the contexts within which this occurs. A comprehensive search process resulted in 31 articles for review. Data were extracted from the articles, and placed in four templates to assist with analysis. Data analysis was an iterative process and involved comparing and contrasting data within and across each template, and cross checking with original articles to determine key patterns in the data. For individuals on methadone, engagement with an intervention appears to be important for improved psychosocial and/or employment outcomes. The engagement process involves attendance at interventions as well as an investment in what is offered. Three intervention contexts (often in some combination) support the engagement process: a) client-centered contexts (or those where clients’ psychosocial and/or employment needs/issues/skills are recognized and/or addressed); b) contexts which address clients’ socio-economic conditions and needs; and, c) contexts where there are positive client-counselor and/or peer relationships. There is some evidence that sometimes ongoing engagement is necessary to maintain positive outcomes. There is also some evidence that complete abstinence from drugs (e.g., cocaine, heroin) is not necessary for engagement. It is important to consider how the contexts of interventions might elicit and/or support clients’ engagement. Further research is needed to explore how an individual’s background (e.g., involvement with different interventions over an extended period) may influence engagement. Long-term engagement may be necessary to sustain some positive outcomes although how long is unclear and requires further research. Engagement can occur without complete abstinence from such drugs as cocaine or heroin, but additional research is required as engagement may be influenced by the extent and type of drug use. The online version of this article (doi:10.1186/s40359-014-0026-3) contains supplementary material, which is available to authorized users.