Pathways to Recovery for Substance Abusers in Treatment

描述(由申请人提供)： 药物使用依赖与多种共生问题日益被认为是一种慢性复发性疾病，可能会持续数十年，需要多年的多次护理才能达到持续的缓解状态。虽然大多数治疗研究都集中在单次治疗上，但进入公共资助治疗的普通人以前曾接受过治疗，并可能再次接受治疗。需要更多的工作来理解长达数十年的成瘾、治疗和康复过程。 这项拟议的研究旨在测试用于其他慢性病患者的生物-心理-社会-精神模型中的具体假设，以便开发可测试的策略，以便随着时间的推移更有效地管理康复。这项研究将从5年扩大到10年，对1326名先后接受治疗的参与者进行纵向研究。样本按护理水平(门诊、重症门诊、美沙酮维持、中途之家、短期住宿、长期住宿)分层，以确保一系列物质使用障碍和成瘾/治疗生涯的阶段。参与者中59%是女性，87%是非裔美国人。使用综合评估方案，我们在6个月、18个月、2、3、4和5(半)年进行了随访率，每波随访率达到93%或以上。具体目标是：1)检查10年中多次治疗发作、复发和康复模式之间的联系；2)评估可能影响一个人启动和维持康复能力的个体差异，如精神疾病的共同发病率、个性和性别；3)探索治疗或其他力量在多大程度上改变康复的中介因素，如动机、应对策略、灵性、社会网络和身体康复环境的变化；以及4)评估持续康复和减毒药物使用在多大程度上减少了与药物使用有关的长期后果，包括非法活动、身体或精神疾病、昂贵的服务利用和死亡。

DESCRIPTION (provided by applicant): Substance use dependence with multiple co-occurring problems is increasingly recognized as a chronic, relapsing condition that may last for decades and require multiple episodes of care over many years before reaching a sustained state of remission. While most treatment research has focused on single episodes of care, the average person entering publicly-funded treatment has been in treatment before and is likely to return to treatment again. More work is needed to understand the decades-long course of addiction, treatment and recovery. The proposed study is designed to test specific hypotheses from a bio-psycho-social-spiritual model used for people with other chronic conditions in order to develop testable strategies for more effectively managing recovery over time. The study will expand from 5 to 10 years a longitudinal study of 1326 participants sequentially admitted to a treatment. The sample was stratified by level of care (outpatient, intensive outpatient, methadone maintenance, halfway houses, short-term residential, long-term residential) to ensure a range of substance use disorders and stage of addiction/treatment career. The participants are 59% female and 87% African American. Using a comprehensive assessment package, we conducted follow-up interviews at 6 months, 18 months, 2, 3, 4 and 5 (half) years achieving follow-up rates of 93% or more per wave. The specific aims are to: 1) examine the association between multiple treatment episodes, relapse, and recovery patterns over the course of 10 years; 2) evaluate individual differences that may moderate one's ability to initiate and sustain recovery, such as, psychiatric co-morbidity, personality, and gender; 3) explore the extent to which treatment or other forces change mediators of recovery, such as changes in motivation, coping strategies, spirituality, social networks, and physical recovery environment; and 4) evaluate the extent to which sustained recovery and attenuated substance use reduce the long-term consequences associated with substance use, including illegal activity, physical or mental illness, expensive service utilization, and death.