An empirical investigation into recovery from illicit drug abuse using recurrent

使用经常性方法对非法药物滥用的康复进行实证研究

• 批准号: 8372718
• 负责人: Julio Sergio Gonzalez Montaner
• 金额: $ 17.14万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8372718
• 关键词: AIDS/HIV problem; Abstinence; Acute; American; Archives; Behavior; Behavioral; British Columbia; California; Canada; Chronic Disease; Cohort Studies; Communities; Crack Cocaine; Crime; Data; Data Sources; Deceleration; Development; Dose; Dropout; Drug Addiction; Drug abuse; Drug usage; Drug user; Engineering; Epidemiology; Etiology; Evaluation; Event; Exposure to; Frequencies; HIV; HIV Infections; HIV Seropositivity; Heroin; Heroin Users; Illicit Drugs; Incidence; Individual; Injection of therapeutic agent; Intervention; Investigation; Joints; Lead; Longitudinal Studies; Maintenance; Medical; Medicare; Methodology; Modeling; Morbidity - disease rate; NIH Program Announcements; Opiate Addiction; Opioid; Overdose; Pattern; Pharmaceutical Preparations; Policies; Policy Developments; Population; Prevention; Process; Productivity; Recovery; Recurrence; Relapse; Relative (related person); Relative Risks; Research; Research Personnel; Research Project Grants; Risk; Risk Reduction; Severities; Staging; Substance abuse problem; System; Testing; Thinking; Time; Treatment Effectiveness; addiction; administrative database; base; care episode; career; clinical practice; cocaine use; cost; dosage; drug of abuse; experience; follow-up; innovation; insight; mortality; multiple drug use; programs; prospective; transmission process; treatment adherence; treatment center; treatment duration; treatment effect

DESCRIPTION (provided by applicant): Drug dependence is acknowledged by the scientific and medical communities as a chronic disease that may require long-term, possibly lifetime management. The costs of drug abuse have increased an average of 5.3 percent per year from 1992 through 2002, reaching an estimated $180.9 billion in 2002. These costs are due in part to the elevated risk of HIV transmission associated with injection drug abuse. It is estimated that some 2.1 million Americans are receiving some form of drug abuse treatment; however longitudinal studies indicate that addicted individuals often cycle through periods treatment, abstinence, and relapse, during which the risk of HIV transmission and mortality are highest. The concept of recovery from drug addiction remains without clear definition or understanding of its etiology. Relative to onset, maintenance, and relapse, deceleration and cessation are the least studied phenomena in drug abuse research. The benefits of long-term abstinence may include decreased risk of mortality, decreased crime, increased productivity, and decreases in the risk of HIV transmission. The processes constituting recovery can be framed in the context of a drug use career, which UCLA Integrated Substance Abuse Programs (ISAP) investigators have argued needs to be studied through longitudinal, dynamic conceptual and analytic approaches. Exploratory analyses conducted by Dennis et al. (2005) suggest that multiple episodes of care over several years are the norm and that rather than thinking of multiple episodes in terms of "cumulative dosage," it might be better thought of as further evidence of chronicity and of treatment system deficiencies and that further development and evaluation models of longer term recovery management is essential. Recurrent event analysis is an emerging innovative methodology that is well suited to identify the determinants of each of the stages of recovery from drug abuse, including regular use, treatment, relapse and abstinence and their attendant behaviors. Our specific aims include analyses on the determinants of durations of: (a) alternating periods of drug treatment and relapse among opioid users; (b) successive periods of drug use frequency in single-drug users (c) parallel durations of drug use among multiple-drug users; and (d) joint analysis of the cumulative and acute effects of recurrent durations of drug treatment on morbidity and mortality. In each case, the modifying effect of HIV infection on the course of recovery from drug abuse. We expect to generate new insights into the course and determinants of recovery from illicit drug dependence that can be used in policy development and in clinical practice to identify promising leverage points for re-engineering interventions in ways that shorten the relapse-treatment-recovery cycle, to increase the long-term effectiveness of treatment and decrease the incidence of HIV/AIDS.

描述（由申请人提供）：药物依赖被科学和医学界公认为一种慢性疾病，可能需要长期，可能是终身管理。从1992年到2002年，药物滥用的费用平均每年增加5.3%，2002年估计达到1809亿美元。这些费用的部分原因是，注射吸毒增加了艾滋病毒传播的风险。据估计，约有210万美国人正在接受某种形式的药物滥用治疗;然而，纵向研究表明，成瘾者经常经历治疗、戒断和复发的周期，在此期间，艾滋病毒传播和死亡的风险最高。药物成瘾康复的概念仍然没有明确的定义或对其病因的理解。相对于发作、维持和复发，减速和停止是药物滥用研究中研究最少的现象。长期禁欲的好处可能包括降低死亡风险，减少犯罪，提高生产力，降低艾滋病毒传播的风险。构成恢复的过程可以在吸毒生涯的背景下进行，加州大学洛杉矶分校综合药物滥用计划（ISAP）的调查人员认为需要通过纵向，动态的概念和分析方法进行研究。Dennis等人（2005）进行的探索性分析表明，几年内多次发作的护理是常态，而不是根据“累积剂量”考虑多次发作，最好将其视为慢性和治疗系统缺陷的进一步证据，并且进一步开发和评价长期恢复管理模型至关重要。复发事件分析是一种新兴的创新方法，非常适合于确定药物滥用康复每个阶段的决定因素，包括定期使用、治疗、复吸和戒断及其伴随行为。我们的具体目标包括分析以下持续时间的决定因素：（a）类阿片使用者中药物治疗和复吸的交替期;（B）单一药物使用者中药物使用频率的连续期;（c）多种药物使用者中药物使用的平行持续时间;（d）药物治疗复吸持续时间对发病率和死亡率的累积和急性影响的联合分析。在每种情况下，艾滋病毒感染对药物滥用康复过程的改变作用。我们期望对非法药物依赖康复的过程和决定因素有新的认识，可用于政策制定和临床实践，以确定有希望的杠杆点，重新设计干预措施，缩短复发-治疗-康复周期，提高治疗的长期有效性，降低艾滋病毒/艾滋病的发病率。