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: 8690000
• 负责人: Julio Sergio Gonzalez Montaner
• 金额: $ 16.75万
• 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 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8690000
• 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）：药物依赖被科学界和医学界认为是一种慢性疾病，可能需要长期甚至终生的治疗。从1992年到2002年，滥用药物的费用平均每年增加5.3%，2002年估计达到1,809亿美元。这些费用部分是由于与注射药物滥用有关的艾滋病毒传播风险增加。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率的风险最高。从药物成瘾中恢复的概念仍然没有明确的定义或对其病因的理解。相对于发病、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率、减少犯罪、提高生产力和降低艾滋病毒传播的风险。构成康复的过程可以在药物使用生涯的背景下进行框架，加州大学洛杉矶分校综合药物滥用项目（ISAP）的研究人员认为，需要通过纵向、动态的概念和分析方法对其进行研究。Dennis等人（2005）进行的探索性分析表明，数年内多次发作的治疗是常态，与其将多次发作视为“累积剂量”，不如将其视为慢性和治疗系统缺陷的进一步证据，进一步开发和评估长期康复管理模型是必不可少的。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恢复的每个阶段的决定因素，包括经常使用、治疗、复发和戒断及其伴随的行为。我们的具体目标包括分析持续时间的决定因素：(a)阿片类药物使用者的药物治疗和复发交替期；(b)单一药物使用者的连续用药频次；(c)多种药物使用者的平行用药频次；(d)联合分析药物治疗复发持续时间对发病率和死亡率的累积和急性影响。在每种情况下，艾滋病毒感染对药物滥用恢复过程的修饰作用。我们期望对从非法药物依赖中恢复的过程和决定因素产生新的见解，可用于政策制定和临床实践，以确定有希望的杠杆点，以缩短复发-治疗-恢复周期的方式重新设计干预措施，提高治疗的长期有效性并降低艾滋病毒/艾滋病的发病率。

项目成果

Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users.

• DOI: 10.1016/j.drugpo.2017.07.009
• 发表时间: 2017-11
• 期刊: The International journal on drug policy
• 作者: Wang L;Min JE;Krebs E;Evans E;Huang D;Liu L;Hser YI;Nosyk B
• 通讯作者: Nosyk B

Evidence-based drug policy: it starts with good evidence and ends with policy reform.

循证毒品政策：始于良好证据，终于政策改革。

• DOI: 10.1016/j.drugpo.2012.10.005
• 发表时间: 2012
• 期刊: The International journal on drug policy
• 作者: Nosyk,B;Wood,E
• 通讯作者: Wood,E

The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California.

• DOI: 10.1111/add.13729
• 发表时间: 2017-05
• 期刊: Addiction (Abingdon, England)
• 作者: Krebs E;Urada D;Evans E;Huang D;Hser YI;Nosyk B
• 通讯作者: Nosyk B

High levels of opioid analgesic co-prescription among methadone maintenance treatment clients in British Columbia, Canada: results from a population-level retrospective cohort study.

加拿大不列颠哥伦比亚省美沙酮维持治疗客户中阿片类镇痛联合处方的高水平：人口水平回顾性队列研究的结果。

• DOI: 10.1111/j.1521-0391.2014.12091.x
• 发表时间: 2014
• 期刊: The American journal on addictions
• 作者: Nosyk,Bohdan;Fischer,Benedikt;Sun,Huiying;Marsh,DavidC;Kerr,Thomas;Rehm,JuergenT;Anis,AslamH
• 通讯作者: Anis,AslamH