Pathways to Recovery for Substance Abusers in Treatment

描述（由申请人提供）： 药物依赖与多种并发问题越来越被认为是一种慢性，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都接受过治疗，而且很可能再次接受治疗。需要做更多的工作来了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-精神模型中的特定假设，以便制定可测试的策略，以便更有效地管理随着时间的推移的恢复。这项研究将从5年扩展到10年，对1326名连续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、短期居住、长期居住）分层，以确保一系列物质使用障碍和成瘾/治疗生涯阶段。参与者中59%为女性，87%为非洲裔美国人。使用综合评估包，我们在6个月、18个月、2年、3年、4年和5年（半）时进行了随访访谈，每波随访率达到93%或以上。具体目标是：1）检查10年内多次治疗事件、复发和恢复模式之间的关联; 2）评估可能影响患者启动和维持恢复能力的个体差异，如精神病共病、个性和性别; 3）探索治疗或其他力量改变恢复介质的程度，如动机，应对策略，灵性，社交网络和物理恢复环境;和4）评估持续恢复和减少物质使用减少与物质使用相关的长期后果的程度，包括非法活动，身体或精神疾病，昂贵的服务使用和死亡。

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.