Entry and Engagement in Methadone Maintenance Treatment

描述(由申请人提供)： 大多数需要药物滥用治疗的人仍然没有得到治疗，相当大比例的吸毒者在短暂的任期内就退出了治疗。因此，有助于了解吸毒者进入和参与药物滥用治疗及其后续结果的研究，对于改进治疗的努力至关重要。鉴于艾滋病毒感染的威胁，对于艾滋病毒感染风险特别高的阿片成瘾者和被广泛用于阿片依赖治疗的美沙酮维持治疗而言，改善治疗进入和参与尤其重要。建议进行一项为期五年的服务研究，以全面审查接受治疗和参与治疗的情况，并从生物心理社会理论角度指导调查。从这一角度来看，拟议的研究将审查三个领域--即个人特征、治疗属性和环境影响--假设影响阿片成瘾者改变的动机和治疗的动机，他们进入并随后参与美沙酮维持治疗，并最终影响他们的康复。在这些领域中的每一个领域，都将检验根据以前的研究和理论选择的特定的、潜在的相关变量的影响。将研究两组成年阿片依赖者，包括最近没有接受治疗也没有兴趣寻求治疗的吸毒者(N=200)和新入院接受美沙酮维持治疗的阿片依赖者(N=400)，两组都参与治疗进入审查，入院组单独参与治疗敬业度审查。综合评估将在基线和3个月(只涉及入院组研究其最初参与治疗的3个月评估)以及之后的6个月和12个月进行。提出了两个独立但互补的结构方程模型来预测(1)治疗进入和(2)治疗投入和结果。这些模型以及这些模型的假设组件将使用结构方程建模技术进行测试，包括将假设模型与看似合理的替代模型进行比较。虽然主要的研究方法是定量的，但将包括强有力的定性研究部分，以提供对改变动机和治疗动机的深入检查，以及对了解治疗进入和参与可能重要的其他变量的深入检查。

DESCRIPTION (provided by applicant): The majority of individuals in need of drug abuse treatment remain untreated, and a sizeable proportion of drug abusers who enter treatment exit after a brief tenure. Thus, research that contributes toward an understanding of drug abusers' entry and engagement in drug abuse treatment, and their subsequent outcomes, is critical to efforts to improve treatment. Given the threat of HIV infection, improving treatment entry and engagement is particularly important with regard to opioid addicts, who are at especially high risk for HIV infection, and methadone maintenance treatment, which is widely used for the treatment of opioid dependence. A five-year services research study is proposed to comprehensively examine treatment entry and engagement, using a biopsychosocial theoretical perspective to guide the investigation. Informed by this perspective, the proposed study will examine three domains - namely, personal characteristics, treatment attributes, and environmental influences - that are hypothesized to affect opioid addicts' motivation to change and motivation for treatment, their entry into and subsequent engagement in methadone maintenance treatment, and, ultimately, their recovery. Within each of these domains, the effects of specific, potentially relevant variables, selected on the basis of previous research and theory, will be examined. Two groups of adult opioid addicts will be studied, including addicts who have not recently received nor are interested in seeking treatment (N = 200) and opioid addicts newly admitted to methadone maintenance treatment (N = 400), with both groups involved in the examination of treatment entry, and the admission group alone involved in the examination of treatment engagement. Comprehensive assessments will be conducted at baseline and 3 months (the 3-month assessment involving only the admission group to study their initial engagement in treatment), and 6 and 12 months thereafter. Two separate, but complementary, structural equation models are posited to predict (1) treatment entry and (2) treatment engagement and outcomes. These models, along with hypothesized components of these models, will be tested using structural equation modeling techniques, including the comparison of hypothesized models with plausible alternate models. While the primary study approach is quantitative, a strong qualitative research component will be included to provide for in-depth examination of motivation to change and motivation for treatment, and of other variables that are potentially important to understanding treatment entry and engagement.