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得不到治疗，相当一部分接受治疗的药物滥用者在短期治疗后退出。因此，有助于了解吸毒者进入和参与吸毒治疗及其随后的结果的研究，对于改进治疗的努力至关重要。鉴于艾滋病毒感染的威胁，改善对艾滋病毒感染风险特别高的类阿片成瘾者的治疗准入和参与，以及广泛用于治疗类阿片依赖的美沙酮维持治疗，尤为重要。一项为期五年的服务研究，提出了全面检查治疗的进入和参与，使用生物心理社会理论的角度来指导调查。根据这一观点，拟议的研究将研究三个领域-即个人特征，治疗属性和环境影响-假设影响阿片类药物成瘾者改变的动机和治疗动机，他们进入并随后参与美沙酮维持治疗，最终，他们的康复。在每一个领域，具体的，潜在的相关变量的影响，选择以前的研究和理论的基础上，将进行审查。将研究两组成人阿片类药物成瘾者，包括最近没有接受也没有兴趣寻求治疗的成瘾者（N = 200）和新接受美沙酮维持治疗的阿片类药物成瘾者（N = 400），两组均参与治疗进入检查，仅入院组参与治疗参与检查。将在基线和3个月（3个月评估仅涉及入院组，以研究其最初参与治疗的情况）以及6个月和12个月后进行综合评估。两个独立但互补的结构方程模型被用来预测（1）治疗进入和（2）治疗参与和结果。将使用结构方程建模技术对这些模型以及这些模型的假设组件进行沿着检验，包括将假设模型与合理的替代模型进行比较。虽然主要的研究方法是定量的，但将包括一个强有力的定性研究部分，以深入研究改变的动机和治疗的动机，以及对理解治疗进入和参与可能重要的其他变量。

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.