An empirical investigation into recovery from illicit drug abuse using recurrent

描述(申请人提供)：药物依赖被科学界和医学界公认为一种慢性病，可能需要长期的、可能是终生的管理。从1992年到2002年，药物滥用造成的损失平均每年增长5.3%，2002年估计达到1809亿美元。这些费用的部分原因是与注射吸毒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，成瘾者往往在治疗、戒断和复发期间循环，在此期间艾滋病毒传播和死亡的风险最高。戒毒的概念仍然没有明确的定义，也没有对其病因的了解。相对于发病、维持和复发，减速和停止是药物滥用研究中最少研究的现象。长期禁欲的好处可能包括降低死亡风险、减少犯罪、提高生产力和降低艾滋病毒传播风险。构成康复的过程可以在药物使用职业的背景下框架，加州大学洛杉矶分校综合物质滥用计划(ISAP)的调查人员认为，需要通过纵向、动态的概念和分析方法来研究。丹尼斯等人进行的探索性分析。(2005)建议，在几年内进行多次护理是常态，与其从“累积剂量”的角度考虑多次护理，不如将其视为慢性和治疗系统缺陷的进一步证据，并指出进一步发展和评估长期康复管理模式是至关重要的。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康复的每个阶段的决定因素，包括定期使用、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下列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吸期交替；(B)单一吸毒者的连续吸毒期；(C)多个吸毒者的平行吸毒期；(D)联合分析重复药物治疗持续时间对发病率和死亡率的累积和急性影响。在每个案例中，艾滋病毒感染对药物滥用康复过程的修正作用。我们期望对戒除非法药物依赖的过程和决定因素产生新的见解，这些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-康复周期、提高治疗的长期有效性和减少艾滋病毒/艾滋病发病率的方式重新设计干预措施。

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.