海洛因辅助治中患者的渴求感和非法海洛因使用状况

1、Craving and illicit heroin use among patients in heroin-assisted treatment海洛因辅助治中患者的渴求感和非法海洛因使用状况 Drug and Alcohol Dependence mpact Factor: 3.836abstract 摘要Aims:To investigate in heroin-assisted treatment(HAT) compared to methadone maintenance treatment (MMT):the course of heroin craving and illicit

2、 heroin use,their mutual association,and their association with multi-domain treatment response. 通过美沙酮维持治疗（MMT）与海洛因辅助治疗（HAT）进行比较，调查：海洛因渴求和非法海洛因使用的过程以及他们之间的相互关系、他们和多域治疗反应的之间的关系。 Design:RCTs on the efficacy of 12 months co-prescribed injectable or inhalable HAT compared to 12 months continued oral MMT

3、. 持续12个月口服美沙酮维持治疗（MMT）与12个月的相同规定剂量注射或吸入的海洛因辅助治疗（HAT）进行比较，比较二者的临床功效。Setting:Outpatient treatment in MMT-or specialized HAT-centers in the Netherlands. 在荷兰，门诊患者的治疗有美沙酮维持治疗和特殊海洛因辅助治疗中心Participants:Chronic, treatment-refractory heroin dependent patients(n=73). 长期，难治性海洛因依赖者（n=73）Study parameters:General

4、craving for heroin (Obsessive Compulsive Drug Use Scale) self-reported illicit heroin use;multi-domain treatment response in physical,mental and social health and illicit drug use. 对海洛因的一般渴求（强迫性冲动使用量表）；自我报告非法海洛因的使用情况；身体、精神、社会健康和非法药物使用上的多领域治疗反应。Findings:The course of heroin craving and illicit heroin

5、 use differed significantly, with strong reductionsin HAT but not in MMT. General heroin craving was significantly related to illicit heroin use.Heroin craving was not and illicit heroin use was marginally related to multi-domain treatment response,butonly in MMT and not in HAT。 （1）海洛因的渴求与非法海洛因使用之间存

6、在差异显著性，在海洛因辅助治疗（HAT）中明显下降，而美沙酮维持治疗（MMT）没有出现； （2）海洛因一般渴求和非法海洛因使用之间存在显著相关； （3）海洛因渴求与多领域治疗反应不存在相关，而非法海洛因使用与多领域治疗反应存在边缘相关，但只存在美沙酮维持治疗（MMT）中，在海洛因辅助治疗（HAT）中并不存在。Conclusions: Heroin craving and illicit heroin use were significantly associated and both strongly decreased in HAT but not in MMT.Craving was no

7、t related to multi-domain treatment response and illicit heroin use was marginally related to treatment response in MMT, but not in HAT.The latter was probably due to the strong reduction in illicit heroin use in most patients in HAT and the small sample size of the sub-study. It is hypothesized tha

8、t the strong reductions in craving for heroin in HAT are related to the stable availability of prescribed, pharmaceutical grade heroin. （1）海洛因渴求和非法海洛因使用之间存在差异显著性，在海洛因辅助治疗（HAT）中明显下降，而美沙酮维持治疗（MMT）没有出现； （2）渴求和多领域治疗反应不相关，非法海洛因使用和多领域治疗反应存在边缘相关，但只存在美沙酮维持治疗（MMT）中，在海洛因辅助治疗（HAT）中不存在。后者可能由于在HAT中，大多数患者对非法海洛因使用

9、的明显减少，子研究的样本小。 （3）假设在HAT中对海洛因的渴求明显减少与稳定的可获取的处方海洛因，海洛因纯度有关。Assessments and instruments评估和工具 Patients were interviewed bimonthly. All interviews and assessments were conducted in an office of the research team,outside the methadone and heroin treatment centers, with no cuesor triggers related to presc

10、ribed or non-prescribed drug use,and after intake of the daily methadone and/or heroin dose. 每两个月对患者进一次行访谈。由研究团队的一个工作人员进行。在美沙酮和海洛因治疗中心之外进行，旨在控制诱发线索（没有线索或处方、非处方药物使用相关的触发器）。在摄取每日规定剂量的美沙酮或海洛因之后再进行访谈. The standard assessment battery in the trials included the European Addic-tion Severity Index (EuropASI

11、) (Kokkevi and Hartgers,1995), the Health Symptoms Scale of the Maudsley Addiction Profile (MAP-HSS) (Marsden et al., 1998), and the Symptom Checklist 90-item version (SCL-90) (Derogatis, 1983). In the craving sub-study two additional assessments were used: the Obsessive Compulsive Drug Use Scale (F

12、ranken et al., 2002), and the Eysenck Personality Questionnaire (EPQ) with a measure of Social Desirability (Eysenck and Eysenck, 1964; Sanderman et al., 1991). 实验中的一系列评估标准包括，欧洲成瘾严重指标问卷(EuropASI) (Kokkevi and Hartgers,1995)、斯里成瘾健康症状量表（MAP-HSS） (Marsden et al. 1998) 、SCL-90症状自评量表（SCL-90(Derogatis, 19

13、83)。渴求子研究中使用的另外两个评估工具：强迫性冲动药物使用量表（OCDUS）(Franken et al., 2002)，埃森克人格问卷（EPQ）测量社交愿望(Eysenck and Eysenck, 1964; Sanderman et al., 1991).。 The Obsessive Compulsive Drug Use Scale (OCDUS) is a 12-item version of the Obsessive Compulsive Drinking Scale (OCDS) (Anton et al., 1996), adapted for heroin depen

14、dence and measuring self-reported heroin craving, in terms of obses-sive thoughts, in the past week (Franken et al., 2002). All items have a 5-point Likert scale (04). Recently, de Wildt et al. (2005) showed that a selection of only five items of the OCDS (1) duration and (2) frequency of obsessions

15、 (ideas, thoughts,impulses, or images) with drinking; (3) distress caused by those obsessions; (4)effort to resist the obsessions; and (5) strength of the drive to consume alcoholic beverages) were able to tap the core concept of craving and showed good internal consistency in alcohol dependent pati

16、ents (a = 0.81). In the current sub-study, this core set of five craving items of the OCDUS, pertaining to thoughts and feelings and behavioral intentions (total score ranging from 0 to 20; internal consistency in this sample of heroin dependent patients: a= 0.77) was used for analysis. 强迫性冲动使用药物量表(OCDUS)，是包含12个项目的强迫性冲动饮酒量表(OCDS)(OCDS) (Anton et al., 1996)，适用于海洛因依赖和自我报告来测量海洛因渴求，是在过去两周，就强迫性思维而言，其中所有项目采用五点记分（0-4）。最近de Wildt et al. (2005) 展示了只选择的OCDS五个项目（1）持续时间，（2）强迫饮酒的频率(ideas, thoughts,impulses, or images)。（3）强迫性造成的压力。（4）努力反抗强迫。（5）推动自己消费酒精（饮料）的强度，这些能够推测渴求的核心概念。在酒精依赖者中