615例海洛因依赖者复吸原因调查与分析

目的··:了解海洛因依赖者脱毒后复吸的原因 ,寻求有效的预防复吸措施。方法··:采用《药物滥用复吸因素调查表》对615例海洛因依赖者脱毒后复吸的情况进行调查。结果··:在615例被调查者中 ,脱毒后出院3d内复吸的占21.79 % ;1个月内复吸的占52.36 % ;6个月内复吸的占93.50 % ;1a内复吸率高达97.89 %。自愿戒毒、强制戒毒与劳教戒毒出所后不同时间内的复吸率比较无显著性差异 (P>0.05)。难以抗拒的对药物的心理渴求是产生复吸的主要心理因素 (占86.99 % ) ;身体不适、失眠等稽延性戒断症状是产生复吸的主要生理因素 (占76.75 % ) ;毒友引诱是产生复吸的主要社会因素 (占75.94 % )。心理、生理、社会诸因素造成海洛因依赖者脱毒后不能保持操守。结论·· :脱毒后给予必要的对症治疗和坚持不懈的行为矫治 ,以及持之以恒的家庭关心、监督 ,社会帮教、扶持 ,政府部门监控、管制和严惩毒贩 ,清除毒源等综合治理 ,是降低复吸率的有效办法     

氯氮平、纳曲酮治疗壮、汉族海洛因依赖者心理渴求疗效分析

目的：对脱毒后的壮、汉族海洛因依赖患者进行氯氯平、纳曲酮治疗,观察其对心理渴求的治疗效果。方法：52例壮族、86例汉族自愿戒毒海洛因依赖者,脱毒后由患者自愿选择氯氮平或纳曲酮治疗3个月,使用心理渴求量表评定患者治疗前、后渴求程度变化。结果：壮、汉族海洛因依赖者治疗前后心理渴求评分值差异有显著性（P〈0．05）,壮、汉族海洛因依赖者之间心理渴求评分值治疗前后差异无显著性（P〉0．05）,壮、汉族海洛因依赖者氯氮平治疗后心理渴求评分值下降较纳曲酮明显,差异有显著性（P〈0．05）。结论：氯氯平、纳曲酮能有效治疗壮、汉族海洛因依赖者脱毒后的心理渴求,且无民族差异,氯氯平治疗效果稍优于纳曲酮。     

吸毒者毒品渴求的综合评估与头发皮质醇

<正>毒品滥用是全球普遍存在的公共卫生问题。戒毒的关键是解除戒断后对毒品的心理依赖(即毒品渴求)来防止复吸[1]。毒品渴求是成瘾者对过去体验过的精神活性物质效应的一种难以抑制的渴望。毒品渴求作为预测因子,渴求程度越高越有可能复吸;作为戒毒工作的结局变量,可用来判断成瘾者是否达到结束治疗的标准[2-4]。客观评价成瘾者的毒品渴求是戒毒效果评估的重要环节,是评估戒毒工作成效的关键技术问题。     

治疗康复模式:"太阳花"治疗康复社区

毒品与吸毒是目前一个全球性的问题,最新统计,全球大约有2亿人吸毒,2003年我国登记在册的吸毒人员已超过105万人.中国对戒毒工作非常重视,从劳动教养,强制戒毒到自愿戒毒(目前全国约有自愿戒毒所1 000多所),从躯体脱毒、心理康复到回归社会,各种模式繁多.但脱毒治疗后3个月内复吸率可达86.7%～98.8%[1].目前国内外专家一致认为吸毒成瘾是一种不顾后果的具有强迫觅药和用药行为的慢性复发性脑疾病[2].因为长期吸毒,大脑机能发生了一系列的慢性病理性改变.身体因素(如稽延性戒断症状、疲劳、失眠等)、心理因素(心理依赖性、暗示、情绪障碍)、社会因素(原吸毒环境)及生活事件(身体和心理应激反应)等诱发复吸[3、4].     

海洛因依赖者自愿戒毒顺从性分析

海洛因依赖者自愿戒毒时对医生的期望值都较高,既要在戒毒时没有痛苦,又不能耐受药物治疗中一些常见的副反应,这种近乎严酷的要求对医生来说原属无可厚非,因为确保戒毒时较少痛苦和选择较少副作用的药物,这亦是医生的职责.但问题的难点在于自愿戒毒者大多数治疗依顺性较差且常干扰医生正常行使其医疗工作的职能,不可理喻,其结果是给自身带来了诸多负面作用和不良后果.因此亦可以说,治疗顺从性与否是决定自愿戒毒成败的重要因素之一.本文就196例自愿戒毒者的治疗顺从性进行调查分析,现报导如下:     

动机-技能-脱敏-心理能量模式对戒毒人员慢性渴求和抑郁的干预效果

目的:评价动机-技能-脱敏-心理能量模式对戒毒人员慢性渴求和抑郁情况的干预效果。方法:选取襄阳市强制隔离戒毒所男性戒毒人员98名,随机分为试验组和对照组,试验组接受动机-技能-脱敏-心理能量模式和戒毒所常规戒毒教育,对照组仅接受戒毒所常规戒毒教育,一个月后用强迫性毒品使用量表和贝克抑郁自评量表评价试验组和对照组慢性渴求和抑郁情况。结果:重复测量方差分析显示:干预后试验组在强迫性毒品使用量表得分上比对照组低(P<0.01),干预后试验组强迫性毒品使用量表和贝克抑郁自评量表得分较干预前自身比较也显著降低(P<0.01),试验组干预后强迫性毒品使用量表和贝克抑郁自评量表得分下降趋势较对照组明显(P<0.01)。结论:动机-技能-脱敏-心理能量模式可以在一定程度上减轻强制戒毒人员慢性渴求和抑郁状况,理论上该研究结果提供复吸预防有关信息。     

127例海洛因依赖者自愿戒毒动机和住院时间与复吸关系的研究

目的：探讨海洛因依赖者自愿住院戒毒的动机、住院时间、出院后复吸情况。方法：采用自编调查问卷，包括一般人口学特征、戒毒动机，住院时间、出院后复吸情况等，就有关问题进行调查。结果：海洛因依赖者以吸毒减量动机为多；住院时间以5～6天为主；出院后第1天复吸者占80％。结论：自愿戒毒所主要功能：维护吸毒人员身体健康，减少毒品对身体伤害。     

甲基苯丙胺渴求量表在戒毒人员中应用的信效度

目的:探讨修订版甲基苯丙胺渴求量表(MA craving scale)在甲基苯丙胺成瘾戒毒人员中的适用性。方法:以460名甲基苯丙胺类成瘾的戒毒人员为施测对象,对数据进行项目分析、探索性因素分析和验证性因素分析。结果:修订版甲基苯丙胺渴求量表共包含5个因子,总量表与分量表的内部一致性系数0.62~0.73之间,重测信度为0.72。验证性因素分析拟合指标为χ²/df=2.93, GFI=0.76, CFI=0.95, IFI=0.93,NFI=0.93, NNFI=0.95, RMSEA=0.056。结论:修订版甲基苯丙胺渴求量表具有良好的信效度,测量结果符合心理测量学指标,适用于评估甲基苯丙胺成瘾戒毒人员的渴求程度。     

海洛因依赖者脱毒期间心理状态的分析

目的:探讨自愿戒毒病人脱毒期间的心理状态变化,为临床治疗和护理提供依据。方法:采用焦虑自评量表、自评抑郁量表、戒断症状观察量表,对76例本院自愿戒毒人员进行3次评定,并对照分析。结果:第2次、第3次量表评定分值与第1次评定对比有统计学意义(P<0.05)。结论:海洛因依赖者在脱毒期间存在明显的焦虑、抑郁和心理渴求,应给予有效的药物辅助治疗和心理干预。     

吸毒患者亲属心理-行为干预方法及效果研究

目的:探索提高吸毒者亲属帮助患者戒毒能力的心理-行为干预方法.方法:对戒毒患者亲属进行与戒毒有关的心理-行为干预,包括:举办讲座、开通热线解答亲属的问题、上门与电话指导等,并通过调查亲属对戒毒成功的态度、帮助戒毒的措施、焦虑状况等对干预效果进行评价.结果:通过干预后,戒毒者亲属帮助其戒毒的措施显著改善(P<0.01),对戒毒患者多采用温和的管理方式(43.33%,P<0.01),亲属焦虑比例下降(P<0.05).结论:对戒毒患者亲属进行心理-行为干预可增强其帮助戒毒的作用.     

自愿戒毒和劳教戒毒后复发因素的调查分析

目的:对自愿戒毒与劳动教养戒毒两种戒毒模式中海洛因成瘾者戒毒后复发因素进行调查分析,探讨戒毒防复发的策略与方法。方法:使用31项《阿片类物质依赖复发情况问卷》,对自愿和劳教戒毒患者两组人群进行复发因素的量表测评和问卷式调查。对其"躯体生理因素、心理因素、药物成瘾性因素和社会环境因素"4个因子结果,以及社会支持量表和抑郁症自评量表等结果进行统计学分析和比较。结果:影响海洛因成瘾戒毒复发的最主要的影响因素依次是"精神心理因素、社会环境因素、躯体生理因素和药物成瘾因素"。劳教戒毒组中"精神心理因素"和"社会环境因素"更加突出。结论:造成海洛因成瘾戒毒后复发的因素是多方面的,劳教戒毒较自愿戒毒的复发因素更为复杂,提示:海洛因成瘾者在接受药物治疗的同时,更要注重心理治疗和回归社会后帮教措施的落实。     

Long-term methadone maintenance reduces protracted symptoms of heroin abstinence and cue-induced craving in Chinese heroin abusers

BACKGROUND: Cession of heroin use may be followed by a protracted-abstinence (PA) syndrome consisting of craving, negative mood, and physiological changes. PA symptoms have rarely been compared between drug-free and methadone-maintained former heroin users after similar lengths of heroin abstinence. METHODS: Seventy former heroin users were included in one of four groups: in day 15-45 of methadone maintenance therapy (short-term MMT), in month 5-6 of MMT (long-term MMT), opiate-free for 15-45 days after methadone-assisted heroin detoxification (short-term post-methadone), and opiate-free for 5-6 months after methadone-assisted heroin detoxification (long-term post-methadone). PA symptoms (negative mood, dyssomnia, somatization, and craving), and blood pressure and pulse were assessed pre- and post-neutral videotape and pre- and post-heroin videotape. RESULTS: Dyssomnia and the total PA score were worst in short-term post-methadone participants, mood was best in long-term MMT participants, and cue-induced craving was least severe in long-term MMT participants. Blood pressure and pulse did not differ across groups. CONCLUSIONS: Even after acute withdrawal, the first months of heroin abstinence after methadone-assisted detoxification may be more difficult in terms of cue-induced craving and other PA symptoms than the first months of heroin abstinence during MMT. Our findings add to the literature supporting MMT for prevention of cue-induced heroin craving.     

海洛因依赖者封闭式集中与分散住院方式的疗效对比分析

目的:探讨自愿戒毒者在戒毒过程中集中与分散封闭住院方式对疗效、疗程的影响。方法:将自愿戒毒者随机分为集中封闭组和分散封闭组并对患者进行各种客观指标测定。结果:集中治疗组美沙酮的消耗量、日最高剂量、全疗程平均日消耗量均高于分散治疗组,但其住院平均天数、疗效则低于分散治疗组,有显著差异。讨论:自愿戒毒者的分散封闭管理治疗较优集中封闭管理治疗。     

Changes in Nutrition-Related Behaviors in Alcohol-Dependent Patients After Outpatient Detoxification: The Role of Chocolate

Background: Previous studies have reported changes in nutrition-related behaviors in alcohol-dependent patients after alcohol detoxification, but prospective studies assessing the effects of these changes on maintaining abstinence are lacking. Objectives: To assess changes in craving and consumption of chocolate and other sweets over time up to six months after outpatient alcohol detoxification treatment and to detect differences in abstinent versus nonabstinent patients. Methods: One hundred and fifty alcohol-dependent patients were included in this prospective observational study. Participants completed self-report questionnaires on nutrition-related behaviors and craving before detoxification treatment (baseline, t1), one week (t2), one month (t3), and six months later (t4). Results: Significant changes in craving for and consumption of chocolate as well as in craving for other sweets were observed over time. Increases were most prominent within the first month. Patients who remained abstinent until t3 consumed three times more chocolate than nonabstainers. One quarter of the patients switched from being rare (t1) to frequent (t3) chocolate eaters, and 84% of these remained abstinent until t3. No significant correlations were found between craving for alcohol and craving for or consumption of chocolate or other sweets. Conclusions/Importance: In the first month after outpatient alcohol detoxification treatment, significant changes in nutrition-related behaviors were observed. These changes were not associated with alcohol craving. For a subgroup, increasing the frequency of chocolate consumption might be a temporary protective factor with respect to alcohol relapse.     

海洛因依赖者脱毒后药物渴求的初步调查

目的··:观察国内临床脱毒后未染毒的海洛因依赖者的渴求状况。方法··:采用单项目的自评量表 ,对705例在北京和重庆地区的强制戒毒机构脱毒后的住院者进行药物渴求程度调查。结果··:在调查期间 ,有38.7 %的被调查者有不同程度的药物渴求。临床脱毒后 ,一个月、二个月、三个月及三个月以上 ,渴求分值的变化没有显著性(F=1.345,P=0.259)。渴求强度与吸香烟的数量之间有相关关系 (标准化回归系数为0.225,t=6.128,P<0.001)。结论·· :部分海洛因依赖者临床脱毒后 ,药物渴求持续存在     

海洛因依赖者医学应对方式及相关因素

目的:了解海洛因依赖者医学应对特点及其相关影响因素。方法:对186名自愿戒毒者,在脱毒治疗完成后5-15d进行调查。调查工具有自编基本项目调查表、医学应对问卷、稽延性戒断症状评定量表以及心理渴求程度Likert型分级法,将其医学应对因子得分与其他非吸毒患者进行比较,并对相关因素进行分析。结果:海洛因依赖者医学应对的“面对”因子得分较低;“回避”、“屈服”因子得分较高(P<0·001);不同性别、年龄、文化程度及职业的海洛因依赖者在医学应对方式上差异无显著性;“屈服”因子分与稽延性戒断症状及心理渴求程度呈正相关(P<0·05)。结论:缺乏面对及过多的屈服、回避是海洛因依赖者医学应对的特点,提示提高康复信心、减少稽延性戒断症状是康复的重要手段。     

Relationship between Tobacco Craving and Quality of Life among French Students: Results of a Cross-Sectional Study

Background: Understanding the factors leading to smoking cessation is of primary importance in reducing the death burden. Recently introduced in the DSM-5, craving is a potentially promising mechanism involved in relapse, but its articulation with quality of life and deprivation on tobacco student's consumers has never been investigated. Objectives: Our study explores the relationship between tobacco craving and sub-dimensions of quality of life when controlling effect of deprivation on a youth population with tobacco consumption. Method: Comparison between deprived and non-deprived students were conducted with online questionnaires on demographic data, level of dependency, perceived quality of life, deprivation and craving. Multivariate linear regression with backward procedure was conducted to assess the predictive validity of these variables on craving. Finally, Bayesian analysis was conducted to evaluate the model proposed by the regression. Results: One hundred and seventy-four participants were included. Craving was significantly correlated with all the other variables and increases when the level of deprivation rises, while it decreases when physical health improves. These results are confirmed by Bayesian linear regression. Conclusions/Importance: Environmental and social factors are usually overlooked when it comes to understanding individuals, deeply rooted biological mechanisms such as craving. Working on physical health is of interest to diminished craving and improves the quality of life during smoking cessation and thereby to support success on the student population. Consequences for the triadic neurocognitive model of addiction are discussed.     

海洛因依赖者脱毒后稽延性戒断症状与渴求的关系

目的··:探讨海洛因依赖者脱毒后造成复吸的重要因素。方法··:采用海洛因稽延性戒断症状自评量表对封闭式戒毒病房的151例海洛因依赖者进行调查,了解稽延性戒断症状与渴求等因素的关系。结果··:稽延性戒断症状与渴求、脱毒时间及吸毒方式有密切关系,与渴求关系最密切的是稽延性戒断症状的睡眠障碍及焦虑项目。结论··:稽延性戒断症状与渴求紧密相关。     

Beliefs as a predictor of relapse in alcohol-dependent Turkish men

OBJECTIVE: The aim of the current study was to evaluate the role of beliefs about alcohol use and craving on predicting relapse as stated in Beck's cognitive theory of alcoholism in detoxified alcohol-dependent patients. METHOD: Seventy male participants who were alcohol dependent according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and who were admitted to an inpatient unit for alcohol detoxification were studied at baseline and at 6 months follow-up. Participants were administered the Structured Clinical Interviews for DSM-IV axis I and DSM-III-R axis II Disorders (SCID-I and SCID-II, respectively), the Beck Anxiety Inventory and the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Beliefs about alcohol use were assessed with the Beliefs About Substance Use Inventory and the Craving Beliefs Questionnaire (CBQ). RESULTS: The relapse rate of the study group was 84.1% (58 patients). The age of onset of alcohol dependence and age at first hospitalization were lower in patients who relapsed. The severity of physical dependence and presence of comorbid antisocial personality disorder were higher in the relapse group. In addition, patients who relapsed had higher scores in the CBQ. According to logistic regression analysis, craving beliefs and the degree of physical dependence were predictors of relapse in alcoholic patients. CONCLUSIONS: Our findings suggest that beliefs about craving and the severity of physical dependence may play an important role in relapse of male alcoholic patients. These factors could have a direct clinical application for predicting relapse to drinking in male alcohol-dependent patients.