心理干预在美沙酮维持治疗中的应用及效果分析

目的：研究心理干预在美沙酮维持治疗中的应用及效果。方法：将120例海洛因依赖者分为美沙酮加心理干预组即研究组和单纯美沙酮干预组即对照组,比较组间治疗保持率的差异。结果：美沙酮加心理干预对提高海洛因依赖者治疗保持率效果显著。结论：心理干预能坚定吸毒者的戒毒愿望与信心,增添应对生活负性事件的能力,抵制毒友的诱惑,加强心理建设,使患者在家庭、社会支持和生活质量等方面都得到改善,帮助吸毒者彻底戒毒,真正回归社会。     

美沙酮维持治疗门诊综合干预效果评价

目的:评估综合干预措施对提高美沙酮维持治疗(MMT)维持率的作用效果。方法:根据随机对照试验设计的原则,我们将美沙酮门诊符合条件的73名在服人员随机分成对照组和治疗组,对照组接受常规美沙酮维持治疗服务和基本的激励措施,干预组在接受常规美沙酮维持治疗服务和基本的激励措施的同时,还接受包括医护人员、戒毒社工及家属提供心理-社会干预服务在内的综合干预措施,分别在1个月、3个月、6个月、9个月、12个月、15个月时观察两组维持率及脱失率的情况,评价其干预效果并进行统计学分析。结果:对照组和干预组在1个月、3个月、6个月、9个月、12个月、15个月时的维持率分别为91.9%、75.7%、64.9%、56.8%、54.1%、48.6%和97.2%、91.7%、88.9%、86.1%、83.3%、77.8%,从第6个月开始,干预组的维持率明显高于对照组,两者差异有统计学意义。结论:有针对性地采取包括心理-社会干预服务在内的综合干预措施,可以提高服药人员依从性,降低脱失率,提高服药率,提高维持治疗的效果。     

美沙酮维持治疗者团体心理辅导效果及心理干预对策分析

目的:在美沙酮药物维持治疗的基础上,探索更有效的心理干预方法和心理康复治疗模式,最大限度减少或避免治疗者的复吸.方法:随机抽取七里河区药物维持治疗门诊美沙酮维持治疗者20名,分为两组,实验组和对照组,开展心理干预和心理康复治疗,并收集测前、测后数据资料进行统计分析.结果:在实施团体心理辅导之前,实验组与对照组在焦虑和应...     

综合心理干预对美沙酮维持治疗患者抑郁症状的疗效观察

目的:对伴有抑郁症状的美沙酮维持治疗患者开展综合心理干预,探讨其效果。方法:治疗前,采用Beck抑郁自评量表(BDI-13)对2006年10月-2009年6月在海口市皮肤性病防治中心和海口市疾病预防控制中心美沙酮维持治疗门诊收治的海洛因成瘾患者405例进行筛选,将筛选出有抑郁症状的199例患者,根据抑郁评分均衡分分为对照组(n=99)和干预组(n=100),对照组仅接受美沙酮维持治疗,干预组除接受美沙酮维持治疗外,同时接受心理干预治疗,内容包括健康教育、支持性心理治疗、集体治疗等。心理干预治疗由门诊专科医务人员负责,每星期两次,为期6个月。6个月后再次采用Beck抑郁自评量表评估。数据采用χ2检验进行分析。结果:干预组的抑郁情绪好转明显高于对照组,P<0.05。结论:药物治疗和综合心理干预的有效结合,可以减轻海洛因患者的抑郁症状,对预防复吸和保持操守有一定的促进作用。     

认知治疗对美沙酮维持治疗者干预疗效分析

目的：研究在美沙酮维持治疗患者中使用认知治疗对其生活质量等方面的影响。方法：对我市社区药物维持治疗门诊收治的美沙酮维持治疗患者进行随机选取,共选择120例,将其通过抽签的方法分为两组,每组60例,对对照组进行常规的咨询和管理,而观察组进行认知治疗,使用基线调查表以及简明健康测量量表,还有功能失调性态度问卷等对患者情况进行判断。结果：除脆弱性以及吸引与排斥外,观察组治疗后其他DAS因子均优于对照组,简明健康测量结果显示除机体疼痛以及躯体功能外观察组治疗后其他因素均优于对照组,差异有统计学意义（P<0.05）。结论：对使用美沙酮进行维持治疗的患者,同时进行认知治疗有助于改善认知模式,对人际处事习惯进行良好的建立,将患者生活质量进行提高。     

心理干预对美沙酮维持治疗者自尊水平和防御机制的影响

目的：探讨心理干预对美沙酮维持治疗者自尊水平及其防御机制的影响。方法：将116例美沙酮维持治疗者随机分为治疗组和对照组各58例,对照组行常规美沙酮口服液维持治疗,治疗组在此基础上给予为期8周的心理干预。于干预前、干预4、8周末用自尊量表（SES）、自卑感量表（FIS）及防御方式问卷（DSQ）进行评估。结果：与干预前比较,治疗组在干预第4、8周末的SES、成熟防御机制评分显著增加,FIS、不成熟防御机制评分明显降低,对照组无显著性改变。组间比较,两组SES、FIS及DSQ评分在干预前无显著性差异,治疗组病人在第4、8周末的SES、成熟防御机制评分显著高于对照组,在第8周末的FIS、不成熟防御机制评分显著低于对照组。结论：心理干预,有助于提高美沙酮维持治疗者的自尊水平,改善其防御机制。     

美沙酮维持治疗中综合干预措施的应用现况

<正>美沙酮维持治疗(Methadone Maintenance Treatment,MMT)是针对海洛因等阿片类物质成瘾者采取的一种替代治疗方法。它是以生物——心理——社会医学模式为基础,应用合法、方便、安全、有效的药物——美沙酮来替代海洛因等阿片类毒品,通过长期持续的治疗改变阿片类物质成瘾者的高危险行为和恢复其各种社会功能~([1])。国内外的     

开展社区美沙酮维持治疗对促进海洛因滥用者进行心理干预的重要性

2003年11月,我国开始实施美沙酮替代维持治疗试点工作,截至2007年12月底,我国社区药物维持治疗门诊已达503个,涉及23个省（区、市）累计收治吸毒人员9．8万。美沙酮替代疗法是目前国际上公认,并能有效控制艾滋病的一种新方法,也是推动戒毒工作的一条有效途径。众所周知,绝大多数吸毒者在生理上脱瘾后,心理上的心瘾尚未戒脱,一旦有了吸毒环境或情境的影响,或遇到毒友吸毒,就可出现心瘾。吸毒产生的欣快感,又在诱惑着生理上已经戒毒的人,使其完全可能重新吸毒。我国开展的美沙酮维持治疗门诊,使滥用者将每日必须出入毒品交易地,取代为可随时得到医疗和心理服务的医疗机构,并使他们有机会得到心理、行为和家庭治疗。同时,也可为吸毒者从事正常生活,如上学、就业和融入社会提供条件。因此,心理辅导下的心理康复至关重要。     

心理干预对美沙酮维持治疗依从性及社会支持的影响

目的:观察心理干预对美沙酮维持治疗患者服药依从性的影响,探索如何为戒毒人员提供更好的综合治疗獉獉方法,以降低美沙酮维持治疗患者的复吸率。方法:选取武汉市三个主城区的3家美沙酮维持治疗点采用数字表獉獉抽样法,随机抽取美沙酮维持治疗患者分为研究组和对照组,最终研究组纳入253名美沙酮维持治疗患者,对照组纳入240名美沙酮维持治疗患者。研究组在接受美沙酮维持治疗的基础上进行为期1年的心理干预,并采用社会支持量表、Mosiky服药依从性量表对两组患者均进行调查分析,最后对两组患者随访后依从性情况进行比较分析。结果:最终研究组有205名(81. 03%%)患者完成随访,对照组中最终有170名(70. 83%)完成随访;研究组在随访獉獉时主观社会支持评分、客观社会支持评分、社会支持利用度、社会支持量表总分及依从性评分较入组时均出现显著提升,且显著高于对照组(P <0. 05)。结论:心理干预可显著提升美沙酮维持治疗服药依从性及社会支持能力,帮獉獉助患者更好的维持治疗,回归家庭、融入社会。     

美沙酮药物维持合并社会、心理干预的疗效观察

目的:探索对美沙酮药物维持治疗门诊的海洛因成瘾者实施社会、心理干预措施的效果。方法:对对照组96名海洛因成瘾者仅给予常规的美沙酮维持治疗,对干预组101名实施美沙酮维持治疗合并社会、心理干预,比较两组间抑郁、焦虑状态、成瘾严重程度的改变情况。结果:经过12个月的治疗,干预组在焦虑、职业/社会支持状况、家庭社会关系、精神状况等方面的改善程度均明显好于对照组。结论:在美沙酮药物维持治疗中,药物维持治疗仅能改善部分海洛因成瘾者的社会心理状况,应该在治疗的同时进行社会、心理综合干预。     

认知治疗对美沙酮维持治疗者干预疗效分析

目的：探讨心理认知干预对美沙酮维持治疗者功能失调性认知及生活质量的影响。方法：采用美沙酮维持治疗者基线调查表、功能失调性态度问卷（DAS）、简明健康测量量表中文版对86例治疗组（美沙酮维持治疗配合心理认知干预组）与52例对照组（口服美沙酮组,接受一般性咨询及管理）治疗前与治疗6个月后分别进行测评并比较。结果：治疗组DAS中完美化、寻求赞许、依赖性、强制性、自主性态度、认知哲学因子分及总分均与对照组有显著性差异（p〈0．01或P〈0．05）,而脆弱性、吸引与排斥因子分与对照组无显著性差异（p〉0．05）;简明健康测量量表中除躯体功能、肌体疼痛外其他6个维度均与对照组存在显著性差异（p〈0．01或P〈0．05）。结论：对美沙酮维持治疗者进行心理认知干预能改善治疗者不良认知模式,建立良好的人际处事习惯,提高治疗者的生活质量。     

盐酸美沙酮口服液在中国美沙酮维持治疗患者体内药动学特征

目的建立盐酸美沙酮（MTD）人体内血药浓度的测定方法 ,并对口服MTD口服液后的美沙酮维持治疗患者（MMTPs）体内的药动学过程进行研究。方法采用Agilent ZORBAX SB-C₁₈（250mm×4.6 mm,5μm）色谱柱,以乙腈-磷酸盐缓冲液（pH 2.5）=32:68（V/V）为流动相,流速1.50 mL·min^-1,检测波长206 nm,盐酸苯海索为内标,对血浆中的MTD浓度进行检测。8名MMTPs口服MTD口服液80 mg,分别于服药前和服药后1、2、3、4、6、8、12、24 h采集血样,测定血浆中MTD的浓度,并采用3P97药动学软件对试验数据进行处理,计算有关药动学参数。结果在0.10～10.00 mg·L^-1内,MTD与内标峰面积的比值与浓度之间呈良好的线性关系（r=0.999 6）。日内及日间精密度（RSD）和回收率均符合要求。MTD药-时曲线经拟合符合二室模型,主要参数:ρ_max（623.13 4-231.06）μg·L^-1;t_max为（2.764±1.13）h;AUC_0→24h为（9 569.56±3 294.88）μg·h·L^-1;AUC_0→∞为（21 522.61±10 825.36）μg·h·L^*（-1）;t_1/2为（23.95±13.61）h。结论本试验建立的检测人血浆中MTD含量的HPLC法,适用性强,重复性好,操作简单,快速准确,成本低廉,可用于MTD药动学的研究;MTD药动学特征和参数在个体间存在较大差异,临床治疗中应实施个体化治疗方案。     

Controlled use of heroin in patients on methadone maintenance treatment

The efficacy of methadone maintenance treatment was evaluated on 93 patients after 10 years of therapy. On the basis of therapeutic compliance, patients were divided into three groups: (a) 40 Total-Agreement subjects on weekly take-home methadone; (b) 28 Partial-Agreement subjects, who regularly attended the clinic daily but presented episodic positive urinalysis; (c) 25 No- Agreement patients, who were absent from the clinic more than twice a monthand had a high rate of urinalysis positive for morphine. Statistical analysis, based on social adjustment improvement and criminality rate decrease, divided the 93 patients into 2 distinct categories. The first category, characterized by high social adjustment and low criminality score, included the Total- and Partial- agreement groups. The second, characterized by significantly lower social adjustment and higher criminality score, included all No-Agreement patients. This suggests that methadone treatment was able to dissociate heroin use from low social functioning. It was concluded that, in a condition of adequate compliance the episodic use of heroin is of no harm to patients on methadone maintenance therapy, that is, methadone maintenance treatment permits a controlled use of heroin.     

Knowledge and stigma regarding methadone maintenance treatment among personnel of methadone maintenance treatment and non-methadone maintenance treatment addiction facilities in Israel

Stigma attached to methadone maintenance treatment is very common. The objective of the current article is to evaluate the presence of stigma and its relation to the extent of knowledge about methadone maintenance treatment. The authors conducted a survey among methadone maintenance treatment and non-methadone maintenance treatment addiction therapists from different treatment centers in Israel, including methadone maintenance treatment clinics (Ministry of Health) and non-methadone maintenance treatment addiction facilities (Ministry of Social Services), using an anonymous questionnaire about methadone maintenance treatment stigma and knowledge. There were 63 therapists from methadone maintenance treatment clinics (63%) and 46 therapists from the social services department (SSD) non-methadone maintenance treatment addiction facilities (9.2%) who responded. Methadone maintenance treatment versus social services department personnel were older (42.7 ± 12.8 versus 37.5 ± 8.2 years; p = 0.03), with fewer females (48 versus 75%; p = 0.006), and 50% were social workers compared to 100% social workers in the SSD group (p < 0.0005). Stigma score was lower among methadone maintenance treatment personnel compared to the social services department personnel (3 ± 2.5 versus 5.0 ± 3.5; p = 0.0001), while the knowledge score about methadone maintenance treatment was higher among the methadone maintenance treatment personnel (10.3 ± 2.9 versus 7.7 ± 2.8; p < 0.0005). The difference in both the stigma and knowledge scores remained significant after controlling for age, gender, and profession. There was a negative correlation between the stigma and knowledge scores among both the methadone maintenance treatment (R = –0.5, p < 0.0005) and the social services department personnel (R = –0.33, p = 0.03). These results revealed a significant correlation between the presence of stigma and the extent of education and knowledge about methadone maintenance treatment, with ignorance and stigma against methadone maintenance treatment being more pronounced among social services department personnel. An educational intervention, especially among social services department personnel, may benefit people who use opioids and improve the overall quality of treatment for opioid addiction in Israel.     

A comparison of private and public methadone maintenance patients

A study was undertaken to examine claims that unsuitable individuals were being admitted into private methadone maintenance programs in New South Wales in late 1985, early 1986. A comparison was made of interview data collected by an independent team of researchers from 457 private and 91 public patients. Exhaustive attempts were made to identify individuals who failed current official admission criteria. While there were statistically and clinically significant differences between private and public methadone patients, there was no evidence that unsuitable individuals were being admitted into maintenance. The data and a review of the literature suggest that the rapid expansion of private sector methadone programs allowed suitable individuals more immediate and more equitable access to maintenance treatment.     

美沙酮维持治疗社区综合干预的前瞻性研究——120例疗效分析

目的：观察美沙酮维持治疗疗效,探索社区综合戒毒康复干预模式。方法：选择二家美沙酮维持治疗（MMT）门诊病例120例开展纵向研究。采用MMT常规干预、社会心理干预（各种宣教培训、集体／个体心理辅导和咨询）及社会帮教监管等综合干预方法。于干预前,干预5月、10月后分别评估患者自愿就诊保持率、多项社会心理测试指标（FAD、SSRS、SAS、SDS）,并逐月检测尿液吗啡含量,观察综合干预效果。结果：干预后：①自愿就诊保持率提高（58．7％→79．2％,P〈0．001）。②社会家庭功能、焦虑情绪获得改善（P〈0．001,P〈0．001）;“社会支持”评分无统计学意义改善（P〉0．05）;但继发抑郁略加重（均分提高0．03）。③尿检阳性率逐月降低,即尿检阴性率明显提高（59．2％→81．9％,P〈0．001）。提示偷吸毒品现象得到有效控制。结论：社会心理综合干预对提高MMT门诊病人的治疗依从性和自愿就诊保持率,帮助病人适应和回归社会将起到积极和重要的作用;建议将综合性社会心理干预作为美沙酮维持治疗的一个重要基础性工作,在有条件的区、县开始施行,从管理要求、队伍建设、人员培训和工作机制等方面不断完善、健全。     

海洛因依赖者美沙酮维持治疗效果分析

目的分析杭州市美沙酮维持治疗(MMT)试点的疗效,为进一步推广MMT提供参考依据。方法采用社区美沙酮维持治疗评估基线调查表、随访调查表,对笔者所在门诊2005-06～2007-06收治的237例海洛因依赖者进行调查。结果①受治者使用毒品的行为明显减少,2年来每次尿吗啡检测均阴性为127例(53.6%),未见共用针具行为;②家庭关系改善,家庭关系良好者从49例(20.7%)增至116例(70.3%);③就业率由入组时的8.9%提高到39.4%;④违法犯罪率降低,由入组前的21.5%降至2.5%。结论实施MMT在改善吸毒者社会功能,降低毒品危害方面成效显著,但还存在脱失率偏高,就业率不足的现象。怎样采取措施,降低脱失率,提高就业率,是今后亟待解决的一个问题。     

Incarcerated intravenous heroin users: Predictors of post-release utilization of methadone maintenance treatment

Incarcerated intravenous heroin users have more problematic patterns of heroin use, but are less likely to access methadone maintenance treatment by their own initiative than heroin users in the community. The present study examined predictors for receiving methadone maintenance treatment post-release among incarcerated intravenous heroin users within a 24-month period. This cohort study recruited 315 incarcerated intravenous heroin users detained in 4 prisons in southern Taiwan and followed up within the 24-month period post-release. Cox proportional hazards regression analysis was applied to determine the predictive effects of sociodemographic and drug-use characteristics, attitude toward methadone maintenance treatment, human immunodeficiency virus serostatus, perceived family support, and depression for access to methadone maintenance treatment after release. There were 295 (93.7%) incarcerated intravenous heroin users released that entered the follow-up phase of the study. During the 24-month follow-up period, 50.8% of them received methadone maintenance treatment. After controlling for the effects of the detainment period before and after recruitment by Cox proportional hazards regression analysis, incarcerated intravenous heroin users who had positive human immunodeficiency virus serostatus (HR = 2.85, 95% CI = 1.80–4.52, p < .001) and had ever received methadone maintenance treatment before committal (HR = 1.94, 95% CI = 1.23–3.05, p < .01) were more likely to enter methadone maintenance treatment within the 24-month follow-up period. Positive human immunodeficiency virus serostatus with fully subsidized treatment and previous methadone maintenance treatment experiences predicted access of methadone maintenance treatment post-release. Strategies for getting familiar with methadone maintenance treatment during detainment, including providing methadone maintenance treatment prior to release and lowering the economic burden of receiving treatment, may facilitate entry of methadone maintenance treatment for incarcerated intravenous heroin users.     

Risk factors for weight gain during methadone maintenance treatment

ABSTRACT

Background: Weight gain was reported during methadone maintenance treatment (MMT). However, its relation to eating habits and specific risk factors, including methadone dose or serum level, was limited. The aims of this study were to characterize risk factors for weight gain and to study current eating habits, food preferences, and nutrition knowledge. Methods: Patients with available measures of weight and height (body mass index [BMI]) at admission to MMT and at follow-up, when methadone serum levels were determined (after 1 year or when stabilized) (N = 114), were studied (using the Addiction Severity Index [ASI], drugs in urine, methadone doses, and serum levels). In addition, 109 current patients with available earlier (5.8 ± 2.6 years earlier) BMI completed eating behavior rating and nutrition knowledge questionnaires, and their current and earlier BMI were compared. Results: The BMI of 114 newly admitted patients increased from 22.5 ± 3.8 to 24.4 ± 4.3 (P < .0005). Once stabilized on methadone, BMI increased further (24.3 ± 4.5 to 25.6 ± 5.0; P < .0005; n = 74), with no change in methadone doses (125.6 ± 32.5 to 128.0 ± 34.1; F = 1.4, P = .2) or serum levels (495.6 ± 263.7 to 539.8 ± 306.2; F = 1.3, P = .2). Repeated-measures analyses revealed that BMI elevation was higher among 45 hepatitis C virus seronegative and 46 non–benzodiazepine-abusing on-admission patients. Those who scored lower on knowledge about healthy diet and showed a higher sweet-foods preference had a higher BMI. Conclusion: BMI increased over time, but independent of methadone dosage and blood levels. As expected, worse diet habits and a desire for sweet foods are related to higher BMI. Paradoxically, healthier status (i.e., hepatitis C seronegative, no benzodiazepine abuse) at admission is predictive of greater weight gain during MMT. Education about nutrition habits is recommended.