改良Delphi法在吸毒人群基数估计中的应用

目的:探索Delphi法在吸毒人群及相关指标估计中的应用情况,为乐山市艾滋病疫情预测及各类相关工作提供吸毒人群基础数据。方法:用改良Delphi法于2004年尝试对乐山市市中区吸毒人群基数及相关指标进行估计。结果:在2004年7月26日,得到乐山市市中区吸毒人群主要指标估计数:乐山市市中区籍现有吸毒人群估计数2480人,约是同期登记在册人数(1101人)的2.5倍;其中男女性别比为4∶1;注射吸毒者所占比例80%,其中男女性别比4∶1;共用针具比例30%;强戒所收戒覆盖率70%;HIV检测覆盖率70.5%;美沙酮覆盖率20%;年流出比例5%;年死亡比例2.5%;年吸毒者增加比例10%,等。结论:经过良好的设计、组织和实施,改良Delphi法可满足吸毒人群基数估计及相关指标估计的需要,但不推荐作为独立方法使用,宜与其他平行估计方法的结果相互补充验证。     

乘数法估计四川乐山市中区吸毒人群基数研究

目的:使用乘数法估计乐山市中区籍现有吸毒人群基数。方法:获得当地强戒所和自愿咨询检测门诊2003年5月31-2004年5月31日收戒或咨询人数r,问卷调查获乘数1/p,N=r/p计算估计数,定性和定量研究结合以解释估计结果。结果:r=507/511人,271份问卷获自称戒毒比例23.99%/4.17、咨询比例32.47%/3.08,估计数2114/1574人。23.99%和核对比例23.25%比较,χ2=0.0952,P=0.7576;一致性检验,k=0.5705,95%可信区间[0.4547,0.6862];灵敏度68.25%和特异度89.42%。与2002年自称戒毒比例(25.54%)比较,χ2=0.1623,P>0.05。公安部门登记、乘数法计算的总吸毒率为0.20%、0.39%和0.29%,三者多重比较,χ2为185.46、320.27、83.85和12.41,均P<0.01。结论:强戒所和VCT门诊为依托机构进行乘数法估计是可行的;自称戒毒比例稳定为24%,VCT比例33%,可满足估计,但需关注戒毒假阴性问题;至2004年7月26日目标人群估计数1574-2114人,是公安部门同期现有吸毒登记数的1.5-2倍。     

改进的Delphi法在吸毒人群规模估计中的应用

目的:探索科学、可行的评估吸毒人群规模的方法。方法:应用改进的Delphi法,于2005年12月至2006年3月期间,请北京市禁吸戒毒领域的专业人员对本市滥用海洛因和新型毒品(冰毒、摇头丸、"K"粉)的人群规模分别做出估计。结果:估计2005年12月北京市滥用海洛因人数的中位数是50000(40000-60000),是同期登记在册人数的2.67(2.14-3.21)倍;估计滥用"新型毒品"人数的中位数是50000(30000-95000)。结论:应用改进的Delphi方法在禁吸戒毒领域专业人员中进行毒品滥用情况调查,方法比较科学、易行;虽然存在一些影响调查结果的因素,但随着研究设计的完善,该方法可应用于毒品滥用流行程度评估研究。     

海洛因依赖者自杀态度调查

目的:了解海洛因依赖者的自杀态度,为预防海洛因依赖者自杀提供参考。方法:用自杀态度问卷海洛因依赖者及普通人进行调查,两组进行比较分析。结果:海洛因依赖者对自杀行为表示宽容、理解、肯定的人数显著高于普通人;对自杀行为表示反对的人显著低于普通人。对自杀者的态度、对自杀者家属的态度、对安乐死的态度,两组比较无显著差异。结论:海洛因依赖者是自杀的高危人群,应给予关注及相应的干预。     

北京、广东、宜昌三地吸毒人群基数的快速评估

目的：探索科学、实用的快速评估吸毒人群基数的方法。方法：采用多轮快速评估方法（改进的Delphi方法），于2005年12月至2006年5月，在北京、广东、宜昌三地的戒毒人员中进行本地区滥用海洛因和新型毒品（冰毒、摇头丸、“K”粉）人数的调查估计。结果：估计2005年12月北京市滥用海洛因人数的中位数是40000（30000～60000），是同期登记在册人数的2．14（1．60～3．21）倍；估计滥用新型毒品人数的中位数是30000（25000～50000）。估计2006年5月广东省滥用海洛因人数的中位数是400000（310000～500000），是同期登记在册人数的2．13（1．65～2．66）倍；估计滥用新型毒品人数的中位数是420000（400000～600000）。估计2006年5月宜昌市滥用海洛因人数的中位数是10500（9000～15000），是同期登记在册人数的2．63（2．25～3．75）倍；估计滥用新型毒品人数的中位数是13000（8000～20000）。结论：应用快速评估方法在戒毒人员中进行毒品滥用情况估计，方法比较科学、实用、易行；虽然存在一些影响估计结果的因素，但随着研究设计和现场实施技术的不断完善，此类快速调查评估可应用于毒品滥用流行程度评估研究。     

海洛因依赖者应付方式研究

目的 :探讨海洛因依赖者的应付行为特点及与之相关因素。方法 :采用“应付方式问卷”、“阿片成瘾严重程度量表”、“症状自评量表”对 6 5名海洛因依赖者进行测查 ,并作相关因素分析。结果 :海洛因依赖者对各种应付方式的使用程度依次是 :解决问题、幻想、退避、自责、合理化和求助 ;海洛因依赖者应付方式在性别上差异无显著性(P >0 0 5 ) ;与应付方式相关的因素有依赖者的文化程度、年龄、初次吸毒年龄及SCL - 90总分、精神病性、焦虑、抑郁和社会功能 (P <0 0 5 )。结论 :海洛因依赖者的应付方式与其年龄、初次吸毒年龄、社会功能及心理健康状态有关 ,建议在对海洛因依赖者进行康复时 ,采取应付训练与心理矫治相结合、鼓励家庭社会共同参与、对其重新社会化等干预策略     

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。     

捕获再捕获法估计四川乐山市中区吸毒人群基数

目的:使用捕获再捕获法估计乐山市中区现有吸毒人群基数。方法:利用强戒所建所以来资料确定平均捕获期和平均捕获间隔期及两次捕获起始点并收集相应时间段内的收戒人数。利用Lincoln-Petersen模型进行估计,定性和定量研究结合以解释说明估计结果等。结果:平均捕获期3.02月,平均捕获间期12.59月,两次捕获期起止时间点为2002年9月30日-2003年1月31日和2004年1月31日-2004年5月31日,对应收戒人数为234人和251人,重复捕获34人。不分层点估计数1742人,标准误240.45,95%CI1220-2163(人)。分层后合计点估计数为1645人,标准误225.46,95%CI1203-2087(人)。结论:75%位数捕获期和平均捕获间期为4个月和12个月,可满足分析需要。Lincoln-Petersen模型简单,费用低,可操作性强。估计结果存有一定程度的低估,可作为估计底限值。选择适当的捕获再捕获模型可提高估计精度。估计数为公安部门同期提供现有吸毒登记数的1.5倍。     

海洛因依赖者的血液细胞学变化

目的 :了解毒品海洛因吸食者的血液细胞学变化 ,探讨毒品对血细胞的影响。方法 :对 1 0 0例自愿戒毒者的血液采用 HEMACEL L PL US52 2 0型五分类血细胞分析仪进行多参数分析并与非海洛因依赖的健康人群比较。结果 :海洛因依赖者红细胞、红细胞分布宽度、血小板分布宽度均低于对照组 ;白细胞计数高于对照组。结论 :海洛因依赖对血细胞数量及形态有一定影响     

北京市吸毒人群基数的快速调查评估

目的:探索科学、实用的快速评估吸毒(海洛因和新型毒品)人群基数的方法。方法:采用多轮快速估计方法,在125名北京市劳教戒毒机构戒毒人员中进行北京市滥用海洛因和新型毒品(冰毒、摇头丸、氯胺酮)人数的评估。结果:估计北京市滥用海洛因人数的平均值是40000,下限是30000,上限是60000,分别是2005年底登记在册人数的2.14、1.60和3.21倍;估计北京市滥用新型毒品人数的平均值是30000,下限是25000,上限是50000。结论:应用快速评估方法在戒毒人群中进行毒品滥用情况估计,方法比较科学、易行;虽然影响估计结果的因素较多,但随着研究设计和现场实施技术的不断完善,此类快速调查评估可应用于药物滥用流行病学研究。     

Five Patterns of Darvon Abuse

The “United Kingdom Statistics of Drug Addiction and Criminal Offences Involving Drugs” (published by the Home Office) gives the following data as of 31st December 1969: of the total number of 1466 known drug addicts (namely, addicts to hard drugs), 499 were taking heroin, and more than double that number, namely 1011, were taking methadone (either alone or with other drugs). A footnote explains that “as a result of a deliberate policy adopted by Hospital Clinics in the treatment of heroin addiction, of weaning patients from heroin on to methadone, methadone has supplanted heroin as the drug most commonly used by addicts.” What is meant by the phrase “most commonly used by addicts” is probably, “most commonly prescribed to addicts,” as, of course, the number of abusers or addicts buying “Chinese heroin” or English heroin or methadone on the black market is unknown. There is, in fact, a certain amount of black market dealing in these and other drugs going on.     

Addicts on Parole: Short-Term and Long-Term Prognosis

Much attention has recently been focused on the question of the extent of heroin use in America. In a worthwhile effort to call public attention to the problem, many estimates of its size have evidenced a tendency toward exaggeration and aggrandizement. This paper presents methods of estimation of the extent of heroin addiction which, when carefully employed, should effectively correct such distorted estimates.

Two general types of estimation are employed, incidence and prevalence. Incidence estimates are concerned with new cases of heroin addiction that occur in a specific population within a given amount of time. These estimates are based upon self-report data from addicts regarding date of first addiction. When corrected for the “lag phase” (that period of time between onset of first addiction and eventual visit to a treatment program), these data permit accurate retrospective charting of incidence trends. Prevalence estimates focus on all known cases of heroin addiction in a specific population within a given amount of time. Three separate types of prevalence estimates from three separate sources are outlined in this article: estimates based on overdose death data, estimates based on crime statistics, and estimates of “unknown” addicts.

In outlining these methods, this article describes the fluctuations in heroin addiction in one major American city, San Francisco, California. After analyzing data gathered from a sample of 2,367 addicts contacted over a 3-year period, this study suggests that the incidence of heroin addiction seems to have declined after 1970. Possible factors underlying this apparent decline in heroin addiction are then discussed, including the post-1970 maturation of the “population at risk,” the effectiveness of antidrug media messages, the changing drug fashions in the heroin subculture, and the gradual deterioration of the quality and potency of street heroin.     

Misadventures in the Drug Trade

Dan Waldorf was a research sociologist who worked in the field of drug use and abuse for 27 years. Most of that time was either in San Francisco or New York City. He wrote two books, three monographs, and 38 articles on the subject–with this being his final article. Fate intervened because this article is autobiographical. Dan's work and his life were intertwined in ways that provided unique insights into drugs and addict lifestyles. The focus of much of his work was “to attack and demolish myths about drug users and heroin addicts” (his words). Dan's legacy is broad ranging, including historical accounts of morphine users and the federal response to close down morphine clinics in the first quarter of this century; he made snowball sampling methods respectable; he saw rationality in the actions of heroin addicts and demonstrated this drug was not all-consuming; and he performed a similar service for cocaine. He struggled to maintain his career as a drug researcher, often without the support of federal monies. As recently as two years before his death, he traveled around the country to document the history of underground needle exchange programs that were developing–using his retirement savings. This article documents his many scientific contributions to our understanding of drug use in general, and the interface of drug use and crime in particular. Dan led a simple yet ever so rich life because he never shied away from telling the truth, and the wisdom of his vision helped so many others of us to see. That is his greatest legacy-and his gift. [Translations are provided in the International Abstracts Section of this issue.]     

海洛因依赖者罹患皮肤感染性疾病的临床调查

目的··:了解海洛因依赖者所患皮肤病的种类和发病机制。方法··:采用《临床皮肤病鉴别诊断学》皮肤感染性疾病诊断标准,对本院1997-1998年强制戒毒的428例符合DSM-Ⅲ-R阿片类依赖诊断标准的428例男性海洛因依赖者的皮肤感染性疾病进行回顾性调查分析。结果··:皮肤疾病的发病率占本院同期住院的11.7%,皮肤感染性疾病类型主要为细菌性皮炎,占56%;真菌性皮炎,占4%;湿疹,占40%。结论··:导致皮肤感染性疾病的原因与海洛因所致免疫功能低下,皮肤血管及微循环功能障碍,海洛因内掺杂质及使用毒品的方式,以及植物神经功能紊乱有一定关系。     

海洛因依赖者家属的生活质量

目的··：评估海洛因依赖者家属生活质量及其影响因素。方法··：应用《生活质量综合评定问卷》（ＧＱＯＬＩ）对１００例海洛因成瘾者家属进行测评,以１００名某社区正常人群生活质量为对照。结果··：海洛因依赖者家属生活质量总分,尤其是心理和社会功能两个维度分明显低于正常对照组,海洛因依赖时间长、家庭中有多个成瘾者、既往有劳教史的家属生活质量较差,海洛因依赖者的配偶及父母生活质量较差。结论··：海洛因成瘾影响其家属的生活质量,有必要进行社会心理干预。     

Networks of verbal habits for drugs

Opiate addicts (n = 90) were asked to give forced associations to 278 words with options for drugs, users of drugs, places of use of drugs, activities including drug use, and stages of addiction. As expected, a major association network for heroin was found and was comprised of associations to heroin, drugs similar to heroin (morphine, methadone), “junkie” (heroin user), “shooting gallery” (place to inject heroin), “hooked” (stage of addiction), drugs (as an activity), and slang names for heroin. Hooked as a status is closer to the core of the heroin habit than “kicking a habit”. Minor association networks were found for the other drugs evaluated which included Benzedrine, alcohol, “goofball” (barbiturate), and “reefer” (marijuana).