海洛因依赖者338例复吸调查

作者对338例海洛因依赖者住院戒毒后又再复吸的时间、复吸动因以及戒毒方法和复吸时间关系方面进行调查，结果发现其中95％的病例在3个月内都复吸，平均复吸时间为25d，复吸原因多为病态渴求．次为同伴引诱，部分依赖者则认为多种原因共同起作用．至于戒毒方法和复吸时间关系．以用抗精神药物戒毒复吸较快，其次为二氢埃托啡，美沙酮；丁丙诺啡最慢。     

重视自愿戒毒全过程管理,提高戒毒成功率

在我国对吸毒人员实行强制戒毒的同时鼓励吸毒人员到自愿戒毒机构自愿戒毒,给他们提供了一条较宽松的戒毒康复之路。但不少自愿住院戒毒者出院后复吸,戒毒成功率很低。我院自愿戒毒专科从１９９１年至今收治了大批自愿戒毒者,从出院后戒毒成功与出院后复吸正反两方面例子中,我们总结经验,认为要提高自愿戒毒的成功率,必须重视自愿戒毒全过程的管理。１重视自愿戒毒病人入院前的筛选和教育自愿戒毒机构注意对自愿戒毒者入院前的筛选和教育,对提高脱毒成功率和减少出院后复吸十分重要。由于吸毒者个人情况和社会关系比较复杂,自愿住院戒毒的…     

戒毒复吸原因的再探讨

目的：各种方法戒毒复吸率极高的原因很多，寻找引发复吸的主要原因和规律，探索行之有效的预防治疗措施，是提高戒毒成功率，延长操守时间的根本目的。方式：劳教戒毒、自愿戒毒、“无毒社区”共394例海洛因依赖者做调查。以戒毒者的自身症状、心理状态、外界原因和思想顾虑等12项内容自制调查表，以无记名方式填写，统计分析结果。调查中只限医生和患者直接交谈，避免外界因素干扰。结果：引起复吸的主要原因：①无聊无事无工作占30．2％；毒友引诱占29．2％；戒毒后很想吸，不吸难忍受者占30．2％；受歧视占23．8％；追求感觉占2l％；因稽延性症状占12％；回到吸毒环境占13．7％。②戒毒后最需要的帮助：理解与支持占57．8％；找工作占26．9％；宽松与自由占12％。结论：①精神依赖是复吸主要因素；海洛因引起的抑郁、焦虑等精神障碍是促使复吸的主要原因；②积极的心理辅导教育以及家庭社会的监督机制，是提高戒毒成功率的根本措施。③不要忽略吸毒者的精神障碍治疗。④禁毒宣传教育是以预防为主的根本措施。     

海洛因依赖者338例复吸调查

作者对338例海洛因依赖者住院戒毒后又再复吸的时间、复吸动因以及戒毒方法和复吸时间关系方面进行调查,结果发现其中95%的病例在3个月内都复吸,平均复吸时间为25 d,复吸原因多为病态渴求,次为同伴引诱,部分依赖者则认为多种原因共同起作用,至于戒毒方法和复吸时间关系,以用抗精神药物戒毒复吸较快,其次为二氢埃托啡,美沙酮;丁丙诺啡最慢。     

443例海洛因依赖者戒毒后复吸的心理社会因素分析

本文采用自编调查表对在我院住院自愿戒毒出院的吸毒者进行戒毒后回归社会后的随访调查，结果表明单纯的戒毒治疗操守率是很低的，其一周内复吸率为５９．９１％，第二次戒毒后一周内复吸率为８８％，第三次戒毒后一周内复吸率为９７．２８％，逐步回归分析可见影响复吸的因素分别为复吸动因、婚姻状况、戒毒方法、吸毒方式、吸毒时间、戒毒时间等，复吸原因的调查结果显示大多是多因素共同作用所致，尤其是戒毒后回归社会时家庭和社会的关怀及督促是重要的。     

减少自愿戒毒病人出院后复吸的几项有效措施

我院自愿戒毒专科从 1 991年至今收治了大批自愿戒毒者 ,从出院后戒断成功与出院后复吸正反两方面例子中 ,我们总结出减少自愿戒毒病人出院后复吸的几方面做法。一、重视自愿戒毒病人入院前的筛选和教育自愿戒毒机构注意对自愿住院戒毒者入院前的筛选和教育 ,对提高脱毒成功率和减少出院后复吸十分重要。由于吸毒者个人情况和社会关系比较复杂 ,自愿住院戒毒的动机也各种各样 ,一些人心理变态 ,人格扭曲 ,道德败坏 ,不少人还是黑社会分子、犯罪分子 ,而自愿戒毒机构的威慑力度不足 ,为防止毒品流入病区 ,保持良好的脱毒治疗环境 ,提高脱毒成…     

海洛因依赖者戒毒动机与复吸的关系

目的 :了解海洛因依赖者自愿戒毒的动机及其与复吸的关系。方法 :对 1 999年 1月至 2 0 0 0年 5月于我院住院的 1 0 2例自愿戒毒者的戒毒动机进行调查 ,并于 1年后随访了解复吸情况。结果 :自愿戒毒者的戒毒动机可归纳为以下几种 :( 1 )主动戒毒型 ;( 2 )家人强迫型 ;( 3)严打期被迫型 ;( 4 )经济拮据型 ;( 5 )重获快感型 ;( 6 )自行戒毒失败型。除主动戒毒型外 ,其它 5型的戒毒动机可谓“不良”,将其合并为一型—被动戒毒型 ;而真正真心戒毒的主动戒毒型比例不高 ,只占 30 % ,其中已婚和年龄越大的主动戒毒型的比例越高。 1年后随访发现 ,戒毒者 1年内复吸率达 84 % ;而主动戒毒型者的复吸率显著低于被动戒毒型者 ( X2 =2 4 .5 7,P<0 .0 1 )。结论 :研究表明 ,在自愿戒毒者住院期间 ,对其加强心理疏导 ,端正戒毒动机 ,可有效降低复吸率     

海洛因依赖者脱毒后复吸因素与预防的探讨

海洛因在阿片类物质中成瘾性最强，危害最大。依赖者脱毒出院后，操守时间短，复吸率高。本文对复吸因素与延长操守时间、提高戒毒疗效进行探讨。一、对象与方法（一）对象：1994年6月～1996年4月，自愿来我中心住院戒毒者共220例，其中60例出院后因复吸而再多次住院的吸毒者。对其本人通过详细询问上次复吸情况并得到其家属证实后，对复吸因素和预防措施进行探讨。60例脱毒后的复吸者中，男性48例占80％，女性12例占20％；年龄21～30岁38例（63．3％），31～40岁19例（31．7％），40岁以上3例。职业：无业24例（40％），个体商29例（48．3…     

社区戒毒模式的探讨

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，海洛因依赖者脱毒后复吸的比率很高，有人保守的估计亦在95％以上。以前传统的强制戒毒、劳教戒毒或自愿戒毒工作模式难以从根本上解决复吸率居高不下的问题。如何有效降低复吸率、尽快提高戒毒工作成效，已成为社会各界关注的焦点，并一直引起党和国家的高度重视。《中华人民共和国禁毒法》对我们戒毒工作者来说，既是莫大的鼓舞，同时更是一种鞭策，必将对我国的禁毒工作产生深远的影响。     

海洛因依赖复吸原因分析

"一日吸毒,十年戒毒,终身想毒",这是对吸毒成瘾者最形象和真实的写照,一旦染上毒瘾,戒毒十分艰难,有92％以上的人不出半年又复吸,复吸率之高,令人心寒.为了探讨复吸者现状,对120例海洛因依赖自愿戒毒者进行调查,现将结果报告如下:     

'It was a nice day...a beautiful day': an analysis of relapse into substance misuse among Indigenous drinkers

This paper presents results from a study investigating relapse prevention options for indigenous clients of alcohol and drug intervention services. The study has 63 'stories' collected through a survey of nine substance misuse services. An adapted version of the Marlatt Relapse Prevention Model was developed to interview clients who had quit drinking but later relapsed into heavy use. The study identified situations influencing the decision to quit, obstacles and dilemmas arising during periods of abstinence, and major triggers associated with relapse into substance misuse. The paper analyses these major triggers and discusses the crucial issues of motivation to quit and maintenance of abstinence. The community environments where indigenous drinkers use alcohol strongly influence successful or unsuccessful attempts to quit. Relapse prevention should be part of a range of public health strategies for tackling substance misuse problems with Indigenous drinkers, and should be included at the minimal intervention level.     

音乐心理剧对海洛因依赖者戒毒动机的干预

目的:研究音乐心理剧对我国海洛因依赖者的戒毒动机和操守的临床干预效果。方法:将62名女性海洛因依赖者随机分为实验组(n=31)和对照组(n=31)。实验组进行为期12周的Joseph.J.Moreno音乐心理剧临床干预;对照组常规治疗。将实验组干预后的戒毒动机与干预前及对照组进行比较;追踪所有被试的复吸情况并进行统计;对总体戒毒动机、操守率和各戒毒动机因子进行相关分析,了解干预的方法对戒毒动机和操守率的干预效果。结果:实验组总体戒毒动机与对照组和干预前相比显著提高(P<0.05);总体戒毒动机与"家庭因子"呈显著正性相关(r=0.364)。实验组操守情况(58.06%,18/31)优于对照组(35.48%,11/31),但无统计学意义上的显著性差异(P>0.05)。结论:音乐心理剧临床干预对提高海洛因依赖人群的戒毒动机有明显作用,但在提高复吸率方面效果不明显。提高戒毒动机需要从家庭角度进行干预。由于文化上的差异,本法在临床运用的过程中有些技术的使用存在一定的局限性。     

Correlates of motivation to quit smoking among alcohol dependent patients in residential treatment

Substance use and smoking co-occur at high rates and substance abusers smoke more and have greater difficulty quitting smoking compared to the general population. Methods of increasing smoking cessation among alcoholics are needed to improve their health. This study investigated predictors of motivation to quit smoking among patients early in residential treatment for substance abuse. The 198 alcohol dependent patients were participating is a larger smoking study at an inner-city residential substance abuse treatment program. Motivation was measured by the Contemplation Ladder. A hierarchical multiple regression was conducted to assess whether perceived barriers to smoking cessation and self-efficacy about quitting were associated with motivation to quit smoking independent of the influence of degree of tobacco involvement, substance use, and comorbid depressive symptoms. Motivation was higher with longer previous smoking abstinence, fewer barriers to quitting, and greater self-efficacy but was not influenced by smoking rate, dependence, or gender. While the combination of alcohol and drug use, alcohol and drug problem severity, and depressive symptoms predicted motivation, no one of these variables was significant. Since barriers to change and self-efficacy are potentially modifiable in treatment, these could be salient targets for intervention efforts. This could be integrated into treatment by assessing barriers and providing corrective information about consequences and methods of overcoming barriers and by providing coping skills to increase confidence in one's ability to quit smoking.     

Experimental model of smoking re-exposure: effects on relapse

This study used a short-term laboratory model of smoking cessation and relapse to prospectively examine the effects of programmed self-administered smoking re-exposure during early abstinence. Sixty-seven subjects who had quit smoking for 3 days were randomly assigned either to smoke five cigarettes in their natural environment or to remain abstinent during the exposure period. The main hypothesis, that relapse to regular smoking would be quicker and more prevalent in exposed subjects, was supported. All exposed subjects had relapsed by 2 days post-exposure while 16% of unexposed subjects remained continuously abstinent throughout the 8 day study. This behavioral effect was seen in spite of acute decreases in reported desire to smoke and increases in guilt measured just after exposure. The study supports a role for stimulus re-exposure effects in the relapse process and suggests that additional research on experimental re-exposure is warranted.     

To smoke or not to smoke: Does delay discounting affect the proximal choice to smoke?

Background: Delay discounting rate shows robust predictive validity for tobacco use behaviors and is a new therapeutic target in the treatment of tobacco use. Identifying factors that influence relations between delay discounting and the choice to smoke cigarettes is key to the development of effective interventions that target delay discounting to reduce cigarette consumption. Objective: To examine relations between delay discounting, motivational factors, self-efficacy, nicotine dependence level, and the proximal choice to smoke in the context of other commonly rewarding activity choices. Methods: In this cross-sectional design, daily smokers (n?=?480) from Amazon Mechanical Turk completed a questionnaire that assessed delay discounting rate; motivation, intention, and self-efficacy to quit smoking; nicotine dependence level, and the preference for immediately engaging in multiple commonly rewarding activities. We hypothesized that 1) greater motivation to quit would be associated with lower priority given to smoking; 2) the relation between delay discounting and the priority given to smoking would be mediated by motivation, self-efficacy, and nicotine dependence level. Results: Greater motivation to quit was significantly associated with a lower priority given to smoking. The relation between delay discounting and the priority given to smoking was marginally mediated by nicotine dependence level (p > .057). Conclusions: Motivation to quit influences decision-making by impacting the prioritization of choices. Nicotine dependence is likely to mediate the relation between delay discounting and the choice to smoke. Interventions that target delay discounting to reduce cigarette consumption or prevent relapse need to account for motivation to quit and nicotine dependence level.     

Effects of monetary contingencies on smoking relapse: influences of trait depression, personality, and habitual nicotine intake.

Of 56 male smokers, 34 were randomly assigned (by 60% random odds) to quit smoking immediately, whereas the remaining 22 were assigned to quit after an additional 31 days. Compensation ($300) was contingent on abstinence for a minimum of 31 or 2 days (depending on random assignment) and completion of all experimental sessions. Contingencies for the immediate-quit group required 31 days of abstinence; those for the delayed-quit group required only 2 days of abstinence. Contingency duration (31 vs. 2 days) predicted days to relapse. All but 4 of the 31-day contingency participants maintained abstinence for at least 31 days, whereas only 3 of the 2-day contingency group abstained for 31+ days. However, 31-day contingencies did not result in longer postcontingency time to relapse. Higher trait neuroticism, depression, and psychopathic deviate scores predicted decreased time to relapse. Prequit cotinine concentrations and Fagerstr?m Tolerance Questionnaire scores failed to predict time to relapse.     

Changes in smoking status among substance abusers: baseline characteristics and abstinence from alcohol and drugs at 12-month follow-up

The impact of change in smoking status on 12-month substance abuse (SA) treatment outcomes was examined among an HMO population seeking SA treatment. Of the 749 participants who entered the study at baseline, 649 (86.9%) were retained at the 12-month follow-up. At treatment entry, 395 participants were smokers and 254 were nonsmokers. At 12-month follow-up, 13% of the 395 baseline smokers reported quitting smoking and 12% of the 254 baseline nonsmokers reported starting/relapsing to smoking. Those who quit smoking were less likely to be diagnosed as alcohol dependent compared to those that remained smokers. Those who started/resumed smoking were more likely to be diagnosed as both alcohol and drug dependent at treatment entry compared to all other groups. Total days abstinent from alcohol and illicit drugs was greatest for individuals who quit smoking (adjusted M=310.6) or who were nonsmokers (adjusted M=294.7) and lowest for those who started/resumed smoking (adjusted M=246.6) or remained smokers (adjusted M=258.2), even after controlling for demographic (i.e. age, income), psychosocial (ASI psychiatric severity), and other treatment characteristics (length of treatment stay, prescribed bupropion) that were associated with days abstinent at 12 months. Self-initiated smoking cessation does not appear to be detrimental to SA treatment outcomes, and may be beneficial. Starting/resuming smoking after entering SA treatment may be a clinical marker for individuals at greater risk of relapse. Future studies may want to measure the smoking status of all participants at all time points in order to include this higher-risk group of substance using smokers.     

强制戒毒与复吸率

探讨有效脱毒和降低复吸率的戒毒方法。方法··:应用美沙酮5d递减 ,续用可乐定5d ,进行脱毒治疗 ;脱毒后采取全封闭管理 ,采用集体上课、个别心理疏导等方法继续进行身心康复治疗90d ;回归社会后重点监控 ,定期回访。结果··:患者均安全脱毒康复 ;随访15个月 ,复吸率为22.2 % (113/508)。结论··:该法安全有效 ,复吸率较低。     

论构建互动持续综合支持戒毒(康复)模式

本文从复吸毒品的多因素分析为切入点,探索强化决心、互动帮教、家庭协同、社会综合、同伴互助、适时跟进支持等方法,构建持续综合支持戒毒康复模式,以改变过去较单一的戒毒康复模式,提高戒毒康复效果,降低复吸率。     

Motivation to Quit Smoking in Substance Abusing Outpatients: Association with Anxiety and Depressive Symptoms

ABSTRACT

Objectives: This cross-sectional study examined the relationship between motivation to quit smoking and symptoms of depression and anxiety among 216 smokers seeking outpatient substance abuse treatment.

Methods: Subjects were administered the Beck Depression Inventory, the Beck Anxiety Inventory, a Likert scale of readiness to quit smoking, the Smoking Stages of Change Algorithm, the Addiction Severity Index and the Fagerstrom Test for Nicotine Dependence.

Results: There was a relationship between anxiety and motivation to quit smoking, with subjects reporting higher anxiety also reporting greater motivation to quit smoking. This relationship held up after controlling for the effects of substance use severity, race, gender, and cigarettes smoked per day. However, there was no relationship between depression and motivation to quit smoking.

Conclusions: This is one of the few studies examining the role of anxiety and depression on motivation to quit smoking among smokers attending a substance abuse treatment program. The findings help to clarify the relationship between mental health symptoms and motivation to quit smoking in a substance abuse treatment setting.