2084例海洛因依赖者脱毒期间发生急性胃炎的分析

目的:研究海洛因依赖者脱毒期间并发急性胃炎的情况。方法:采用回顾性研究方法,收集2003年1月至2004年1月期间,经胃镜检查伴有急性胃炎的海洛因依赖者2084例的临床资料,并分析急性胃炎与海洛因的用法、用量、持续时间及戒断时间的关系。结果:2084例海洛因依赖者中有442例(21.21%)脱毒期间发生急性胃炎;并发现日滥用量大、戒断时间长、吸毒年限长、静脉注射者急性胃炎的发生率高(P<0.01)。结论:海洛因依赖者脱毒期间可能发生急性胃炎,应予以注意。     

康复训练—海洛因依赖治疗中的重要环节

目的··:了解康复训练在海洛因依赖治疗后防复吸中的效果。方法··:随访调查分析72例经脱毒治疗后接受康复训练和352例同期脱毒后未接受康复训练的海洛因依赖者的复吸率。结果··:与仅脱毒而未经过康复训练的海洛因依赖者比较,接受康复训练者吸毒冲动及觅药行为明显减少,6个月时复吸率为93.1 % (对照组6个月的复吸率100 % )。结论··:康复训练在一定程度上能降低复吸率,是海洛因依赖治疗中的重要环节     

海洛因依赖者氯氮平引起意识障碍的临床分析

目的:探讨海洛因依赖者在脱毒期使用氯氮平解决睡眠障碍的临床特点。方法:对我院1123例海洛因依赖者脱毒期使用氯氮平引起意识障碍的31例与随机抽取的100例进行回顾性分析与对照。结果:⑴研究组与对照组的人口学特征、毒品日滥用量、吸毒方式、吸毒年限等无显著差异(P>0.05)。⑵研究组考虑28例为意识模糊,3例为昏睡状态。⑶意识障碍均发生在第一次服用氯氮平后24小时内。结论:海洛因依赖者脱毒期使用氯氮平后出现意识障碍除少数病例与联用药物有关,其余病例均缺乏有据的预测性,故应慎用氯氮平来解决海洛因依赖者的睡眠障碍。     

沪穗两地海洛因依赖流行病学对比研究

目的 :分析沪穗两地海洛因依赖者的流行病学差异。方法 :回顾性调查了 6 30例上海地区和 4 0 4例广州地区的住院脱毒治疗的海洛因依赖者的情况。结果 :沪穗两地海洛因依赖者的一般人口学特征、毒品滥用情况、实验室检查、脱毒治疗情况等方面均存在一些差异。上海地区的吸毒者中女性比例较高 (32 .4 % )、无业者较多 (5 1 4 % ) ,而广州的吸毒者中男性比例较高 (82 .7% )、个体职业者较多 (40 8% ) ;广州海洛因依赖者成瘾程度相对较重 ,吸毒后脑电图异常和ALT异常较多 ,上海地区注射海洛因依赖者较多 ,乙肝病毒感染率较高。结论 :沪穗两地海洛因依赖者具有不同的流行病学特点 ,应采取不同的防治策略     

海洛因依赖者脱毒期间发生急性胃穿孔的特点与防治

目的··:总结海洛因依赖者在脱毒过程中发生急性胃穿孔的发病原因、临床特点和防治方法。方法··:对我所1997年1月 -1999年3月收治的32例海洛因依赖者并发急性胃穿孔的临床资料进行回顾性分析 ;结果··:32例患急性胃穿孔的海洛因依赖者中 ,男性31例 ,(占96.8 %),女性1例 (占3.1 % );采用自然戒断法 (冷火鸡法 )脱毒者27例(占84.3 %);既往有胃病史者25例(占78.1 %);脱毒1周内发病者31例(占96.8 %);日滥用量>0.6g发病者28例(占87.5 %) ;吸毒年限1.9 -3a发病者26例(占81.3 %);采用烫吸 +静脉注射 +肌肉注射吸毒方式发病者30例(占93.7 %)。结论··:既往有胃病史的男性海洛因依赖者 ,采用自然戒断脱毒法的1周内最容易发生急性胃穿孔 ;急性胃穿孔的发生与海洛因滥用量、吸毒时间和吸毒方式有一定的关系 ;建议对上述患者应采用药物脱毒且适当延长脱毒时间     

海洛因依赖者月经情况调查分析

目的:探讨女性海洛因依赖者月经周期变化与吸毒方式、吸毒时间、吸毒剂量的关系及躯体脱毒后月经恢复情况.方法:采用自编调查问卷包括一般人口学特征、吸毒情况、既往月经情况及吸毒后月经变化等,选取了425例女性海洛因依赖者就相关问题进行调查.结果:海洛因依赖者月经紊乱以闭经及月经周期延长多见;月经紊乱发生率随吸毒剂量增加、吸毒时间延长而递增;注射毒品比其他吸毒方式更易引起月经紊乱;戒断毒品6个月内97.8%的吸毒者月经可恢复正常.结论:海洛因对女性生殖内分泌系统能存在显著影响,但为可逆性改变.     

海洛因依赖者并发呼吸系统疾病500例分析

目的:通过观察海洛因依赖者的胸片改变,了解本地区海洛因依赖者与并发呼吸系统疾病的关系。方法:对我中心2003年6月至2005年12月收治人员的体检资料中抽取500例胸片进行阅片分析,同时调阅其病历资料以了解其吸毒时间,吸食量,吸毒方式。结果:胸片检查阳性率达30.6%(阳性胸片153份)明显高于普通人群,而且,滥用时间越长,剂量越大,胸片异常率越高;静脉或肌注较烫吸对呼吸系统的危害更大。结论:本地区海洛因依赖者并发呼吸系统疾病的比率较高,且与滥用时间、剂量、及方式相关,注射吸毒比烫吸危害更大。提请临床脱毒治疗过程中关注其呼吸系统状况,做到早预防、早发现、早治疗。     

462例海洛因依赖患者脱瘾治疗分析

目的了解海洛因依赖者进行药物脱瘾治疗的影响因素。方法回顾性分析1994～1998年住院脱瘾治疗海洛因依赖患者462例，治疗过程美沙酮单一使用或联合丁丙诺啡，比较两种疗法的一般资料和脱瘾效果。结果两组患者由于在吸毒时间、烫吸时间，首次吸毒年龄、职业方面差异有极显著性，选择脱瘾药物治疗方法不同。结论海洛因依赖脱瘾治疗必须个体针对性选择药物。     

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。     

海洛因依赖者脱毒后失眠症的中医辩证论治

近年来研究证实，海洛因依赖者失眠症的患病率高达99％，失眠贯穿于吸毒及脱毒治疗的全过程，甚至有时成为戒毒成功的主要障碍，作者谈一下海洛因依赖者失眠症的中医辩证论治。     

Predictors of discharges against medical advice from a short-term hospital detoxification unit.

The primary goal of this study was to identify factors associated with patients leaving a 3-day hospital detoxification unit against medical advice (AMA). Medical records of 302 patients who were admitted for alcohol or other drug withdrawal were reviewed. Variables examined were: demographics, reported history of drug use, urine toxicology at admission, medication received during the detoxification, and admission day. Data were analyzed using a case-control design. Logistic regression was used to identify independent predictors. We found that being younger, having a shorter history of cocaine abuse, being admitted on a Friday and being an opiate dependent patient treated with clonidine only during the detoxification, were significantly associated with leaving AMA. These findings may provide information that can help clinicians identify those patients who are most at risk for leaving AMA. This will in turn allow them the opportunity to initiate preventive measures to decrease unnecessary attrition and improve utilisation of treatment resources.     

Characteristics of Opiate Users Leaving Detoxification Treatment Against Medical Advice

ABSTRACT

Substance-dependent patients leaving against medical advice (AMA) pose a unique challenge to detoxification programs. Most notably, AMA patients fail to access residential or outpatient treatment needed after detoxification and often return to detoxification treatment multiple times which has deleterious results for the patient and is taxing to the healthcare system. Using retrospective data from 89 daily opiate-using detoxification patients completing detoxification and 95 patients leaving AMA, we sought to identify patient characteristics useful in predicting AMA discharges from detoxification. Bivariate analyses indicated that AMA patients reported drug use did not impair their health, were injection drug users, younger and had fewer previous treatment admissions. Binomial logistic regression indicated that AMA patients were more likely to be unemployed and report that drug use did not impair their health. Patients completing detoxification were less likely to be injection drug users and less likely to be self-referred to treatment. Identifying patients at risk of leaving AMA provides an opportunity for clinicians to intervene in an effort to increase treatment engagement for these patients.     

The Relationship Between Generalized Anxiety Symptoms and Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders

Background: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). Objective and Method: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. Results: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. Conclusions/Importance: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance.     

Differences among those who complete and fail to complete inpatient detoxification

Some individuals hospitalized for alcohol or drug detoxification leave against medical advice (AMA). We hypothesized that certain characteristics would be associated with AMA discharges. A case-control study of 1,426 hospital admissions for detoxification (representing 1,080 individuals) was conducted to compare patients leaving the hospital AMA (n=231) with a random sample of those completing detoxification (n=286). Latino ethnicity, detoxification from drugs, Friday or Saturday discharge, Medicaid or no health insurance, and not being treated by one specific attending physician were characteristics associated with an AMA discharge in a backward logistic regression model. Although 85% of the patients with all these characteristics left AMA, only one patient, without any of these five characteristics, did so. We conclude that clinicians can use certain clinical features to predict AMA discharge. Additional research could evaluate if treatment strategies that consider these ethnic and socioeconomic disparities may reduce rates of AMA discharge.     

One year outcomes for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS)

AIM: To determine 1 year outcomes for drug use, criminality, psychopathology and injection-related health problems in those entering treatment for heroin dependence in Australia. DESIGN: Longitudinal prospective cohort study. PARTICIPANTS: Seven hundred and forty five individuals entering treatment (methadone/buprenorphine maintenance therapy; detoxification; residential rehabilitation) and 80 heroin users not seeking treatment. SETTING: Sydney, Melbourne and Adelaide, Australia. FINDINGS: A total of 657 individuals were re-interviewed at 1 year, 80% of the original sample. There were substantial reductions in heroin and other drug use across all three treatment modalities. The majority of those who had entered treatment were heroin abstinent at 1 year (maintenance therapy 65%, detoxification 52%, residential rehabilitation 63%) compared to 25% of the non-treatment sample. The reduction in heroin use among the treatment samples was paralleled by reductions in poly drug use. There were also substantial reductions in risk-taking, crime and injection-related health problems across all treatment groups, and less marked reductions among the non-treatment group. Psychopathology was dramatically reduced among the treatment modalities, while remaining stable among the non-treatment group. Positive outcomes at 1 year were associated with a greater number of cumulative treatment days experienced over the 1 year follow-up period ('treatment dose') and fewer treatment episodes undertaken in that time ('treatment stability'). CONCLUSIONS: At 1 year, there were impressive reductions in drug use, criminality, psychopathology and injection-related health problems following treatment exposure. The positive findings were associated with a greater "dose" of treatment, and with more treatment stability over the follow-up period.     

The association between cocaine use and short-term outcomes for the treatment of heroin dependence: findings from the Australian Treatment Outcome Study (ATOS)

The aim of this study was to determine the prevalence of cocaine use among individuals presenting for treatment for heroin dependence, describe the clinical profile of heroin users who also use cocaine and to establish the effects of cocaine use on short term outcomes for the treatment for heroin dependence. A longitudinal follow-up of 549 heroin users recruited in Sydney for the Australian Treatment Outcome Study was conducted at 3-month post-baseline interview. At baseline, current cocaine use was common (39%) and was associated with increased drug use, needle risk taking and criminality. The 3-month prevalence of cocaine use declined significantly to 19%. Thirty-five per cent of those who had used cocaine at baseline continued to use at 3 months, while 9% of the sample had commenced cocaine use. Those who entered residential rehabilitation at baseline were less likely than other treatment entrants and the non-treatment group to have used cocaine at follow-up. Treatment retention was not affected by baseline cocaine use status; however, baseline cocaine users (CU) displayed higher levels of heroin use, polydrug use and drug-related problems. A poorer outcome was associated with the commencement or continuation of cocaine use, while cessation of cocaine use resulted in significant improvements on these measures. Cocaine use was common among individuals seeking treatment for heroin dependence and was an important moderator of treatment outcome. It appears that cocaine use has a strong negative effect on treatment outcome over and above that caused by polydrug use generally. [Williamson A, Darke S, Ross J, Teesson M. The association between cocaine use and short-term outcomes for the treatment of heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2006;25:141 - 148]     

Comparative Treatment Effectiveness: Effects of Program Modality and Client Drug Dependence History on Drug Use Reduction

This study examined treatment outcome as a function of program modality, clients’ lifetime patterns of drug dependence, and their interaction, controlling for current level of drug use at treatment intake. Data were based on 2,966 clients who were interviewed at intake and at 1-year follow-up as part of the Drug Abuse Treatment Outcome Study (DATOS), which included programs of four major modalities. Subjects’ lifetime patterns of drug dependence were classified into nine groups according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association; 1987) diagnostic criteria and time of onset of drug use career. Outcome measure was the reduction of heroin use or cocaine use at follow-up from levels at intake. The results showed that rates of lifetime drug dependence and current drug use at DATOS admission were highest among methadone maintenance clients and lowest among outpatient drug-free clients. Drug use reduction was observed for all modalities. The presence of dependence diagnosis was associated with less improvement when current use level at intake was controlled. Clients dependent on heroin but not currently daily users benefited most from inpatient and residential programs. Methadone programs were also relatively ineffective in reducing cocaine use. Characteristics of the client’s drug dependence history, in addition to the current or presenting drug problem, should be assessed to guide treatment planning. The high rate of cocaine dependence among methadone clients, most of whom were dependent on heroin, poses considerable challenge to contemporary opiate substitution treatments. Published by Elsevier Science Inc.     

Is inhalant use a risk factor for heroin and injection drug use among adolescents in the United States?

PURPOSE: We examined whether inhalant use was associated with heroin and injection drug use (IDU) among adolescents aged 12 to 17 in the United States. METHODS: Data were drawn from the 2002/2003 administrations of the National Survey on Drug Use and Health (NSDUH). We conducted logistic regression analyses to estimate associations of inhalant use with heroin use, heroin injection, and IDU, respectively, among adolescent drug users (N=8161). RESULTS: Approximately 30.9% of adolescents had ever used at least one illicit drug. More than one-fifth (22.2%) of adolescents were past-year or recent drug users. Among past-year adolescent drug users, 1.4% had progressed to heroin use and 1.2% reported IDU. Adolescents who had used inhalants and marijuana were 2.8 and 2.9 times as likely as adolescents who had used marijuana but not inhalants to report heroin use and any IDU, respectively. Adolescents who had used inhalants or other drugs but not marijuana were unlikely to use heroin. However, inhalant users, irrespective of their marijuana use histories, had greater odds of IDU than drug users who had not used inhalants. Adolescent drug users who were females, school dropouts, whites, or delinquents had significantly increased odds of heroin use and IDU. Cigarette smoking before the age of 15 was strongly associated with heroin use, and a history of foster care placement was associated with IDU. CONCLUSIONS: This national study of American adolescents identifies several subgroups of recent drug users, such as females, school dropouts, and youth who have used inhalants and marijuana, which have substantially increased odds of heroin use and IDU. Screening, prevention, and treatment interventions targeted to these groups might reduce medical and social complications of heroin use and IDU.