Residential rehabilitation for drug users: a review of 13 months' intake to a therapeutic community
作者:J. Keen、P. Oliver、G. Rowse、N. Mathers
DOI:10.1093/fampra/18.5.545
日期:2001.10.1
Background. Residential rehabilitation based on ‘therapeutic community’ treatment for drug users is a treatment option which is attractive to GPs and others referring drug users for treatment. Whilst there is evidence that maintenance-based programmes for drug users are effective, there have been fewer attempts to evaluate the effectiveness of abstinence-based programmes which are relatively more intensive and expensive interventions.Objective. This paper reports and evaluates the outcomes for 13 months' intake of 138 drug users to a residential community.Methods. We carried out a retrospective cohort study using existing clinical and residential record data. The setting is a residential rehabilitation centre run by the charity Phoenix House in Sheffield, UK, offering a 1-year programme for heroin addicts including community detoxification overseen by primary care specialist doctors and residential rehabilitation. Participants were all patients who entered treatment between 1 February 1998 and 28 February 1999 inclusive. An analysis was carried out of clinical records and other records kept by clinicians and staff at the centre. Outcome measures were numbers of days of retention in treatment and reasons for departure, categorized as completed treatment, planned or unplanned departure and expulsion from the programme. For patients who underwent in-house detoxification, a further outcome measure was whether or not detoxification was complete at discharge.Results. Heroin was the main drug of abuse in 85% of admissions. Mean length of time for which individuals had been drug dependent was 8 years (range 1.3–20.1 years). The mean length of stay was 80.2 days (range 1–394, 95% confidence interval 61.8–98.6). Thirty-four individuals (25%) completed 90 days or more. No association was found between length of stay and age, sex, route of administration, polydrug use, length of time addicted or age of first addiction. Sixty-five per cent of those who received in-house detoxification completed the detoxification period. When patients were classified as ‘successes’ or ‘failures’ by reason for departure from the programme, 94 (68.1%) were classified as failures and 18 (13.0%) as successes. Data were unavailable for 26 patients. Success was not associated with any characteristic at entry apart from being drug free as opposed to requiring detoxification (P = 0.048, chi-square = 6.06, df = 2).Conclusion. This study shows overall low levels of programme completion and high levels of unplanned departure and eviction from the programme amongst these long-term drug users. On the other hand, the importance of abstinence for those who achieve it in residential rehabilitation should not be underestimated, nor should the possibility that long-term outcomes are influenced by the learning process involved in the intervention. It may be possible to operate better selection procedures in order to optimize outcomes.
背景。 以 "治疗社区 "治疗为基础的住院康复治疗对全科医生和其他介绍吸毒者接受治疗的人来说是一种很有吸引力的治疗方法。虽然有证据表明以维持为基础的戒毒计划对吸毒者是有效的,但对以禁欲为基础的戒毒计划的有效性进行评估的尝试较少,因为这些计划的干预强度相对较大,费用也较高。本文报告并评估了 138 名吸毒者在寄宿社区接受 13 个月戒毒治疗的结果。我们利用现有的临床和住宿记录数据开展了一项回顾性队列研究。研究地点是英国谢菲尔德由慈善机构凤凰之家(Phoenix House)运营的一家寄宿康复中心,该中心为海洛因成瘾者提供为期一年的项目,包括由初级保健专科医生监督的社区戒毒和寄宿康复。参与者为 1998 年 2 月 1 日至 1999 年 2 月 28 日(含)期间接受治疗的所有患者。我们对该中心的临床记录以及临床医生和工作人员保存的其他记录进行了分析。衡量结果的指标是治疗保留天数和离开的原因,分为完成治疗、计划内或计划外离开以及被逐出计划。对于接受内部戒毒的患者,另一项结果衡量指标是出院时是否完成戒毒。85%的入院患者主要滥用海洛因。对毒品产生依赖的平均时间为 8 年(1.3-20.1 年不等)。平均住院时间为 80.2 天(范围为 1-394,95% 置信区间为 61.8-98.6)。有 34 人(25%)住院时间达到或超过 90 天。在住院时间与年龄、性别、给药途径、使用多种药物、成瘾时间或首次成瘾年龄之间没有发现任何关联。在接受内部戒毒的患者中,65%的人完成了戒毒。按离开戒毒计划的原因将患者分为 "成功 "和 "失败 "两类,94 人(68.1%)被归类为失败,18 人(13.0%)被归类为成功。有 26 名患者的数据无法获得。除了无毒品而不是需要戒毒外,成功与参加时的其他特征无关(P = 0.048,chi-square = 6.06,df = 2)。这项研究表明,在这些长期吸毒者中,完成计划的总体水平较低,计划外离开和退出计划的比例较高。另一方面,不应低估在住院康复中实现戒断的人的重要性,也不应低估长期结果受到干预措施所涉及的学习过程影响的可能性。也许可以采用更好的选择程序,以便取得最佳效果。