基于社区的药物滥用康复项目中进行的戒烟治疗：寻找转归预测因素以改善治疗
2011/10/11
摘要
背景：基于社区的门诊患者药物滥用康复项目是一项隶属于“国家药物滥用治疗临床试验网络”的多中心戒烟治疗（SC）临床试验，研究了SC治疗转归的预测因素。
目的：判断基线状态下哪些人口统计学参数和临床参数可以作为治疗期间戒烟的预测因子。
方法： 对来自5个美沙酮维持治疗项目和2个药物和酒精依赖治疗项目的吸烟者进行随机分组，一组为SC治疗作为药物滥用治疗的辅助手段，另一组为常规药物滥用治疗。SC治疗包括团体咨询（1～8周）和经皮尼古丁贴剂治疗（21 mg/天, 1-6周; 14 mg/天, 7～8周）。采用logistic回归评价人口统计学参数和戒烟的临床预测因素。
结果：治疗期间戒烟与年龄小、西班牙裔或白人（与非洲裔美国人相对）、受雇或学生、基线状态每天更少的吸烟量、基线状态下药物依赖严重程度低和较高的美沙酮剂量（美沙酮治疗组亚组）成正相关。
结论和科学意义：今后要想做好酒精和药物依赖患者的SC治疗，重点是要考虑到以下几个问题：一是要降低主要药物或酒精的依赖程度，其次对于吸烟和药物滥用较严重的患者需进行个性化治疗，最后，干预措施应当考虑到患者的受教育程度。对转归预测因素的分析可能有助于找到更好的治疗方法。
（陈欣 审校）
Am J Drug Alcohol Abuse. 2011 Sep;37(5):472-8.
目的：判断基线状态下哪些人口统计学参数和临床参数可以作为治疗期间戒烟的预测因子。
方法： 对来自5个美沙酮维持治疗项目和2个药物和酒精依赖治疗项目的吸烟者进行随机分组，一组为SC治疗作为药物滥用治疗的辅助手段，另一组为常规药物滥用治疗。SC治疗包括团体咨询（1～8周）和经皮尼古丁贴剂治疗（21 mg/天, 1-6周; 14 mg/天, 7～8周）。采用logistic回归评价人口统计学参数和戒烟的临床预测因素。
结果：治疗期间戒烟与年龄小、西班牙裔或白人（与非洲裔美国人相对）、受雇或学生、基线状态每天更少的吸烟量、基线状态下药物依赖严重程度低和较高的美沙酮剂量（美沙酮治疗组亚组）成正相关。
结论和科学意义：今后要想做好酒精和药物依赖患者的SC治疗，重点是要考虑到以下几个问题：一是要降低主要药物或酒精的依赖程度，其次对于吸烟和药物滥用较严重的患者需进行个性化治疗，最后，干预措施应当考虑到患者的受教育程度。对转归预测因素的分析可能有助于找到更好的治疗方法。
（陈欣 审校）
Am J Drug Alcohol Abuse. 2011 Sep;37(5):472-8.
Reid MS, Jiang H, Fallon B, Sonne S, Rinaldi P, Turrigiano E, Arfken C, Robinson J, Rotrosen J, Nunes EV.
Source
Department of Psychiatry, New York University School of Medicine , New York, NY , USA.
Department of Psychiatry, New York University School of Medicine , New York, NY , USA.
Abstract
BACKGROUND: Predictors of smoking cessation (SC) treatment outcome were explored in a multisite clinical trial of SC treatment at community-based, outpatient, substance abuse rehabilitation programs affiliated with the National Drug Abuse Treatment Clinical Trials Network.
OBJECTIVES: To explore baseline demographic and clinical predictors of abstinence during treatment.
METHODS: Cigarette smokers from five methadone maintenance programs and two drug and alcohol dependence treatment programs were randomly assigned to SC treatment as an adjunct to substance abuse treatment as usual or to substance abuse treatment as usual. SC treatment consisted of group counseling (weeks 1-8) plus transdermal nicotine patch treatment (21 mg/day, weeks 1-6; 14 mg/day, weeks 7-8). Demographic and clinical predictors of smoking abstinence were evaluated among those patients assigned to the active SC condition (N = 153) using logistic regression.
RESULTS: Abstinence during treatment was positively associated with younger age, Hispanic or Caucasian (as opposed to African American) ethnicity/race, employment or student status, fewer cigarettes per day at baseline, lower severity of the primary substance problem at baseline, and higher methadone doses (among the subsample in methadone treatment).
Conclusions and Scientific Significance: During future efforts to improve SC treatments among drug- and alcohol-dependent patients, consideration should be given to adequate treatment to reduce the severity of the primary drug or alcohol problem, tailoring treatments for patients with greater severity of smoking and of the primary substance problem, and culturally sensitive interventions. Analysis of predictors of outcome may be a useful tool for treatment development.
BACKGROUND: Predictors of smoking cessation (SC) treatment outcome were explored in a multisite clinical trial of SC treatment at community-based, outpatient, substance abuse rehabilitation programs affiliated with the National Drug Abuse Treatment Clinical Trials Network.
OBJECTIVES: To explore baseline demographic and clinical predictors of abstinence during treatment.
METHODS: Cigarette smokers from five methadone maintenance programs and two drug and alcohol dependence treatment programs were randomly assigned to SC treatment as an adjunct to substance abuse treatment as usual or to substance abuse treatment as usual. SC treatment consisted of group counseling (weeks 1-8) plus transdermal nicotine patch treatment (21 mg/day, weeks 1-6; 14 mg/day, weeks 7-8). Demographic and clinical predictors of smoking abstinence were evaluated among those patients assigned to the active SC condition (N = 153) using logistic regression.
RESULTS: Abstinence during treatment was positively associated with younger age, Hispanic or Caucasian (as opposed to African American) ethnicity/race, employment or student status, fewer cigarettes per day at baseline, lower severity of the primary substance problem at baseline, and higher methadone doses (among the subsample in methadone treatment).
Conclusions and Scientific Significance: During future efforts to improve SC treatments among drug- and alcohol-dependent patients, consideration should be given to adequate treatment to reduce the severity of the primary drug or alcohol problem, tailoring treatments for patients with greater severity of smoking and of the primary substance problem, and culturally sensitive interventions. Analysis of predictors of outcome may be a useful tool for treatment development.
Am J Drug Alcohol Abuse. 2011 Sep;37(5):472-8.
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初级保健医务人员劝说戒烟：在有无饮酒、药物或精神疾病患者中的戒烟效果比较
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