RESUMO
This study examined the Community Reinforcement Approach's (CRA) effect on AIDS risk behaviors and the relationship between comorbid psychiatric disorders and the risk for AIDS behavior in opioid dependent patients entering methadone maintenance treatment. Additionally, we looked at AIDS risk behaviors as they related to the Addition Severity Index (ASI), Beck Depression Inventory, Symptom Checklist-90-Revised (SCL-90-R), and the Social Adjustment Scale-Self Report (SAS-SR). Subjects (N = 227) were drawn from a large clinical trial that examined the effectiveness of a Community Reinforcement Approach for treatment of opioid dependence. Both CRA and standard treatment demonstrated a significant effect on reduction of AIDS risk behaviors. There was no relationship found regarding comorbid psychiatric disorders with the risk for AIDS behavior. However, there were correlations with other psychiatric, social, and substance abuse variables. Multivariate analyses indicated that increased drug and legal ASI composite scores were the primary predictors of increased AIDS risk behavior.
Assuntos
Síndrome da Imunodeficiência Adquirida/transmissão , Transtornos Mentais/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Assunção de Riscos , Síndrome da Imunodeficiência Adquirida/psicologia , Adulto , Serviços Comunitários de Saúde Mental , Comorbidade , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Escalas de Graduação Psiquiátrica , Comportamento SocialRESUMO
The authors studied the efficacy of the community reinforcement approach (CRA) as compared to standard counseling in opiate-dependent patients on methadone maintenance. One hundred eighty subjects were randomized to three treatment conditions: standard, CRA, and CRA with relapse prevention (CRA/RP). Of these, 151 subjects were followed up 6 months after intake. Since few of the RP sessions had been concluded at the 6-month follow-up, the two CRA groups were combined for analyses. Weekly urinalysis drug screens and Addiction Severity Index (ASI) scores at intake and 6 months were compared. The combined CRA groups did significantly better than the standard group in the following areas: consecutive opiate-negative urinalysis (3 weeks), and the 6-month ASI drug composite score. These results support the benefit of adding CRA strategies to the treatment of patients who are opiate dependent and on methadone maintenance. Because of insufficient treatment exposure to RP at the 6-month follow-up, the additive effect of RP could not be adequately evaluated; further follow-up will be required.
Assuntos
Terapia Comportamental , Dependência de Heroína/reabilitação , Metadona/uso terapêutico , Motivação , Reforço Social , Feminino , Seguimentos , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Dependência de Heroína/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Inventário de Personalidade , Fatores de Risco , Centros de Tratamento de Abuso de Substâncias , Abuso de Substâncias por Via Intravenosa/reabilitação , Resultado do TratamentoRESUMO
Psychiatric disorders have become an increasing concern in the treatment of substance abusers. The introduction of the Human Immunodeficiency Virus (HIV) into this population has further complicated treatment. This study examines the prevalence of psychiatric disorders in an opioid dependent population maintained on methadone. Results from this preliminary analysis show high rates of psychiatric disorders in this population. Additionally, needle sharing behavior appears to be increased in patients with a diagnosis of dysthymia. These findings have direct implications for aggressive screening and treatment of psychiatric disorders in methadone maintenance clinics.