針對接受鴉片類替代藥物療法之注射藥癮者藥物諮商的介入效果
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Date
2011/8/1-2014/7/31
Authors
李思賢
方凱企
束連文
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Abstract
藥癮諮商被認為是整合性鴉片類替代療法的一環，但過去少有研究探討其效益與成 本。要治療藥物成癮，必須同時從生理與行為面進行戒治，因此在給予美沙冬藥物之外， 進一步的行為諮商介入措施是相當重要的。本四年期研究目的是評估藥物與危險行為諮 商（BDRC）的介入成效，BDRC 是非緊湊、採認知行為取向的諮商。本研究假設是接 受藥物治療合併BRDC 諮商會有較好的成本效益，與造成較好的留置率、再使用海洛因 情形較低、與較低愛滋感染率。由於台灣與印尼在經濟、宗教、與IDU 愛滋感染率不同， 本雙邊合作研究得以分析替代療法與BDRC 是否有跨文化的效果。雙邊合作團隊預計在 台北與印尼雅加達合作醫院分別收取300 位新加入美沙冬替代治療病患，取得同意書後 隨機分派到實驗組（接受BDRC 諮商介入）與控制組（無諮商介入）。每一位個案會至 少追蹤12 個月（基準、第6 與12 個月），瞭解其治療後的生理、心理與社會面向的諮 商效果。本雙邊合作研究將由賓州大學Metzger 教授團隊、耶魯大學Charwaski 教授團 隊、台北主持人李思賢教授團隊、與印尼主持人Adhi Nurhidayat 醫師團隊共同進行。
Drug counseling is considered to be an integral part of methadone treatment, but few studies have been designed to assess its benefits and costs. To treat addiction we need both biological and behavioral interventions. Thus it is important to do more than distribute methadone for treatment. The specific aims of this four year study are to evaluate the impact of Behavioral Drug and Risk Counseling (BDRC), a low intensity, cognitive behavioral approach that integrates drug counseling and risk reduction intervention. Those assigned to the BDRC arm will be compared to those who receive treatment as usual which includes an initial risk reduction intervention and counseling as needed.We hypothesize that the structured, low intensity BDRC approach will be more cost effective and result in higher rates of retention in treatment, lower rates of drug use and lower rates of HIV risk. Since differences exist in the economy, religion, and HIV sero-prevalent rate between Taiwan and Indonesia, research data will be compared to test cross cultural effectiveness of substitution treatment and BDRC counseling. To test these hypotheses, the research team in Taipei and Jakarta will recruit 300 injecting drug users respectively as they enter methadone treatment at the collaborative hospitals. Following informed consent procedures, research staff will randomize participants to either the BDRC intervention or to treatment as usual. All participants will be fully assessed at baseline and months 6 and 12. The proposed work will be built on collaborations that have been established with the PI of the University of Pennsylvania team, the Yale BDRC team, the Taiwan PI Tony Szu-Hsien Lee, the Indonesian Investigator Adhi Nurhidayat.
Drug counseling is considered to be an integral part of methadone treatment, but few studies have been designed to assess its benefits and costs. To treat addiction we need both biological and behavioral interventions. Thus it is important to do more than distribute methadone for treatment. The specific aims of this four year study are to evaluate the impact of Behavioral Drug and Risk Counseling (BDRC), a low intensity, cognitive behavioral approach that integrates drug counseling and risk reduction intervention. Those assigned to the BDRC arm will be compared to those who receive treatment as usual which includes an initial risk reduction intervention and counseling as needed.We hypothesize that the structured, low intensity BDRC approach will be more cost effective and result in higher rates of retention in treatment, lower rates of drug use and lower rates of HIV risk. Since differences exist in the economy, religion, and HIV sero-prevalent rate between Taiwan and Indonesia, research data will be compared to test cross cultural effectiveness of substitution treatment and BDRC counseling. To test these hypotheses, the research team in Taipei and Jakarta will recruit 300 injecting drug users respectively as they enter methadone treatment at the collaborative hospitals. Following informed consent procedures, research staff will randomize participants to either the BDRC intervention or to treatment as usual. All participants will be fully assessed at baseline and months 6 and 12. The proposed work will be built on collaborations that have been established with the PI of the University of Pennsylvania team, the Yale BDRC team, the Taiwan PI Tony Szu-Hsien Lee, the Indonesian Investigator Adhi Nurhidayat.