电针刺激厌恶治疗酒依赖的临床疗效评价

Evaluation of the clinical effect of electro-acupuncture aversion therapy of alcohol-dependence

目的:评估电针刺激厌恶疗法治疗酒依赖的疗效。方法:于2006-04/07在四川大学华西医院心理卫生中心住院患者中随机选择35例男性患者,均符合CCMD-3酒依赖的诊断标准,且自愿参加本实验,无电针刺激厌恶治疗禁忌证。平均年龄(41.4±8.2)岁,平均饮酒年限(21.3±8.0)年,平均日饮酒量350～1200mL(乙醇含量50～60mL/L)。采用简单随机方法随机分为电针刺激厌恶治疗组20例及对照组15例。两组在年龄、性别、种族及饮酒史方面差异无显著性意义。应用汉密顿焦虑量表评价患者的焦虑症状(其评分为0～4分,5级:0-无症状,1-轻,2-中等,3-重,4-极重)。自编饮酒渴求程度量表评估患者饮酒渴求程度(包括想到酒、看见酒、闻到酒及其他触发事件共4项,每项以0～7分评定(0=无,7=经历过的最高渴求程度,总分28分)。入院后第1周,两组均接受生理性脱毒治疗,包括苯二氮类药物及对症支持治疗。第2周开始,两组均进行饮酒渴求程度及汉密顿焦虑量表评分并参加团体心理治疗。电针刺激厌恶治疗组同时接受1个疗程的电针刺激厌恶治疗:治疗所用仪器为韩氏穴位刺激仪,治疗时将电极安放在前臂,将电流从小到大逐渐增加,直至患者难以忍受,再取其1/4的值为基本电流,治疗中视患者反应可略加调整;选择单一的饮酒行为作为目标行为。治疗开始时给患者呈现其既往最常饮用的酒(种类、浓度及酒具应与平时一致),令其想象一个饮酒情境,当患者饮酒欲望出现时,立即给予电刺激,电流强度以求助者出现不愉快情绪体验及相应生理反应为宜,每次持续电刺激10min,然后休息5min,再重复进行1次前述操作;在治疗过程中应予言语暗示增强其厌恶体验。电针治疗1次/d,10次为1个疗程。电针治疗疗程结束后比较两组的饮酒渴求程度及汉密顿焦虑量表评分。结果:35例患者均进入结果分析。①两组住院第2周时饮酒渴求程度及汉密顿焦虑量表评分差异不显著。②两组治疗后的饮酒渴求程度及汉密顿焦虑量表评分与治疗前比较均降低,治疗后电针刺激厌恶治疗组饮酒渴求程度及汉密顿焦虑量表评分均低于对照组[治疗前:饮酒渴求程度评分:19.75±1.86,20.27±2.46,汉密顿焦虑量表评分:17.90±4.05,18.60±4.21;治疗后:饮酒渴求程度评分:1.45±1.28,4.27±3.03,汉密顿焦虑量表评分:2.45±2.46,6.33±4.37,P<0.001,P<0.005]。③出院后2个月随访中,电针刺激厌恶治疗组有4例复饮,复饮率20.0%,对照组有5例复饮,复饮率33.3%,两组复饮率差异不显著。结论:电针刺激厌恶治疗可有效消退饮酒行为,复饮率倾向于更低。酒艹卓依赖的理想心理治疗方案应在其他治疗模型的基础上加以电针刺激厌恶治疗。

AIM： To evaluate the effect of aversion therapy with electro-acupuncture of alcohol dependence. METHODS： Thirty-five male inpatients were randomly selected from the Center for Psychological Health, Huaxi Hospital of Sichuan University between April and July 2006. All enrolled subjects, who had no contraindi- cations of aversion therapy with electro-acupuncture, met CCMD-3 diagnostic criteria for alcohol dependence and voluntarily participated in the experiment. The average age of patients was （41.4±8.2） years, and the average drinking time was （21.3±8.0） years. On an average, patients drank 350-1200 mL daily （50-60 mL/L of alcohol）. Patients were randomized into aversion therapy with electro-acupuncture group （aversion therapy group, n=20） and the control group （n=15）, and there was no significant difference in age, sex, race and drinking between the two groups. Hamilton Anxiety Scale （HAMA） was adopted to evaluate the anxiety of patients （the score ranged from zero to 4 points with 5 grades. Zero as no syndrome, l point as slight, 2 points as moderate, 3 points as heavy and 4 points as severe）. Patients＇ drinking conditions were evaluated by self-made alcohol-dependence scale （Including 4 items： thinking of drinking, sighting of alcohol, smelling of alcohol and other events. Each item was scaled as 0-7 points： Zero as none, 7 as experienced the highest dependence with a total score of 28 points.） Patients in both groups underwent physiological detoxification treatment in the first week of hospitalization, including benzodiazepines and supportive treatments. Patients were evaluated by selfmade alcohol-dependence scale and HAMA and received psychological treatment in group from the second week. Patients in the aversion therapy group received one course of aversion treatment by electro-acupuncture at the same time： Han＇ s acupoint nerve stimulator was adopted. The electrode was placed on the forearm with the current gradually increased from weak to strong, a quarter of which was taken as the basic current while the patient could not bear, and it was regulated in the treatment according to the patients＇ reaction. Drinking only was considered as the target behavior. Patients were supplied with the alcohol they usually drank （the same alcohol of the same concentration with the same glass） at the beginning of the treatment, and they were required to image a drinking situation. Electron stimulation was given immediately at patients＇ alcohol-dependence came at the current intensity that patients felt unpleasant and accompanied with corresponding physiological response. The stimulation lasted for 10 minutes each time with a 5-minute rest, and then repeated once. Verbal suggestion was given in the treatment to increase the aversion. Electroacupuncture treatment was given once a day and 10 times as one course. The alcohol-dependence and HAMA score were compared between the two groups after the treatment. RESULTS： A total of 35 patients were involved in the analysis of results. ①There were no significant differences in alcohol-dependence scale and HAMA at the second week of hospitalization between the two groups. ② The scores of alcohol-dependence scale and HAMA were decreased significantly in both groups after treatment than those before treatment, and the scores of alcohol-dependence scale and HAMA in aversion therapy group after the treatment was lower than those in the control group [Score of alcohol-dependence before treatment： 19.75 ±1.86,20.27 ±2.46. Score of HAMA before treatment： 17.90±4.05,18.60±4.21. Score of alcohol-dependence after the treatment：1.45±1.28,4.27±3.03. Score of HAMA after the treatment： 2.45±2.46,6.33±4.37,P 〈 0.001 ,P 〈 0.005].③ In the followup of 2 months post-discharge, 4 patients ih the aversion therapy group redrank with the percent of 20.0%, while 5 patients in the control group redrank with the percent of 33.3%, and there was no remarkable difference between the two group in the percent. CONCLUSION： Aversion therapy with electro-acupuncture can effectively resolve the drinking with a lower percent of re-drink. Ideal psychological therapy of alcohol-dependence is aversion therapy with electro-acupuncture based on other treatments.