心理矫治对海洛因依赖者美沙酮维持治疗干预效果的研究

Effect of Psychological Correction in Heroin Addicts with Methadone Maintenance Therapy

背景长期吸食海洛因会产生一系列的躯体和精神情绪问题,目前美沙酮维持治疗是海洛因依赖患者最有效的治疗方法。海洛因依赖者多具有心理问题,但目前我国心理矫治对海洛因依赖者的治疗尚处于起步阶段。目的探讨心理矫治对接受美沙酮维持治疗的海洛因依赖者的干预效果。方法2018年1—6月随机抽取武汉市4个区中5所最具代表性的美沙酮维持治疗门诊,选取连续治疗2年及以上的400例海洛因依赖者,采用随机数字表法分为个体矫治组86例、团体矫治组120例、同伴矫治组115例和对照组79例。个体矫治组:由具有二级心理咨询师资格证书的专业心理咨询工作人员为患者治疗,1次/周,0.5 h/次,共24次。团体矫治组:由具有二级心理咨询师资格证书的专业心理咨询工作人员承担治疗工作,10~15人/组,1次/周,1.5 h/次,共24次。同伴矫治组:以小组合作学习的形式,利用同伴压力的积极因素,对海洛因依赖者进行教育。个体矫治组、团体矫治组、同伴矫治组和对照组均采用美沙酮维持治疗,严格按照用药剂量和用药程序,由门诊医护人员告知服药相关的注意事项。采用自制一般情况调查表收集患者人口学资料,采用社会支持评定量表(SSRS)、Morisky服药依从性量表(MMAS-8)以及症状自评量表(SCL-90)评价患者治疗情况。结果个体矫治组、团体矫治组、同伴矫治组、对照组分别有73例(84.9%)、99例(82.5%)、92例(80.0%)、61例(77.2%)最终完成随访。个体矫治组、团体矫治组、同伴矫治组干预后SSRS、MMAS-8评分高于对照组,SCL-90评分低于对照组(P<0.05);个体矫治组、团体矫治组干预后SSRS、MMAS-8评分高于同伴矫治组,SCL-90评分低于同伴矫治组(P<0.05);个体矫治组干预后SSRS、MMAS-8评分高于团体矫治组,SCL-90评分低于团体矫治组(P<0.05)。结论心理矫治对行美沙酮维持治疗的海洛因依赖者有较好的干预效果,而且三种不同矫治方法之间效果存在差异,可以根据患者的具体情况进行选择。

Background Long-term use of heroin can cause a series of physical,mental and emotional problems.At present,methadone maintenance therapy(MMT)is the most effective treatment for heroin-dependent patients.Many drug addicts have psychological problems,but the psychological correction for drug addicts in China is still in its infancy.Objective To investigate the effect of psychological correction on heroin-dependent patients receiving MMT.Methods From January to June 2018,from 5 most representative clinics treating heroin addicts with MMT randomly selected from 4 districts of Wuhan,400 such patients with a consecutive treatment for at least 2 years were enrolled and were divided into individual correction group(n=86,each was intervened with MMT combined with correction services delivered by professional counseling workers with intermediate national psychological consultant qualification for 24 times,once a week,0.5 hour each time),group correction group(n=120,intervened with MMT combined with correction services delivered by professional counseling workers with intermediate national psychological consultant qualification in subgroups of 10-15 individuals for 24 times,once a week,1.5 hours each time),peer correction group(n=115,intervened with MMT combined with the positive stress influence from peers during the group cooperative learning),and control group(n=79,only intervened with MMT with strict adherence to the stipulated dosage and the medication procedure,with medication-related precautions informed by outpatient medical workers)by random number table method.The self-made General Situation Questionnaire was used to collect the demographic data.The Social Support Rating Scale(SSRS),8-item Morisky Medication Adherence Scale(MMAS-8),and SCL-90 were used to evaluate the treatment effect.Results 73 cases(84.9%),99 cases(82.5%),92 cases(80.0%),and 61 cases(77.2%)in the individual correction group,group correction group,peer correction group,and control group completed the follow-up.The control group had lower mean scores of MMAS-8 and SSRS,and higher mean SCL-90 score after intervention compared with other groups(P<0.05).The peer correction group showed lower mean scores of MMAS-8 and SSRS,and higher mean SCL-90 score after intervention compared with other two correction groups(P<0.05).Individual correction group demonstrated higher mean scores of MMAS-8 and SSRS,and lower mean SCL-90 score after intervention compared with group correction group(P<0.05).Conclusion Psychological correction has a good effect on drug addicts with MMT.There are differences in the effects between three correction methods,which can be selected according to the specific situation of the patient.