甲基苯丙胺使用者成瘾行为发展阶段特征分析

Characteric analysis of developmental stages about methamphetamine addictive behavior

目的根据成瘾行为的发展过程对甲基苯丙胺使用者进行阶段划分,探讨不同阶段使用者的特点,为制订有针对性的临床干预措施提供理论参考。方法以某强制隔离戒毒所2018年9月至2019年12月收治的男性甲基苯丙胺使用者作为研究对象,在其入所1周内完成临床诊断、访谈及问卷评估,研究对象按成瘾行为的阶段特征进行区分。使用视觉模拟评分法(visual analogue scale,VAS)、Barrett冲动量表(Barrett impulsiveness scale,BIS)、CogState量表对所有被试进行评估。使用SPSS 20.0进行统计分析,组间比较采用方差分析或秩和检验,采用多因素Logistic回归分析探究与成瘾行为发展相关的因素。结果(1)强迫性用药组在累计使用时长[24(8,48)月,12(4,24)月,22(10,36)月]、用药剂量[(6.6±3.8)片,(2.8±1.4)片,(4.5±3.4)片]、渴求感评分[1.0(0,5.0)分,0(0,1.0)分,1.0(0,3.0)分]都高于其它两组(P<0.05),且有更多既往使用海洛因的经历[20.4%,9.8%,14.8%,P<0.05];规律性用药组则较其它两组有更多的戒毒次数[1(1,3)次,1(0,1)次,1(1,2)次,P<0.05]。强迫性用药组Barrett冲动量表总评分[(42.8±13.3)分,(34.5±13.6)分,(36.1±14.9)分]及各维度的评分[行动冲动:(37.5±15.8)分,(27.8±13.4)分,(29.2±17.8)分;认知冲动:(43.2±18.0)分,(39.4±17.0)分,(37.2±18.1)分;非计划冲动:(47.2±19.8)分,(38.8±18.7)分,(40.7±20.8)分]都要显著高于其它两组(P<0.05);而在认知评估中强迫性用药组ISL和SEC两个模块的评分均显著低于其它两组[(16.50±4.87)分,(19.30±4.78)分,(18.33±4.91)分;(0.76±0.21)分,(0.89±0.22)分,(0.81±0.21)分;P<0.05]。(2)多因素Logistic回归分析显示甲基苯丙胺累计使用时长(β=0.022,OR=1.022,95%CI:1.003~1.042)、用药剂量(β=0.625,OR=1.869,95%CI:1.196~2.921)、渴求感(β=0.194,OR=1.214,95%CI:1.002~1.215)、Barrett总分(β=0.036,OR=1.037,95%CI:1.013~1.061)、非计划冲动评分(β=0.040,OR=1.041,95%CI:1.004~1.038)、行动冲动(β=0.033,OR=1.214,95%CI:1.001~1.068)对成瘾的阶段性分组有影响。结论甲基苯丙胺成瘾行为是一个逐步发展的过程,处于不同阶段的甲基苯丙胺使用者在物质使用、冲动性高低、认知功能等方面都有不同的特点;成瘾行为的发展与物质使用的时间、剂量相关,也与使用者的人格冲动性相关,且发展到强迫性用药的患者认知功能较其它两个阶段的受损明显。要动态识别甲基苯丙胺使用者,开展有针对性的治疗干预措施,尽可能阻断成瘾的进程,以达到减少伤害的目标。

Objective To differentiate the methamphetamine users according to the developmental stages of addictive behavior,and explore the characteristics of different stages in order to provid a theoretical reference for our clinical intervention.Methods Take the male methamphetamine users in compulsory detoxification institute whom were admitted from September 2018 to December 2019 as research objects.All the objects were asked to complete clinical diagnosis,interview and questionnaire evaluation in one week.According to the developmental stages of addictive behavior,the subjects were divided into occasional use group(n=51),regular use group(n=95)and compulsive use group(n=157).All subjects were evaluated using visual analogue scale(VAS),Barrett impulsiveness scale(BIS)and CogState scale.SPSS 20.0 software was used for statistical analysis,AVOVA or Kruskal-Wallis H test was used for group comparison.Multiple Logistic regression analysis was used to explore the factors associated with the development of addictive behavior.Results(1)The compulsive use group had higher cumulative duration(24(8,48),12(4,24),22(10,36)),average dose(6.6±3.8,2.8±1.4,4.5±3.4)and craving score(1(0,5),0(0,1),1(0,3))than the other two groups(all P<0.05).And individuals in compulsive use group had more previous heroin use experience(20.4%,9.8%,14.8%,P<0.05).The regular use group had more withdrawal times than the other two groups(1(1,3),1(0,1),1(1,2),P<0.05).The total scores of Barrett impulsiveness scale(42.8±13.3,34.5±13.6,36.1±14.9)and the scores in all dimensions in the compulsive use group were significantly higher than those in the other two groups(motor impulsiveness:37.5±15.8,27.8±13.4,29.2±17.8;attentional impulsiveness:43.2±18.0,39.4±17.0,37.2±18.1;non-planning impulsiveness:47.2±19.8,38.8±18.7,40.7±20.8;P<0.05).In the compulsive use users,the ISL(16.50±4.87,19.30±4.78,18.33±4.91)and SEC(0.76±0.21,0.89±0.22,0.81±0.21)scores about cognitive assessment were significantly lower than other two groups(both P<0.05).(2)The results of multiple Logistic regression analysis showed that cumulative duration(β=0.022,OR=1.022,95%CI:1.003-1.042),dosage(β=0.625,OR=1.869,95%CI:1.196-2.921),craving(β=0.194,OR=1.214,95%CI:1.002-1.215),the total scores of Barrett impulse scale(β=0.036,OR=1.037,95%CI:1.013-1.061),scores of non-planning impulsiveness(β=0.040,OR=1.041,95%CI:1.004-1.038),scores of motor impulsiveness(β=0.033,OR=1.214,95%CI:1.001-1.068)were associated with the periodic grouping of addictions.Conclusions Addictive behavior is a progressive process and methamphetamine users at different stages have different characteristics in substance use,impulsiveness and cognitive function.The development of addictive behavior is associated with the time,dosage and craving of substance use,as well as the personality impulsivity of users.And the compulsive users suffered more cognitive impairment than the other two groups.The methamphetamine users should be identified dynamically and targeted therapeutic intervention measures should be carried out to block the addictive process to achieve the goal of harm reduction.