Titre : | Is residential treatment effective for opioid use disorders? A longitudinal comparison of treatment outcomes among opioid dependent, opioid misusing, and non-opioid using emerging adults with substance use disorder (2014) |
Auteurs : | Z. SCHUMAN-OLIVIER ; M. C. GREENE ; B. G. BERGMAN ; J. F. KELLY |
Type de document : | Article : Périodique |
Dans : | Drug and Alcohol Dependence (Vol.144, November 2014) |
Article en page(s) : | 178-185 |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus géographique ETATS-UNISThésaurus mots-clés TRAITEMENT RESIDENTIEL ; JEUNE ADULTE ; ETUDE LONGITUDINALE ; OPIOIDES ; EFFICACITE ; ETUDE CLINIQUE |
Résumé : |
ENGLISH:
Background: Opioid misuse and dependence rates among emerging adults have increased substantially. While office-based opioid treatments (e.g., buprenorphine/naloxone) have shown overall efficacy, discontinuation rates among emerging adults are high. Abstinence-based residential treatment may serve as a viable alternative, but has seldom been investigated in this age group. Methods: Emerging adults attending 12-step-oriented residential treatment (N = 292; 18-24 years, 74% male, 95% White) were classified into opioid dependent (OD; 25%), opioid misuse (OM; 20%), and no opiate use (NO; 55%) groups. Paired t-tests and ANOVAs tested baseline differences and whether groups differed in their during-treatment response. Longitudinal multilevel models tested whether groups differed on substance use outcomes and treatment utilization during the year following the index treatment episode. Results: Despite a more severe clinical profile at baseline among OD, all groups experienced similar during-treatment increases on therapeutic targets (e.g., abstinence self-efficacy), while OD showed a greater decline in psychiatric symptoms. During follow-up relative to OM, both NO and OD had significantly greater Percent Days Abstinent, and significantly less cannabis use. OD attended significantly more outpatient treatment sessions than OM or NO; 29% of OD was completely abstinent at 12-month follow-up. Conclusions: Findings here suggest that residential treatment may be helpful for emerging adults with opioid dependence. This benefit may be less prominent, though, among non-dependent opioid misusers. Randomized trials are needed to compare more directly the relative benefits of outpatient agonist-based treatment to abstinence-based, residential care in this vulnerable age-group, and to examine the feasibility of an integrated model. Highlights: N = 292 (18-24-year olds) residential treatment with strong linkage to continuing care. 29% of emerging adults with opioid dependence were abstinent at 12 months follow-up. Emerging adults with opioid misuse, but not dependence, had fewest days of abstinence. Opioid misusers were more likely to use alcohol and cannabis during follow-up. Opioid misusers were less likely to engage in outpatient care during follow-up. FRANÇAIS : Une hospitalisation en centre d'addictologie (HA), à visée de sevrage, serait-elle efficace pour traiter durablement les troubles de l'usage d'opioïdes des jeunes adultes ? C'est ce que suggère une étude réalisée sur un échantillon de 292 individus âgés de 18 à 24 ans répartis en sous-groupes sur des critères de dépendance aux opioïdes (25 %), trouble du mésusage d'opioïdes (20 %) et non-usage d'opioïdes (55 %). Si ce mode de prise en charge semble profitable aux jeunes adultes dépendants et à ceux présentant des troubles du mésusage, notamment en termes de taux d'abstinence durant le traitement, les patients dépendants témoignaient quant à eux d'une réduction plus sensible des symptômes psychiatriques, plus de jours d'abstinence et une réduction des polyconsommations associées dont l'usage de cannabis et d'alcool. Enfin, chez les patients dépendants, le maintien de l'abstinence sur un an s'élevait à 29% contre 17 % pour des soins en ambulatoires (SA), d'après les données recueillies par les auteurs dans le cadre d'une autre étude tandis qu'à 6 mois, les taux d'abstinence pour les deux modes de prise en charge étaient quasi équivalents (HA : 42,5 % et SA : 38 %). [Actualités des addictions, 17/12/2014] |
Domaine : | Autres substances / Other substances ; Drogues illicites / Illicit drugs |
Affiliation : | Harvard Medical School, Department of Psychiatry, USA |
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