Substance use and psychiatric outcomes following substance use disorder treatment: An 18-month prospective cohort study in Chile.

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-01-09 DOI:10.1111/add.16731

Ignacio Bórquez, Noa Krawczyk, Ellicott C Matthay, Rafael Charris, Sofía Dupré, Mariel Mateo, Pablo Carvacho, Magdalena Cerdá, Álvaro Castillo-Carniglia, Eduardo Valenzuela

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Abstract

Background and aims: Evidence from high-income countries has linked duration and compliance with treatment for substance use disorders (SUDs) with reductions in substance use and improvements in mental health. Generalizing these findings to other regions like South America, where opioid and injection drug use is uncommon, is not straightforward. We examined if length of time in treatment and compliance with treatment reduced subsequent substance use and presence of psychiatric comorbidities.

Design: Prospective cohort analysis (3 assessments, 18 months) using inverse probability weighting to account for confounding and loss to follow-up.

Settings: Outpatient/inpatient programs in Región Metropolitana, Chile.

Participants: Individuals initiating publicly funded treatment (n = 399).

Measurements: Exposures included length of time in (0-3, 4-7, 8 + months, currently in) and compliance with treatment (not completed, completed, currently in) measured in the intermediate assessment (12 months). Primary outcomes were past-month use of primary substance (most problematic) and current psychiatric comorbidities (major depressive episode, panic, anxiety or post-traumatic stress disorders) measured 6 months later (18 months). Secondary outcomes included past month use of alcohol, cannabis, cocaine powder and cocaine paste.

Findings: 18.3% [95% confidence interval (CI) = 14.7%-22.6%] of individuals participated for 3 or fewer months in treatment and 50.1% (95% CI = 45.2%-55.1%) did not complete their treatment plan at 12 months. Participating for 8 + months in treatment was associated with lower risk of past month use of primary substance at 18 months [vs. 0-3 months, risk ratio (RR) = 0.62, 95% CI = 0.38-1.00] and completion of treatment (vs. not completed, RR = 0.49, 95% CI = 0.30-0.80). Neither participating 8 + months (vs. 0-3 months, RR = 0.83, 95% CI = 0.57-1.22) nor treatment completion (vs. not completed, RR = 1.02, 95% CI = 0.72-1.46) were associated with lower risk of psychiatric comorbidity at 18 months.

Conclusions: Longer time in treatment and compliance with treatment for substance use disorders in Chile appears to be associated with lower risk of substance use but not current comorbid psychiatric conditions 18 months after treatment initiation.

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物质使用障碍治疗后的物质使用和精神结局：智利一项为期18个月的前瞻性队列研究。

背景和目的：来自高收入国家的证据表明，药物使用障碍治疗的持续时间和依从性与减少药物使用和改善精神健康有关。将这些发现推广到其他地区，如南美，阿片类药物和注射药物的使用并不常见，并不简单。我们检查了治疗时间长度和治疗依从性是否减少了随后的药物使用和精神合并症的存在。设计：前瞻性队列分析（3次评估，18个月），使用逆概率加权来考虑混淆和随访损失。背景：智利Región Metropolitana的门诊/住院项目。参与者：开始公共资助治疗的个人（n = 399）。测量：暴露包括在中期评估（12个月）中测量的时间长度（0-3个月、4-7个月、8个月以上，目前）和治疗依从性（未完成、完成，目前）。主要结局是6个月后（18个月）测量的过去一个月主要物质的使用情况（最成问题的）和当前精神合并症（重度抑郁发作、恐慌、焦虑或创伤后应激障碍）。次要结果包括过去一个月使用酒精、大麻、可卡因粉末和可卡因糊。结果：18.3%[95%可信区间(CI) = 14.7%-22.6%]的个体参与治疗3个月或更少，50.1% （95% CI = 45.2%-55.1%）的个体在12个月时未完成治疗计划。参与治疗8个月以上与18个月时上个月使用主要药物的风险较低相关[相对于0-3个月，风险比(RR) = 0.62, 95% CI = 0.38-1.00]和治疗完成（相对于未完成，RR = 0.49, 95% CI = 0.30-0.80）。参与治疗8个月以上（相对于0-3个月，RR = 0.83, 95% CI = 0.57-1.22）和治疗完成（相对于未完成，RR = 1.02, 95% CI = 0.72-1.46）与18个月时精神合并症的风险降低无关。结论：在智利，较长的治疗时间和对药物使用障碍的依从性似乎与药物使用风险较低有关，但与治疗开始后18个月的当前共病精神状况无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.