Effect Evaluation Of Psychological Intervention In Community-based Drug Treatment

ObjectivesTo evaluate the effect of psychological intervention in community-based drug treatment by compare the compliance and effectiveness between comprehensive group (Jitai tablet+psychological intervention+social support) and pure group (Jitai tablet+social support).MethodsA 2-year controlled cohort study was conducted. According to strict inclusion and exclusion criteria,374 eligible subjects from 12 districts and 65 communities in Shanghai entered the cohort, comprehensive group (n=206) and pure group (n=168). Both groups were treated by Jitai tablets for 1 year, after the treatment they were observed for another 1 year. Comprehensive group accepted psychological intervention 12 times during the first year. Everyone in the cohort was intervened with social support during the study. Physical examinations, questionnaire surveys, laboratory tests and scale evaluations were conducted at baseline, the end of 8th,26th, 52th,64th,78th and104th week. Scales and questionnaires were filled by trained Anti-drug social workers with face to face interviews. Questionnaires mainly included demographic dates, drug compliance, drug using history and adverse events occurred. The main scales used were self-rating depression scale, self-rating anxiety scale, rating scale for protracted withdrawal symptoms, addiction severity index and SF-36. Visual analogue scale was used to evaluate pain degree and psychological craving. Laboratory tests mainly included blood biochemical, blood routine, urine routine, urine drug, electrocardiogram and pregnancy detection. Physical examinations mainly included height, weight, pulse, blood pressure, systolic and respiratory frequency. The main response variable was relapse rate, and the secondary indexes were depression, anxiety, pain degree, psychological craving, addiction severity index, protracted withdrawal symptoms and health status.Results1 Relapse rate:The relapse rate of comprehensive group at 8th,26th,52th,64th, 78th and104th week follow-up became 3.88%,6.31%,11.17%,12.62%,14.56% and 15.53%, respectively, The relapse rate of pure group became 0.60%,5.36%,10.71%, 11.90%,17.26% and 20.83%. Chi-square test indicated the difference of 8th week relapse rate between the two groups was statistically significant. Relapse rate of comprehensive group was higher than pure group. The differences of other follow-up points between the two groups were not statistically significant. After the correction, the difference of 78th and 104th week relapse rate between the two groups was statistically significant. Relapse rate of pure group was higher than comprehensive group.2 Drop out: The drop out rate of comprehensive group at 8th,26th,52th,64th,78th and104th week follow-up became 9.22%,16.50%,25.73%,29.13%,31.55%, and 32.04%. The drop out rate of pure group became 7.74%,25.60%,36.31%,42.26%, 46.43% and 48.81%. Chi-square test indicated the difference of 64th,78th and 104th week drop out rate between the two groups was statistically significant. Drop out rate of pure group was higher than comprehensive group.3 Self-rating anxiety and depression: there was statistically significant difference in self-rating depression at 8th week follow-up point. The self-rating depression score of comprehensive group was higher than pure group. The findings from MIX method indicated that time main effect and interaction effect showed statistically significant difference. There were statistically significant differences in self-rating anxiety at 78th and 104th week follow-up points. The self-rating anxiety score of pure group was higher than comprehensive group. The findings from MIX method indicated that time main effect and interaction effect showed statistically significant differences.4 Pain degree and psychological craving:From 52th to 104th week, wilcoxon test indicated the differences in 4-week and 24-hours craving between the two groups were statistically significant. The findings from MIX method indicated that time main effect and group main effect of 4-week and 24-hours craving showed statistically significant differences. There were statistically significant differences in pain degree between the two groups at 64th,78th and104th week follow-up points. MIX method indicated that time main effect and group main effect showed statistically significant differences.5 Addiction Severity Index (ASI): At baseline, there were statistically significant differences in factors of drug addiction, alcohol addiction and legal status. At 8th week follow-up point, there were statistically significant differences in factors of drug addiction, alcohol addiction, legal status, and family/social relationships. At 26th week follow-up point, there were statistically significant differences in factors of medical status, drug addiction, alcohol addiction, legal status, and family/social relationships. At 52th week follow-up point, there were statistically significant differences in factors of medical status and legal status. At 64th week follow-up point, there were statistically significant differences in factors of medical status, drug addiction, alcohol addiction, legal status and employment status. At 78th week follow-up point, there were statistically significant differences in factors of medical status, alcohol addiction, legal status and employment status. At 104th week follow-up point, there were statistically significant differences in factors of medical status, alcohol addiction, legal status and employment status.6 Protracted withdrawal symptoms:From baseline to 104th week follow-up point, there were no statistically significant differences in protracted withdrawal symptoms score between the two groups. MIX method indicated that time main effect showed statistically significant differences in all factors, interaction effect showed statistically significant differences in sleep disorder factor.7 SF-36:There were statistically significant differences in factors of mental component summary, social function and mental health at 8th week follow-up point, general health at 78th and 104th week follow-up point. The others were no statistically significant differences.8 Compliance with the intervention: 98.06% of the participants in comprehensive group, and 7.02% in pure group showed good medication compliance. Chi-square test indicated the difference of medication compliance between the two groups was not statistically significant.153 participants in comprehensive group took part in 10 group psychology sessions and above, accounting for 74.27%.Conclusions1 The two community drug treatments mode, Jitai tablets, psychological intervention and social support, Jitai tablets and social support, can decrease relapse rate effectively.2 The effect of psychological intervention in relapse prevention was been observed after the intervention period.3 The psychological intervention has a good effect on anti-anxiety and anti-depression, decreasing psychological craving and pain degree. But the effect on protracted withdrawal symptoms, addiction severity index and improving health status is not obvious.