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Abstract
We examined whether differences in abstinence orientation are related to differences in treatment patterns by analyzing assessment data from a total of 161 German treatment settings offering opioid maintenance therapy. According to an index value, settings were divided into low (LAOs), medium (MAOs), and high abstinence-oriented settings (HAOs). Logistic, multinomial logistic, and linear regression analyses were carried out. HAOs prescribed lower maximum dosages of methadone and enforced rules for handling of concomitant drug use more rigidly than MAOs and LAOs. Patients in HAOs were more likely to undergo psychotherapeutic and psychiatric treatment than in MAOs and LAOs. Limitations, conclusions, and future research are suggested.
RÉSUMÉ
L'orientation vers l'abstinence et caractéristiques du traitement: Une analyse de cliniques allemands qui offrent des traitements par les agonistes opioïdes
Nous avons examiné si les différences dans l'orientation vers l'abstinence sont liées à des caractéristiques différentes du traitement, en analysant les données de N = 161 cliniques allemands qui offrent des traitements par les agonistes opioïdes. Selon des paramètres combinés, les cliniques ont été classifiées en orientation faible (LAO), moyenne (MAO) ou forte (HAO) vers l'abstinence. Régressions logistiques multiples et régressions linéaires ont été utilisées. HAOs ont prescrit des doses maximales moins élevées de méthadone et réglaient l'usage concomitant plus strictement que les LAOs et MAOs. Les patients des HAOs ont été plus probablement soumis aux traitements psychothérapeutiques et psychiatriques. Limitations, conclusions et pistes de recherches futures sont proposées.
RESUMEN
La orientación de la abstinencia y patrones de tratamiento: Un análisis de centros de Alemania ofreciendo mantenimiento con opioides
Se comprobó si las diferencias en la orientación de la abstinencia están en relación con las diferencias en los patrones de tratamiento de análisis de datos de la evaluación de un total de N = 161 centros de Alemania ofreciendo mantenimiento con opioides. Acorde con un valor índice los centros se dividieron en aquellos con orientacion baja (LAO), media (MAO) y de alta (HAO) a la abstinencia. Un análisis de regresión logística y lineal fue aplicada. Centros HAOs prescribieron menores dosis máximas de metadona e implementaron de forma más rígida normas para el manejo del uso concomitante que los centros MAO y LAO. Pacientes en centros HAO tenían mayor probabilidad de someterse a un tratamiento psicoterapéutico y psiquiátrico que en aquellos en centros MAO y LAO. Limitaciones, las conclusiones y futuras investigaciones son sugeridas.
THE AUTHORS
Sebastian Trautmann, Dipl.-Psych., studied Psychology at the Technische Universitaet Dresden, Germany. In 2006 and 2009, he completed his clinical internships at a long-term rehabilitation unit for addicted people in Vienna (Austria) and the University Hospital of Dresden (Germany). Since 2010 he is a research assistant at the Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden. Since 2010 he is also in training in a postgraduate psychotherapy program (cognitive-behavioral therapy) at the Outpatient Treatment Center, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden (IAP-TUD). His areas of interest include addiction research (opiate agonist therapy, patterns of alcohol use among German soldiers) and the diagnostic assessment of mental disorders among the elderly.
Professor Hans-Ulrich Wittchen, Ph.D., is Chairman of the Institute of Clinical Psychology and Psychotherapy and Director of the Center of Clinical Epidemiology and Longitudinal Studies (CELOS) at the Technische Universitaet Dresden, Germany. He is also Honorary Professor at the Ludwig-Maximilians-University in Munich. His research combines psychological sciences and neuroscience with epidemiological approaches in the field of disorders of the brain, with an emphasis on the developmental pathways of anxiety and depressive substance use disorders. He has been a principal investigator and coprincipal investigator of several national and international large-scale clinical epidemiological and family genetic studies on the prevalence risk factors, and course and outcomes of mental and substance use disorders. He received several awards such as the Medvantis Research Award 2005. He serves as a member of the Executive Committee and vice president of the European College of Neuropsychopharmacology (ECNP) and is a member of several Advisory and Steering Committees (e.g., European Brain Council, APA DSM-V Task Force). He is author and coauthor of several books, diagnostic instruments, and numerous research articles. He is editor, or on the editorial board of several peer-reviewed journals, including International Journal of Methods in Psychiatric Research, Psychological Medicine, Addiction, Drug and Alcohol Dependence, and Behavioral Psychotherapy.