氯氮平、纳曲酮治疗壮、汉族海洛因依赖者心理渴求疗效分析

目的：对脱毒后的壮、汉族海洛因依赖患者进行氯氯平、纳曲酮治疗,观察其对心理渴求的治疗效果。方法：52例壮族、86例汉族自愿戒毒海洛因依赖者,脱毒后由患者自愿选择氯氮平或纳曲酮治疗3个月,使用心理渴求量表评定患者治疗前、后渴求程度变化。结果：壮、汉族海洛因依赖者治疗前后心理渴求评分值差异有显著性（P〈0．05）,壮、汉族海洛因依赖者之间心理渴求评分值治疗前后差异无显著性（P〉0．05）,壮、汉族海洛因依赖者氯氮平治疗后心理渴求评分值下降较纳曲酮明显,差异有显著性（P〈0．05）。结论：氯氯平、纳曲酮能有效治疗壮、汉族海洛因依赖者脱毒后的心理渴求,且无民族差异,氯氯平治疗效果稍优于纳曲酮。     

纳曲酮用于海洛因依赖治疗

目的 :了解纳曲酮抗复吸治疗效果。方法 :采用回顾性临床资料分析方法 ,分析 5 0例海洛因依赖者躯体脱毒后使用纳曲酮抗复吸治疗的临床资料。结果 :应用纳曲酮抗复吸治疗 6个月 ,患者对海洛因渴求程度分值从1 96±s 0 88降至 0 2 5±s 0 4 4 (P <0 0 1) ,复吸率从 2 8 6 %降至 5 0 % (P <0 0 1) ,17例原静脉注射毒品者复吸时11例改为烫吸 ,1例改为肌肉注射。结论 :纳曲酮能减轻或消除海洛因正性强化作用 ,间接淡化患者对海洛因的渴求程度 ,降低复吸率 ,无明显毒副作用 ;可使静脉注射海洛因者改变滥用方式 ,降低毒品危害     

快速脱毒加纳曲酮栓植入治疗海洛因依赖

目前公认海洛因依赖是一种慢性中毒性脑病。高复吸率是其特点。如何控制海洛因依赖患者的复吸率。提高戒毒的效果，是药物依赖治疗专业不断探讨的一个课题。盐酸纳曲酮是目前防止海洛因依赖复吸的唯一一种药物。而一般戒毒方法在自愿戒毒机构很难成功接受纳曲酮治疗，结果其戒毒复吸率高达90％-99％，而即使接受纳曲酮治疗后，因为海洛因患者的特点。服药的顺从性差．半年操守率仅达20％-30%，更谈不上长期操守，复吸率仍居高不下。     

美沙酮、丁丙诺啡、可乐定、纳曲酮“阶梯式”疗法治疗海洛因依赖脱毒后复吸患者33例

采用美沙酮、丁丙诺啡、可乐定、纳曲酮为主药的“阶梯式戒毒疗法”，治疗３３例戒毒后屡次复吸的海洛因依赖者。成功戒断８例，已操守０．５ａ以上，停服纳曲酮２个月以上；仍在服纳曲酮１６例，已分别服用１－４个月，操守率７２．７％；失败９例，其中服纳曲酮１－２个月后又复吸海洛因４例，治疗中失去联系而脱试３例，服纳曲酮１次后，戒断症状重而中止，改为自然康复２例，失败率２７．３％；配合心理疏导，有显著抗复吸作用，心理依赖降低，戒毒效果良好。     

曲唑酮联合纳曲酮对海洛因依赖者防复吸的疗效

目的评估曲唑酮联合纳曲酮治疗海洛因依赖者防复吸的临床疗效及安全性。方法将160例海洛因依赖者随机分成两组,试验组和对照组各80例。两组患者均先经过东莨菪碱复合麻醉(杨氏1+1)脱毒治疗,待尿吗啡检测转阴性后,研究组给予曲唑酮(100²00 mg·d-1,bid)联合纳曲酮(50 mg·d-1,qd)治疗,对照组单纯给予纳曲酮治疗,住院治疗2周后维持治疗12个月。采用心理渴求量表(PCS)、稽延性戒断症状量表(PWSS)和纳曲酮维持率在出院时与维持治疗1、3、6、9、12个月后进行评分分析,用副反应症状量表(TESS)评价安全性。结果共135例完成全部研究,对照组67例,研究组68例。与出院时相比,两组治疗1、3、6、9、12个月的PCS得分及PWSS得分均下降(P<0.01)。治疗1、3、6个月时研究组的PCS和PWSS均低于对照组(P<0.05),9、12个月时两组组间无显著差异(P>0.05);研究组的纳曲酮维持率高于对照组,有非常显著差异(P<0.01)。两组不良反应轻微,研究组的TESS总分小于对照组(P<0.05或P<0.01);6个月后两组比较无显著差异(P>0.05)。结论曲唑酮能明显提高纳曲酮维持治疗的依从性。曲唑酮联合纳曲酮是一种安全、有效的预防海洛因依赖者复吸的治疗方案。     

海洛因依赖者纳曲酮治疗过程中意外催瘾的研究

目的:探讨海洛因依赖者纳曲酮抗复吸治疗中意外催瘾的作用。方法:对49例应用纳曲酮抗复吸治疗的海洛因依赖者随访6个月,了解患者意外催瘾经历,以及意外催瘾对患者偷吸、脱毒后操守率及服用纳曲酮保持率的影响。结果:27例(55.1%)有意外催瘾的经历;与无意外催瘾组比较,在1-4周内,有意外催瘾组的偷吸人数少(P<0.05,P<0.01),2-25周的操守率高(P<0.05);Cox回归分析发现,稽延性戒断症状、患者孤独、沉闷情绪及家庭经济困难是纳曲酮治疗保持率的风险因素。结论:意外催瘾具有厌恶疗法样作用,对应用纳曲酮抗复吸治疗的海洛因依赖者的抗偷吸和抗复吸具有积极意义。     

盐酸纳曲酮防复吸初步研究

用盐酸纳曲酮胶囊对１８２例海洛因依赖者脱毒后防复吸治疗，经１２个月临床观察，结果显示：１年内防复吸治疗巩固率为２７．５％。多数人在坚持服药２个月后，恶劣心境、人格扭曲、烦躁不安等精神症状改善，提示盐酸纳曲酮是一种有效的防复吸药物，它给有戒毒愿望的海洛因依赖者摆脱毒品困扰带来一线曙光     

海洛因依赖者纳曲酮治疗中合并心理行为治疗的疗效分析

海洛因依赖者一个月的复吸率95%左右,纳曲酮治疗有预防复吸的作用。我院在对海洛因依赖者纳曲酮治疗中同时加强心理行为治疗,取得了较明显的疗效。1临床资料:病例为2001年7月至2003年3月,自愿戒毒治疗的68例均符合CCMD-3海洛因依赖者的诊断标准。其中男性54例,女性14例。年龄为18～42岁,平均26±2岁,平均吸毒时间4±1年。每次吸毒量为0.5～2g。采用的纳曲酮治疗量为30～50mg/日。2方法:海洛因依赖病人在纳曲酮治疗的同时根据病人的心理渴求早期加强心理行为治疗。主要采用的方法为系统脱敏、暴露疗法,并加强其认知的矫正。具体做法是针对…     

美沙酮,丁丙诺啡,可乐定,纳曲酮“阶梯式”疗法治疗海…

采用美沙酮、丁丙诺啡、可乐定、纳曲酮为主药的“阶梯式戒毒疗法”，治疗３３例戒毒后屡次复吸的海洛因依赖者。成功戒断８例，已操守０．５ａ以上，停服纳曲酮２个月以上，仍在服纳曲酮１６例，已分别服用１－４个月，操守率７２．７％，失败９例，其中服纳曲酮１￣２个月后复吸海洛因４例，治疗中失去联系而脱试３例，服纳曲酮１次后，戒断症状重而中止，改为自然康复２例，失败率２７．３％，配合心理疏导，有显著抗复吸作用，心     

海洛因瘾康复期使用纳曲酮防止复吸100例

目的：观察盐酸纳曲酮防止海洛因依赖者戒毒后复吸疗效。方法：ｍｏ１～２每日口服纳曲酮片１５～２０ｍｇ，ｍｏ３～４服１０～１５ｍｇ，ｍｏ５～６服５～１０ｍｇ，６ｍｏ为一个疗程。结果：３ｍｏ复吸率为４２％，６ｍｏ复吸率为７２％，显效率为４５％，有效率为７４％。结论：服药后可明显减轻海洛因依赖者对毒品渴求感和焦虑症状，降低复吸率。纳曲酮本身无依赖性，副作用轻微。     

中医辨证论治并心理行为干预抗复吸研究

目的：探讨中医辨证论治和心理行为干预对海洛因依赖者复吸的影响。方法：采用中医辨证论治和心理行为干预的综合疗法治疗自愿戒毒的海洛因依赖者52例，并以49例单纯美沙酮脱毒者对照观察；采用Hamilton焦虑量表（MAMA）、昆明药物依赖性康复中心制定的《阿片类药物戒断症状量表》（OWS）和中科院心理所修订的明尼苏达多相人格调查表（MMPI）评定疗效，并随访观察两组病人出院6个月复吸率。结果：综合干预组患者MAMA和OWS评分均值分别是3．62±1．69、6．94±2．48，复吸率为71．4％，对照组分别为4．33±2．61、7．83±2．26和复吸率91．7％，两者比较均存在显著性差异（P〈0．01）；综合干预组MMPI的临床量表Pd、Hs、D、Pt、Hy、Sc、Mf,Si的分数均值明显低于对照组（P〈0．0s）。结论：中药复方的多靶点药理作用和心理行为干预的综合疗法能调整戒毒者的机体整体功能，恢复健全的人格和行为模式，从而降低戒毒者的心理渴求，减少觅药行为，有效降低复吸率。     

A randomised, controlled trial of low dose naltrexone for the treatment of opioid dependence

AIM: To investigate the efficacy of low doses of naltrexone in relapse prevention for heroin dependence. DESIGN: Double blind, randomised comparison of three groups-Group 1 taking 50mg per day, Group 2: 0.5mg per day, and Group 3: 0.05 mg per day. PARTICIPANTS: Sixty-six dependent heroin users. INTERVENTIONS: After detoxification followed by 1 week on 50mg per day naltrexone, participants were randomised to trial medication. All were offered counselling and monitored with weekly clinical reviews. Research interviews were conducted at three and 6 months. OUTCOME MEASURES: Retention in treatment and heroin use at 3 and 6 months. Secondary outcome measures were side effects and craving. FINDINGS: Mean days retained in randomised treatment were-Group 1: 58.9 days; Group 2: 46.6 days; and Group 3: 47.8 days. Differences in retention were not significant using survival analysis. However, nine of the first 60 participants, transferred to the 50 mg dose, and one transferred to a lower dose (chi-square = 0.142; P = 0.018). At follow-up, there was no relationship between abstinence from heroin and naltrexone dose, nor between level of heroin use and dose. There were no differences between groups in craving or depression. CONCLUSION: Low doses of naltrexone had no discernible advantage, and participants preferred 50mg per day. Despite preference for blocking doses of naltrexone, outcomes appeared to be independent of naltrexone dose.     

美沙酮维持治疗中海洛因依赖者心理渴求的研究

目的：探讨海洛因依赖者在美沙酮维持治疗过程中对海洛因心理渴求的程度和发展规律。方法：应用视觉类比量表（VAS）制定心理渴求程度量表对海洛因依赖者在美沙酮维持治疗过程中不同阶段、不同剂量、依从性高低三类情况下对海洛因的心理渴求程度进行调查和比较,应用SPSS13．0进行统计分析结果。结果：美沙酮维持治疗过程中海洛因依赖者VAS评分入组前和入组后有显著性统计学意义差异（P〈0．01）;入组后15天、3个月、6个月、12个月之间差异没有明显统计学意义（P〉0．05）;高依从性组和低依从性组有明显统计学意义差异（P〈0．01）;高、中、低剂量组之间差异没有明显统计学意义（P〉0．05）。结论：海洛因依赖者心理渴求程度在随着美沙酮维持治疗时间的延长而呈下降趋势,其中在治疗初期下降最明显;服药依从性高者心理渴求程度明显低于服药依从性低者;在美沙酮维持治疗过程中美沙酮剂量的高低对海洛因依赖者心理渴求程度影响不明显。     

稽延性戒断症状对纳曲酮服药依从性的影响

目的：探讨稽延性症状对纳曲酮依从性的影响和二者的相关性。方法：采用回顾性流行病学调查的方法，在广东、北京、浙江等地搜集到531例服用纳曲酮的海洛因依赖者，调查有关人口学和社会学信息、药物滥用史、纳曲酮使用和稽延性戒断症状的情况。分析纳曲酮短期组（服用时间≤4周）、中期组（服用时间〉4周且〈24周）和长期组（服用时间≥24周）脱毒后的稽延性戒断症状评分和服用纳曲酮时间的关系。结果：纳曲酮短期组、中期组和长期组患者脱毒后的稽延性戒断症状评分总分和睡眠障碍、焦虑情绪和躯体症状三类中的7个分项得分经F检验，P〈0.05。经进一步的组间两两t检验，在中期组和短期组之间，总分和易醒、早醒、全身无力、手脚不舒服4个分项得分P〈0．05。在长期组和短期组之间，总分和易醒、入睡困难、全身无力、烦躁不安4个分项得分P〈0.05。在长期组和中期组之间，总分和各分项得分P〉0．05。稽延性戒断症状与纳曲酮的依从性呈负相关，在短期-中期-长期组相关性检验中，稽延性戒断症状的总分和4个分项得分（入睡困难、易醒、烦躁不安和全身无力）P〈0．05。在短期-中期组相关性检验中，稽延性戒断症状的总分和6个分项得分（入睡困难、易醒、早醒、全身无力、全身难受和四肢不适）P〈0．05。结论：稽延性戒断症状是影响纳曲酮早期服药依从性的重要因素，对长期依从性没有影响。如果在服用纳曲酮早期，稽延性戒断症状得到较好控制，纳曲酮的依从性和防复吸的疗效会提高。     

家庭帮教对海洛因依赖者康复的影响

目的：探讨家庭帮教对海洛因依赖者康复的影响。方法：选择100例自愿戒毒的海洛因依赖者作为研究对象,按照随机数字表法分为观察组和对照组。每组50例,采用症状自评量表（SCL—90）评定两组不同时期（出院时、出院6个月后）的心理健康状况。两组均进行系统的美沙酮替代治疗,并配合常规的健康教育,研究组出院后实施家庭帮教等各种心理干预措施。结果：研究组患者出院6个月后复吸率为65．79％,对照组患者复吸率为93.33％,两者比较存在显著差异（P〈0．01）;出院6个月后研究组SCL—90各因子评分均值明显低于对照组（P〈0．05）。结论：对海洛因依赖者实施家庭帮教等心理干预措施,可明显改善其心理状态,降低复吸率。     

A randomized control trial of group counseling in a naltrexone treatment program

This study evaluated the additional effectiveness of a 12-week manualized group counseling program over a structured naltrexone treatment program. The randomized controlled trial, the first of its kind in Australia, was conducted at Turning Point Alcohol and Drug Centre, Melbourne, Australia.

Ninety-seven participants received a 50 mg dose of naltrexone daily and were randomized to either the experimental (n = 52) or control (n = 45) conditions. The experimental group received a structured group counseling program, which used a cognitive-behavioral relapse prevention approach.

Using intention-to-treat analyses, there was only one statistically significant difference between the groups, with the control group reporting a significantly higher level of physical functioning at Week 6. All participants improved significantly in their level of heroin use and in psychosocial functioning between Baseline and Weeks 6, 12, and 24. It is not possible to conclude from these results whether or not group counseling provides additional benefit to naltrexone treatment.     

盐酸纳曲酮对阿片类成瘾脱毒后防止复发效能的再评价──1088例纳曲酮维持治疗临床研究

目的··:就盐酸纳曲酮防止阿片类成瘾脱毒后复发的效能进行再评价。方法··:1088例完成脱毒治疗的海洛因依赖者给予纳曲酮治疗。药物剂量相对固定在40-50mg·d-1,并随患者反应调整。治疗期间定期门诊或出诊随访。结·果·:服用纳曲酮6个月的保持率为33.4%,与自身同期操守率(2.4%)比较具有显著性差异。服用纳曲酮后,再吸海洛因的欣快感、渴求程度及偶吸海洛因的发生率均降低。纳曲酮的不良反应轻,包括:睡眠障碍、消化系统症状和乏力,少数患者转氨酶呈一过性增高。在纳曲酮治疗的同时给予积极的家庭支持和社会帮教,提供生活和就业技能的指导,减少偶吸的机会等措施,有助于提高服药保持时间。结论··:进一步证实了纳曲酮对预防我国阿片类依赖者脱毒后复吸具有肯定的辅助治疗作用。     

Effects of lofexidine on stress-induced and cue-induced opioid craving and opioid abstinence rates: preliminary findings

Objective A preliminary study examined whether lofexidine decreases stress-induced and cue-induced opioid craving and improves opioid abstinence in naltrexone-treated opioid-dependent individuals. Materials and methods Eighteen opioid-dependent patients were stabilized for 4 weeks with naltrexone (50 mg daily) and lofexidine (2.4 mg bid) before entering a 4-week randomized, double-blind placebo-controlled discontinuation study where one group continued on lofexidine for an additional 4 weeks, while the second was tapered to placebo (Lofexidine–naltrexone vs Placebo–naltrexone). Ten patients also participated in guided imagery exposure to stress, drug cue, and neutral scenarios in a single laboratory session. Results Lofexidine–naltrexone patients had higher opioid abstinence rates and improved relapse outcomes as compared to the Placebo–naltrexone group. Furthermore, Lofexidine–naltrexone patients had significantly lower heart rates and an attenuated stress and drug cue-induced opioid craving response in the laboratory as compared to the Placebo–naltrexone group. Conclusions Although preliminary, these findings are the first to document lofexidine’s potential in addressing stress-related opioid craving and relapse outcomes in humans. The results also suggest that combination therapies that target both drug-related reinforcement (naltrexone) and stress- and cue-related aspects of drug seeking could be beneficial in addiction relapse prevention. Further development of lofexidine to address stress-related opioid craving and relapse is warranted.     

Naltrexone and buprenorphine combination in the treatment of opioid dependence

Naltrexone treatment has demonstrated some advantages for special populations of heroin addicted individuals, but patients' compliance seems to be very poor, with a low adherence and low retention rate. Kappa-opioid system overdrive seems to contribute to opioid protracted abstinence syndrome, with dysphoria and psychosomatic symptoms during naltrexone treatment. The objective of this observational study was to determine the effectiveness of a functional k antagonist in improving naltrexone treatment outcome. A partial mu agonist/kappa antagonist (buprenorphine) and a mu antagonist (naltrexone) were combined during a 12 weeks protocol, theoretically leaving k antagonism as the major medication effect. Sixty patients were submitted to outpatient rapid detoxification utilizing buprenorphine and opioid antagonists. Starting on the fifth day, 30 patients (group A) received naltrexone alone. Alternatively, 30 patients (group B) received naltrexone (50mg oral dose) plus buprenorphine (4 mg sublingual) for the 12 weeks of the observational study. The endpoints of the study were: retention in treatment, negative urinalyses, changes in psychological symptoms (Symptom Checklist-90 Revised: SCL-90) and craving scores (visual analysis scale (VAS)). Thirty-four subjects (56.67%) completed the 12 weeks study. Twenty-one patients (35.0%) had all urine samples negative for opiates and cocaine. nine subjects (15.0%) had urine samples negative for cocaine and opiates for the last 4 weeks of the study. five subjects (8.3%) continued to use cocaine during the 12 weeks of the study. No significant change in pupillary diameter after buprenorphine administration was evidenced during clinical observations from baseline across the weekly measurements. Retention rates in group A (naltrexone) and group B (naltrexone + buprenorphine) at week 12 were respectively 40% (12 patients) and 73.33% (22 patients), with a significant difference in favour of group B (p= 0.018). Patients treated with naltrexone in combination with buprenorphine (B patients) showed a significantly lower rate of positive urines for morphine (4.45%) and cocaine metabolites (9.09%) than those treated with naltrexone alone (A) (25%, morphine; 33.33% cocaine) (p< 0.05; p< 0.05). Irritability, depression, tiredness, psychosomatic symptoms and craving scores decreased significantly less in Group A patients than in group B patients. The dysfunction of opioid system with kappa receptors hyper-activation provoked by heroin exposure, probably underlying dysphoric and psychosomatic symptoms during naltrexone treatment, seems to be counteracted, at least in part, by buprenorphine. The combination of buprenorphine and naltrexone may significantly improve the outcome of opioid antagonists treatment in terms of retention, negative urinalyses, and reduced dysphoria, mood symptoms and craving.