美沙冬維持療法患者之酒精使用問題

Abstract

目的：探究美沙冬維持療法患者酒精使用問題的盛行率及預測因子，並探討美沙冬維持療法患者退出治療的預測因子；酒精使用問題分為「過量及有害飲酒」與「酒精濫用及酒精依賴」兩個層次說明。 方法： 本研究為前瞻性追蹤研究，研究對象為行政院衛生署桃園療養院、行政院衛生署豐原醫院兩家醫院中438位持續美沙冬維持療法六個月以上的患者，在初診時收集每位患者的人口學及臨床特徵，在治療期間收集治療相關變項，「過量及有害飲酒」與「酒精濫用及酒精依賴」之測量採用中文版酒精使用問題診斷量表及呼氣酒精濃度。 結果：美沙冬維持療法患者之過量飲酒及有害飲酒盛行率為31.4%，酒精濫用及酒精依賴盛行率為12.0%。美沙冬維持療法患者之過量飲酒及有害飲酒的保護因子有服藥出席率大於等於90%（OR=0.54，95%CI=0.30-0.97）、年齡大於35歲（OR=0.48，95%CI=0.27-0.86），原本有酒精使用（OR=5.30，95%CI=2.87-9.76）為危險因子。美沙冬維持療法患者退出治療的預測因子為美沙冬劑量小於60毫克(Wald test p-value<0.001)、未接受公費補助(Wald test p-value<0.001)。 結論：美沙冬維持療法患者的「過量及有害飲酒」高盛行率強調了酒精使用問題篩檢及介入是有需要的；越年輕、 遵醫囑性差、原本有酒精使用的美沙冬維持療法患者須接受「過量及有害飲酒」的篩檢。

OBJECTIVE: To examine the prevalence rate and predictors of alcohol use problem, as well as predictors of dropout among patients undergoing methadone maintenance treatment (MMT). Alcohol use problem is defined as two levels separately, level one is excessive and hazardous drinking, level two is alcohol abuse and dependence. METHODS: This is a prospective follow-up study. Study population includes 438 patients retaining more than 6 months in MMT from the Fong-Yuan Hospital and Tau-Yuan Psychiatric Center. Demographic and clinical characteristics were collected for each patient at the beginning, and treatment-related variables were collected during treatment process. Excessive drinking and hazardous drinking, alcohol abuse and dependence were measured by Chinese Version Alcohol Use Disorders Identification Test (Chinese Version AUDIT) and breath alcohol concentration. RESULT: The prevalence rate of excessive drinking and hazardous drinking among MMT patients is 31.4%, and the prevalence rate of alcohol abuse and dependence is 12.0%. The predictors of excessive and hazardous drinking among MMT patients include attendance rate more than 90%（OR=0.54，95%CI=0.30-0.97）, age older than 35 years old（OR=0.48，95%CI=0.27-0.86）,and alcohol use at intake（OR=5.30，95%CI=2.87-9.76） is a risk factor. The predictors of dropout among MMT patients include methadone dose less than 60 mg (Wald test p-value<0.001), without governmental fund (Wald test p-value<0.001). CONCLUSION：The high prevalence rate of excessive and hazardous drinking among MMT patients underscores the needful screening and intervention for alcohol use problem .Those patients who are younger and have poor adherence, alcohol use at intake should be screened for excessive and hazardous drinking.