權變管理對於接受美沙冬維持治療之鴉片類成癮個案戒菸之效應

Abstract

研究目的：本研究探討權變管理相較照常治療組在接受美沙冬維持治療之鴉片類成癮個案戒菸之效應進行探討。 研究方法：本研究招募42位受試者，隨機分配各21位至權變管理組與照常治療組，並且進行追蹤26週。主要結果為香菸使用指標：呼氣一氧化碳濃度、Fagerstrom 尼古丁依賴量表（Fagerstrom Nicotine Dependence Scale FNDS）。次要結果為自陳每週香菸使用支數，FNDS總分，酒精使用指標：呼氣酒精濃度，與其他非法物質使用狀況。 研究結果：結果顯示權變管理組的的一氧化碳呼氣濃度，初始平均為14.7ppm，到第二十六週時降低為5.0ppm; 照常治療組的的一氧化碳呼氣濃度，初始平均為12.3ppm，到第二十六週時降低為8.0ppm.以mixed model檢定，未達統計顯著(p=0.67)。呼氣酒精呼氣酒精濃度，以混合模式檢定，權變管理組呼氣酒精濃度下降之趨勢顯著優於照常治療組(p=0.047)。 研究結論：應用權變管理之戒菸治療，對於鴉片類藥物依賴且接受美沙冬維持治療可能可能有幫助，需要進一步的研究設計，並收集更多個案來證實是否有此效果。前述治療，對於酒精使用之降低，也可能有幫助。

Objective：The study aims to investigate the efficacy of contingency management on smoking cessation for methadone maintained opioid dependent patients Methods：Forty-two cases were recruited in the study and were randomly assigned to treatment-as-usual group and contingency management group. Twenty-one cases in each group. The cases received tobacco abstinence treatment for twenty-six weeks .Primary outcome measures were exhaled carbon monoxide level. Secondary outcomes were score of Fagerstrom Nicotine Dependence Scale (FNDS), self-reported daily consumption of cigarettes, exhaled alcohol concentration and use of amphetamine and opioids. Results: The exhaled carbon monoxide level decreased from 14.7ppm to 5.0ppm in the contingency management group and 12.3ppm to 8.0ppm in the treatment as usual group. No significant difference was found with linear mixed model analysis. (p=0.67) Exhaled alcohol concentration was decreased significantly more in the contingency management group than in the treatment as usual group with linear mixed model analysis. (p=0.047) Conclusions: Contingency management for tobacco abstinence treatment maybe effective for opioid dependent patients receiving methadone maintenance treatment. However, further study recruiting more cases is needed to confirm the efficacy. The treatment may also be helpful to reduce alcohol drinking among the population studied.