In China, opioid use is a salient issue with over three quarters of the 1.14 million people with a drug use disorder reporting heroin as their primary substance
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In China, opioid use is a salient issue with over three quarters of the 1.14 million people with a drug use disorder reporting heroin as their primary substance
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This study enrolled 180 patients from three communities in Shanghai, China, that had recently completed two years of compulsory treatment and were thus eligible to begin three years of community rehabilitation. All patients met criteria for DSM-IV heroin dependence before starting compulsory treatment. Participants were randomized to CPI (n = 90) or usual community care (UCC, n = 90).
The main purpose of CPI was to prevent relapse and improve mental health and quality of life through CBT, MI, case management, and urine testing. CPI included individual intervention sessions for 60-minutes once per week and 90 minute small group intervention meetings held once every 2 months. UCC consisted of monthly visits by a social worker and urine tests. Participants were assessed at baseline and at the end of the intervention (one year later).
Rates of relapse, defined as meeting criteria for heroin dependence, were 25.9% and 22.7% for CPI and UCC, respectively. Patients with longer lifetime heroin use (odds ratio [OR]: 1.25), longer lifetime amphetamine use (OR: 5.6), and history of injection drug use (OR: 2.8) were more likely to relapse. For example, relapse was 1.25 times more likely for patients with longer lifetime heroin use.
Regarding mental health status at the end of the intervention, participants in both groups showed improvement over time though the CPI group had significantly lower (i.e., better) scores for somatization (i.e., psychological distress presented as physical symptoms), obsessive-compulsive, anxiety, phobia-anxiety, paranoia, and psychoticism as compared to UCC. For quality of life, the CPI group had higher (i.e., better) scores in physical role limitation and emotional role limitation as compared to UCC.
While not traditional measures of success for a substance use program, it may be important to recognize these other areas that are associated with broader recovery. Not only does quality life tend to improve over time following treatment, but quality of life satisfaction may predict continuous abstinence. When evaluating addiction programs, these measures can provide additional insight into their benefit.
While providing community rehabilitation is an important first step, the services provided must be useful and effective. In 2010, 216,000 patients with opioid use disorders were registered in compulsory treatment facilities in China while only 84,000 were registered in community rehabilitation programs which is considered the next phase in substance use treatment cascade in this setting. Currently, these 3-year programs include regular urine testing, drug-related education, and job services.
The CPI intervention did not result in improved substance use outcomes for former opioid dependent individuals in China. However, relapse rates were very low at the end of the intervention (roughly 75% in both conditions had not relapse).
This may indicate:
Other examples from the U.S. show that the mixture of positive and negative consequence for abstinence/substance use can help people maintain abstinence. In the Physician Health Program where 75 to 85% of recovering physicians remain abstinent, the threat of losing their medical license and disruption to their career may act as a deterrent to use and keep participants engaged in the long-term monitoring and treatment supports. However, it is hard to develop and implement these long-term recovery management paradigms in general clinical practices due to lack of reimbursement and funding from insurance.
Compulsory drug rehabilitation is a controversial human rights issue. Twelve United Nations agencies including the World Health Organization issued a joint statement calling for the close of these facilities in favor of voluntary, evidence-based treatment. Please see here for an argument in favor of compulsory treatment for opioid dependence and here for an argument against it.
Since there appears to be a benefit for mental health and quality of life with the psychosocial model, future research should focus on how to best integrate these techniques in the community setting.
Additionally, with extraordinary low rates of relapse in this setting (i.e., following compulsory treatment), research into the active ingredients and mechanisms through which these kinds of programs are able to achieve these very low relapse rates are needed and could inform program development in the U.S. and other countries.
Zhong, N., Yuan, Y., Chen, H., Jiang, H., Du, J., Sun, H., . . . Zhao, M. (2015). Effects of a Randomized Comprehensive Psychosocial Intervention Based on Cognitive Behavioral Therapy Theory and Motivational Interviewing Techniques for Community Rehabilitation of Patients With Opioid Use Disorders in Shanghai, China. J Addict Med. doi: 10.1097/adm.0000000000000139
l
This study enrolled 180 patients from three communities in Shanghai, China, that had recently completed two years of compulsory treatment and were thus eligible to begin three years of community rehabilitation. All patients met criteria for DSM-IV heroin dependence before starting compulsory treatment. Participants were randomized to CPI (n = 90) or usual community care (UCC, n = 90).
The main purpose of CPI was to prevent relapse and improve mental health and quality of life through CBT, MI, case management, and urine testing. CPI included individual intervention sessions for 60-minutes once per week and 90 minute small group intervention meetings held once every 2 months. UCC consisted of monthly visits by a social worker and urine tests. Participants were assessed at baseline and at the end of the intervention (one year later).
Rates of relapse, defined as meeting criteria for heroin dependence, were 25.9% and 22.7% for CPI and UCC, respectively. Patients with longer lifetime heroin use (odds ratio [OR]: 1.25), longer lifetime amphetamine use (OR: 5.6), and history of injection drug use (OR: 2.8) were more likely to relapse. For example, relapse was 1.25 times more likely for patients with longer lifetime heroin use.
Regarding mental health status at the end of the intervention, participants in both groups showed improvement over time though the CPI group had significantly lower (i.e., better) scores for somatization (i.e., psychological distress presented as physical symptoms), obsessive-compulsive, anxiety, phobia-anxiety, paranoia, and psychoticism as compared to UCC. For quality of life, the CPI group had higher (i.e., better) scores in physical role limitation and emotional role limitation as compared to UCC.
While not traditional measures of success for a substance use program, it may be important to recognize these other areas that are associated with broader recovery. Not only does quality life tend to improve over time following treatment, but quality of life satisfaction may predict continuous abstinence. When evaluating addiction programs, these measures can provide additional insight into their benefit.
While providing community rehabilitation is an important first step, the services provided must be useful and effective. In 2010, 216,000 patients with opioid use disorders were registered in compulsory treatment facilities in China while only 84,000 were registered in community rehabilitation programs which is considered the next phase in substance use treatment cascade in this setting. Currently, these 3-year programs include regular urine testing, drug-related education, and job services.
The CPI intervention did not result in improved substance use outcomes for former opioid dependent individuals in China. However, relapse rates were very low at the end of the intervention (roughly 75% in both conditions had not relapse).
This may indicate:
Other examples from the U.S. show that the mixture of positive and negative consequence for abstinence/substance use can help people maintain abstinence. In the Physician Health Program where 75 to 85% of recovering physicians remain abstinent, the threat of losing their medical license and disruption to their career may act as a deterrent to use and keep participants engaged in the long-term monitoring and treatment supports. However, it is hard to develop and implement these long-term recovery management paradigms in general clinical practices due to lack of reimbursement and funding from insurance.
Compulsory drug rehabilitation is a controversial human rights issue. Twelve United Nations agencies including the World Health Organization issued a joint statement calling for the close of these facilities in favor of voluntary, evidence-based treatment. Please see here for an argument in favor of compulsory treatment for opioid dependence and here for an argument against it.
Since there appears to be a benefit for mental health and quality of life with the psychosocial model, future research should focus on how to best integrate these techniques in the community setting.
Additionally, with extraordinary low rates of relapse in this setting (i.e., following compulsory treatment), research into the active ingredients and mechanisms through which these kinds of programs are able to achieve these very low relapse rates are needed and could inform program development in the U.S. and other countries.
Zhong, N., Yuan, Y., Chen, H., Jiang, H., Du, J., Sun, H., . . . Zhao, M. (2015). Effects of a Randomized Comprehensive Psychosocial Intervention Based on Cognitive Behavioral Therapy Theory and Motivational Interviewing Techniques for Community Rehabilitation of Patients With Opioid Use Disorders in Shanghai, China. J Addict Med. doi: 10.1097/adm.0000000000000139
l
This study enrolled 180 patients from three communities in Shanghai, China, that had recently completed two years of compulsory treatment and were thus eligible to begin three years of community rehabilitation. All patients met criteria for DSM-IV heroin dependence before starting compulsory treatment. Participants were randomized to CPI (n = 90) or usual community care (UCC, n = 90).
The main purpose of CPI was to prevent relapse and improve mental health and quality of life through CBT, MI, case management, and urine testing. CPI included individual intervention sessions for 60-minutes once per week and 90 minute small group intervention meetings held once every 2 months. UCC consisted of monthly visits by a social worker and urine tests. Participants were assessed at baseline and at the end of the intervention (one year later).
Rates of relapse, defined as meeting criteria for heroin dependence, were 25.9% and 22.7% for CPI and UCC, respectively. Patients with longer lifetime heroin use (odds ratio [OR]: 1.25), longer lifetime amphetamine use (OR: 5.6), and history of injection drug use (OR: 2.8) were more likely to relapse. For example, relapse was 1.25 times more likely for patients with longer lifetime heroin use.
Regarding mental health status at the end of the intervention, participants in both groups showed improvement over time though the CPI group had significantly lower (i.e., better) scores for somatization (i.e., psychological distress presented as physical symptoms), obsessive-compulsive, anxiety, phobia-anxiety, paranoia, and psychoticism as compared to UCC. For quality of life, the CPI group had higher (i.e., better) scores in physical role limitation and emotional role limitation as compared to UCC.
While not traditional measures of success for a substance use program, it may be important to recognize these other areas that are associated with broader recovery. Not only does quality life tend to improve over time following treatment, but quality of life satisfaction may predict continuous abstinence. When evaluating addiction programs, these measures can provide additional insight into their benefit.
While providing community rehabilitation is an important first step, the services provided must be useful and effective. In 2010, 216,000 patients with opioid use disorders were registered in compulsory treatment facilities in China while only 84,000 were registered in community rehabilitation programs which is considered the next phase in substance use treatment cascade in this setting. Currently, these 3-year programs include regular urine testing, drug-related education, and job services.
The CPI intervention did not result in improved substance use outcomes for former opioid dependent individuals in China. However, relapse rates were very low at the end of the intervention (roughly 75% in both conditions had not relapse).
This may indicate:
Other examples from the U.S. show that the mixture of positive and negative consequence for abstinence/substance use can help people maintain abstinence. In the Physician Health Program where 75 to 85% of recovering physicians remain abstinent, the threat of losing their medical license and disruption to their career may act as a deterrent to use and keep participants engaged in the long-term monitoring and treatment supports. However, it is hard to develop and implement these long-term recovery management paradigms in general clinical practices due to lack of reimbursement and funding from insurance.
Compulsory drug rehabilitation is a controversial human rights issue. Twelve United Nations agencies including the World Health Organization issued a joint statement calling for the close of these facilities in favor of voluntary, evidence-based treatment. Please see here for an argument in favor of compulsory treatment for opioid dependence and here for an argument against it.
Since there appears to be a benefit for mental health and quality of life with the psychosocial model, future research should focus on how to best integrate these techniques in the community setting.
Additionally, with extraordinary low rates of relapse in this setting (i.e., following compulsory treatment), research into the active ingredients and mechanisms through which these kinds of programs are able to achieve these very low relapse rates are needed and could inform program development in the U.S. and other countries.
Zhong, N., Yuan, Y., Chen, H., Jiang, H., Du, J., Sun, H., . . . Zhao, M. (2015). Effects of a Randomized Comprehensive Psychosocial Intervention Based on Cognitive Behavioral Therapy Theory and Motivational Interviewing Techniques for Community Rehabilitation of Patients With Opioid Use Disorders in Shanghai, China. J Addict Med. doi: 10.1097/adm.0000000000000139
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