Predictors of abstinence maintenance after cocaine inpatient detoxification: A prospective study

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE American Journal on Addictions Pub Date : 2024-05-18 DOI:10.1111/ajad.13571

Margaux Poireau PhD, Virgile Clergue-Duval PhD, Angéline Maillard PhD, Romain Icick PhD, Julien Azuar MD, Pauline Smith PhD, Mathieu Faurent MD, Emmanuelle Volle PhD, Christine Delmaire PhD, Julien Cabé PhD, Vanessa Bloch PhD, Florence Vorspan PhD

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Abstract

Background and Objectives

Cocaine is a highly addictive substance, and with no approved medication for cocaine use disorder (CUD), leading to a heavy burden. Despite validated psychosocial treatments, relapse rates after detoxification are very high in CUD. Few consistent factors can predict abstinence after detoxification. Our study, therefore, aimed at identifying factors predicting abstinence among CUD patients after inpatient detoxification.

Methods

Eighty-one CUD inpatients were included during detoxification and characterized for clinical and sociodemographic data at baseline and at a follow-up of 3 months after discharge, including a standard measure of their abstinence duration from cocaine. We performed Cox univariate analyzes to determine the factors associated with abstinence maintenance, followed by a multivariate Cox regression to identify independent predictors.

Results

Abstinence maintenance was shorter in patients injecting cocaine (hazard ratio [HR] = 5.16, 95% confidence interval [CI]: 2.01–13.27, p < .001) and using cocaine heavily in the month before inclusion (HR = 1.03, 95% CI: 1.00–1.06, p = .046). Conversely, abstinence maintenance was longer in patients with longer inpatient detoxification stays (HR = 0.96, 95% CI: 0.94–0.99, p = .015) and prescribed with selective serotonin reuptake inhibitors (SSRIs) (HR = 0.30, 95% CI: 0.16–0.56, p < .001).

Discussion and Conclusions

Patients with severe CUD may require longer inpatient stays to achieve abstinence. Regarding SSRI prescription, more specific studies are needed to provide stronger recommendations about their use in clinical practice.

Scientific Significance

Our findings suggest several modifiable factors to improve inpatient treatment response in CUD. As there are no specific recommendations about the optimal duration of inpatient stay, our results could pave the way for evidence-based guidelines.

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可卡因住院戒毒后保持戒断的预测因素：前瞻性研究。

背景和目标：可卡因是一种极易上瘾的物质，目前尚无治疗可卡因使用障碍（CUD）的有效药物，这给患者带来了沉重的负担。尽管采取了有效的社会心理治疗，但 CUD 戒毒后的复发率非常高。很少有一致的因素可以预测戒毒后的戒断情况。因此，我们的研究旨在确定预测 CUD 患者在住院戒毒后戒断的因素：方法：我们纳入了戒毒期间的 81 名 CUD 住院患者，并对他们在基线和出院后 3 个月随访期间的临床和社会人口学数据进行了分析，包括对他们戒断可卡因时间的标准测量。我们进行了 Cox 单变量分析，以确定与维持戒断相关的因素，然后进行了多变量 Cox 回归，以确定独立的预测因素：结果：注射可卡因的患者维持戒断的时间较短（危险比 [HR] = 5.16，95% 置信区间 [CI]：2.01-13.27，P 讨论和结论：严重的 CUD 患者可能需要更长的住院时间才能实现戒毒。关于SSRI的处方，需要进行更具体的研究，以便为临床实践中使用SSRI提供更有力的建议：我们的研究结果表明，有几种可调整的因素可改善 CUD 患者的住院治疗反应。由于目前还没有关于最佳住院时间的具体建议，我们的研究结果可以为制定循证指南铺平道路。

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来源期刊

American Journal on Addictions SUBSTANCE ABUSE-

CiteScore

5.00

自引率

0.00%

发文量

118

期刊介绍： The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.