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Abstract：
BACKGROUND: Retention in substance use treatment is essential to treatment success. While programmatic factors are known to influence retention, less is known about the role of involuntary discharges from drug or alcohol treatment programs. Therefore, we sought to identify the prevalence of and factors associated with involuntary discharge due to ongoing substance use.
METHODS: Data were derived from two community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada. Generalized estimating equation (GEE) analyses were used to identify variables associated with involuntary discharge from treatment programs due to ongoing substance use.
RESULTS: Between June 2017 and March 2020, 1487 participants who accessed substance use treatment and completed at least one study interview were included in this study. Involuntary discharge from a treatment program due to ongoing substance use was reported by 41 (2.8%) participants throughout the study, with 23 instances reported at baseline and another 18 reported during study follow-up. In a multivariable GEE analysis, involuntary discharge was positively associated with homelessness (Adjusted Odds Ratio [AOR] = 3.22, 95% Confidence Interval [95% CI]: 1.59-6.52), daily injection drug use (AOR = 1.87, 95% CI 1.06-3.32) and recent overdose (AOR = 2.50, 95% CI 1.38-4.53), and negatively associated with age (AOR = 0.93, 95% CI 0.90-0.96). In sub-analyses, participants have most commonly been discharged from in-patient treatment centres (52.2%), recovery houses (28.3%) and detox programs (10.9%), and for using heroin (45.5%) and/or crystal methamphetamine (36.4%).
CONCLUSIONS: While involuntary discharge was a relatively rare occurrence, those who were discharged due to active substance use possessed several markers of risk, including high-intensity injection drug use, homelessness, and recent non-fatal overdose. Our findings highlight the need for increased flexibility within treatment programs to account for those who re-initiate or continue to use substances during treatment.
METHODS: Data were derived from two community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada. Generalized estimating equation (GEE) analyses were used to identify variables associated with involuntary discharge from treatment programs due to ongoing substance use.
RESULTS: Between June 2017 and March 2020, 1487 participants who accessed substance use treatment and completed at least one study interview were included in this study. Involuntary discharge from a treatment program due to ongoing substance use was reported by 41 (2.8%) participants throughout the study, with 23 instances reported at baseline and another 18 reported during study follow-up. In a multivariable GEE analysis, involuntary discharge was positively associated with homelessness (Adjusted Odds Ratio [AOR] = 3.22, 95% Confidence Interval [95% CI]: 1.59-6.52), daily injection drug use (AOR = 1.87, 95% CI 1.06-3.32) and recent overdose (AOR = 2.50, 95% CI 1.38-4.53), and negatively associated with age (AOR = 0.93, 95% CI 0.90-0.96). In sub-analyses, participants have most commonly been discharged from in-patient treatment centres (52.2%), recovery houses (28.3%) and detox programs (10.9%), and for using heroin (45.5%) and/or crystal methamphetamine (36.4%).
CONCLUSIONS: While involuntary discharge was a relatively rare occurrence, those who were discharged due to active substance use possessed several markers of risk, including high-intensity injection drug use, homelessness, and recent non-fatal overdose. Our findings highlight the need for increased flexibility within treatment programs to account for those who re-initiate or continue to use substances during treatment.
摘要：
背景：药物使用治疗中的保留对治疗成功至关重要。虽然已知方案因素会影响保留，对药物或酒精治疗计划中的非自愿排放的作用知之甚少。因此,我们试图确定由于持续药物使用导致的非自愿出院的患病率和相关因素.
方法：数据来自两项社区招募的前瞻性队列研究，这些研究涉及温哥华吸毒人群，加拿大。使用广义估计方程（GEE）分析来确定与由于持续使用药物而导致的治疗计划的非自愿出院相关的变量。
结果：在2017年6月至2020年3月期间，本研究纳入了1487名接受物质使用治疗并完成至少一次研究访谈的参与者。在整个研究过程中，有41名（2.8％）参与者报告了由于持续使用药物而导致的治疗计划的非自愿出院。在基线时报告了23例，在研究随访期间报告了另外18例。在多变量GEE分析中，非自愿出院与无家可归呈正相关（调整后的赔率比[AOR]=3.22，95%置信区间[95%CI]：1.59-6.52），每日注射药物使用（AOR=1.87，95％CI1.06-3.32）和近期用药过量（AOR=2.50，95％CI1.38-4.53），与年龄呈负相关(AOR=0.93，95%CI0.90-0.96)。在子分析中，参与者最常从住院治疗中心出院(52.2%)，复苏屋(28.3%)和排毒计划(10.9%)，以及使用海洛因(45.5%)和/或结晶甲基苯丙胺(36.4%)。
结论：虽然非自愿出院相对罕见，那些因使用活性物质而出院的人拥有几个风险标记，包括高强度注射药物的使用，无家可归,以及最近的非致命性用药过量.我们的发现强调了在治疗计划中需要增加灵活性，以解决那些在治疗期间重新开始或继续使用物质的人。
方法：数据来自两项社区招募的前瞻性队列研究，这些研究涉及温哥华吸毒人群，加拿大。使用广义估计方程（GEE）分析来确定与由于持续使用药物而导致的治疗计划的非自愿出院相关的变量。
结果：在2017年6月至2020年3月期间，本研究纳入了1487名接受物质使用治疗并完成至少一次研究访谈的参与者。在整个研究过程中，有41名（2.8％）参与者报告了由于持续使用药物而导致的治疗计划的非自愿出院。在基线时报告了23例，在研究随访期间报告了另外18例。在多变量GEE分析中，非自愿出院与无家可归呈正相关（调整后的赔率比[AOR]=3.22，95%置信区间[95%CI]：1.59-6.52），每日注射药物使用（AOR=1.87，95％CI1.06-3.32）和近期用药过量（AOR=2.50，95％CI1.38-4.53），与年龄呈负相关(AOR=0.93，95%CI0.90-0.96)。在子分析中，参与者最常从住院治疗中心出院(52.2%)，复苏屋(28.3%)和排毒计划(10.9%)，以及使用海洛因(45.5%)和/或结晶甲基苯丙胺(36.4%)。
结论：虽然非自愿出院相对罕见，那些因使用活性物质而出院的人拥有几个风险标记，包括高强度注射药物的使用，无家可归,以及最近的非致命性用药过量.我们的发现强调了在治疗计划中需要增加灵活性，以解决那些在治疗期间重新开始或继续使用物质的人。
