| Relapse prevention issue after detoxification in patients with drugdependenthas been the focus and difficult point in addiction treatmentmedicine. The regulary methods that include drug and compulsoryabandonment could not solve the problem of relapse. It provides a new way totreat drug addiction by ablating the nucleus accumbens with stereotacticsurgery (surgical operation for drug dependence),which was invented by thedepartment of Neurosurgery, Tangdu Hospital, the Fourth Military MedicalUniversity in 2000. Since 2002, Tangdu Hosptial reported the results about thesurgery, a number of units in China began to perform the surgery. And itcaused wide public concern from the world. Although different hospitals gotassessments of the short-term (1-2 year) efficacy and safety for this new typeof surgery, currently it is considered that the short-term efficacy of surgery is acceptable and the surgery would have little bad effect on the physical andmental health of patients in the short term. The long-term efficacy and safetyof ablating the nucleus accumbens to treat opioid drug dependence bystereotactic surgery are worthy of further observation and investigation. Thestudy is to investigate 272 patients with drug dependence who underwent thesurgery before 2004 in Tangdu Hospital, and it will investigate the long-term(more than 5 years) efficacy and safety of the surgery by the way of samplingsurvey. This study will supply a strong theoretical basis for the proper clinicalapplication of the surgery in the future. Meanwhile, the relapse reasons of thepatients after surgery will be analyzed in order to improve the non-relapse rate.It will provide a guide for the specific support measures for relapse preventionafter surgery.[Aims[Aims]The aims are to evaluate the long-term (more than 5 years) efficacy andsafety of the surgery to treat drug dependence and analyze the main relapsereason of patients after surgery.[Methods]1. To sample 100 patients (36.8%) at random from the 272 patients whounderwent the surgery from July 2000 to November 2004. To communicatewith the patients face to face by follow-up visit from August to October 2009.To investigate the non-relapse rate (more than 5 years) after surgery accordingto the complains of patients, morphine urine test and Naloxone introducingaddiction test.2. To investigate the information about the patients'general demographic,drug addiction preoperative and side effects after surgery. To evaluate the physical health of patients by normal physical examination and nervoussystem examination.3. To assess the degree of drug craving, protracted abstinence symptomof opium-addicts and olfactory function by relative tests.4. To evaluate the personality, mental health and quality of life inpatients by EPQ, SCL-90, WHOQOL-BREF and SF-36.5. Meanwhile, to investigate the relative information from patients incompulsory detoxification center in Xi'an, and the patients were set as onecontrol group; the surgical group was divied into non-relapse group andrelapse group.6. To investigate the relapse reasons of patients after surgery and tocalculate the cumulative abstinent probability more than 5 years after surgery.[Results[Results]1. There were 52 non-relapse patients, 35 relapse patients and 13patients who refuse the follow-up or lost according to the results of morphineurine test and Naloxone introducing addiction test during the follow-up visit inthe sample of 100 patients. The non-relapse rate could reach 52% more then 5years, and the relapse rate only reaches 48% (include the people who werelost).2. Among 87 patients, there were 84 males and 3 males with the averageage of 36.96 years. 78 patients (89.7%) whose diplomas were lower than highschool. 61 patients (70.1%) had normal jobs. 59 patients (67.8%) were married.All the patients were addicted to opiate drug with the average time of 9.13years of drug abuse. The longest one is 17.79 years. The average dose of drugtaking was 0.49g each time, 3.28 times each day. They abused the drug for1.72g each day. 3. There were no significant differences in age, sex ratio and drug abusehistory among the surgical group, non-relapse group, relapse group and nonsurgicalgroup (p>0.05). The non-surgical group could be suitable as a controlgroup.4. The results of assessment of drug craving showed that degree of drugcarving in surgical group, non-relapse group and relapse group significantlydecreased postoperatively and currently compared with preoperatively(p<0.05). But the degree in relapse group was still higher than non-relapsegroup (p<0.05).5. The results of protracted abstinence symptom of opium-addicts testshowed that the serious degree of abstinence symptom was lower in nonrelapsegroup and surgical group than that in non-surgical group (p<0.05), butthe degree of abstinence symptom was lower in non-surgical group than nonrelapsegroup (p<0.05).6. The olfactory function of surgical group decreased significantly insurgical group and relapse group postoperatively compared with preoperatively(p<0.05).7. The complains of patients about the adverse effects after surgery showedthat 29 patients (33.3%) had at least one non-specificity adverse effect in thefollowing: fever (21 person-time),infection (2 person-time), nausea and emesia(11 person-time). But all the adverse effects were transient, all patients recoveredduring 1 month postoperatively. But in the aspect of specific side effects, 15patients (17.2%) had at least one specificity adverse effect in the following: poorconcentration (4 person-time), poor short-term memory (7 person-time),aconuresis (3 person-time), declined interest in surrounding things (11 persontime),changes in sexual desire (2 person-time), but the patients gradually recovered postoperatively. Up till to the end of follow-up, 2 patients (2.3%) stillhad changes in sexual changes, 9 patients (10.3%) had poor short-term memory (4person-time) and declined interest in surrounding things (6 person-time) in variousdegrees. And the adverse effects did not seriously influence the life and work ofthe patients. All patients had accepted general medical examination andcomprehensive nervous system checkup. They had no markedly abnormalsymptoms in the aspect of mind, communication, sensory function and motorfunction after surgery in more than 5 years.8. The assessment in the test of EPQ showed that surgical group hadhigher scores in Neuroticism and Psychoticism scales but had lower scores inLie scale than normal control (p<0.05), had lower scores in Neuroticism scalethan non-surgical group (p<0.05); the non-relapse group only had higherscores in Psychoticism scale and had lower scores in Lie scale than normalcontrol (p<0.05), and had lower scores in Neuroticism scale than relapse group(p<0.05); the relapse group had higher scores in Neuroticism and Psychoticismscales and had less scores in Lie scale than normal control (p<0.05), and therewas no significant differences in scores of all the scales between relapse groupand non-surgical group (p>0.05).9. The results of the test in SCL-90 showed that the non-surgical grouphad higher scores in other 8 scales except the scale of Interpersonal Sensitivitythan normal control (p<0.05), but had lower scores in the scales ofSomatization, Anxiety, Photic Anxiety and Psychoticism than the non-surgicalgroup (p<0.05); there was no siginificant differences between the non-relapsegroup and normal control in all scales (p>0.05); the non-relapse group hadlower scores in other 8 scales except Hostility than the non-surgical group(p<0.05), and had lower scores only in the scale of Somatization than relapse group (p<0.05); the relapse group had higher scores in other 8 scales exceptthe scale of Interpersonal Sensitivity than normal control (p<0.05), and hadlower scores in the scale of Photic Anxiety than the non-surgical group(p<0.05).10. The results of the test in WHOQOL-BREF showed that the nonsurgicalgroup had lower scores in Physical, Psychological, Social Relationshipdomains than normal control (p<0.05), but had higher scores in Physical,Social Relationship, Environment domains than non-surgical group (p<0.05);the non-relapse group had higher scores in Environment domain than normalcontrol (p<0.05), and had higher scores in all domains than non-surgical andrelapse group (p<0.05); the relapse group had lower scores in Physical,Psychological, Social Relationship domains than normal control (p<0.05), buthad higher scores in Environment domain than non-surgical group (p<0.05).11. The results of the test in SF-36 showed that the surgical group hadlower scores in Role physical, Bodily pain, Socail Functioning, Mental healthscales than normal control (p<0.05); and had higher scores in Physicalfunctioning, Bodily pain, Social functioning scales than non-surgical group(p<0.05); the relapse group only had lower scores in Role emotional scale andhad higher scores in Vitality scale than normal control (p<0.05), had higherscores in 7 scales except Role emotional than non-surgical group (p<0.05), hadhigher scores in Bodily pain, General health, Vitality, Social functioning, Roleemotional scales than relapse group (p<0.05); the relapse group had lowerscales in Role-physical, Bodily pain, General health, Social functioning, Roleemotional scales than normal control (p<0.05), and there was no significantdifferences between relapse and non-surgical group (p>0.05).12. The majority of relapse patients relapsed in the first 1-3 years after surgery. The main relapse reason is due to the social factor including thenegative life events, lack of family care; the second reason is due topsychological factor including the bait from the drug dealer and environment;the last reason is due to physical factor including abstinent symptom.[Conclusion[Conclusion]1. The non-relapse rate could reach 52% during the follow-up visit bythe way of sampling survey more than 5 years after surgery. It is higher thanany other means for detoxification at present. And the degree in craving fordrug and abstinent symptom significantly decreased after surgery. So, the longtermefficacy of surgery for detoxification would be good.2. The patients had several kinds of adverse effects, but the incidencerate is relatively low (17.2%). The patients gradually recovered in more than 5years after surgery and the adverse effects would not severely influenceindividual life and work. The surgical group is better than non-surgical groupin the test of personality, mental health, the quality of life. The non-relapsegroup had a good comprehensive health, and they are close to the normalcontrol. Relapse group is bad in health status because of the effect of drug.They are close to the non-surgical group. It would not have bad effect on themental and physical health of the patients who underwent the operation byablating the nucleus accumbens.3. The relapse reason is due to lack of social, family care and bait fromthe environment of drug abuser. |
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