Stout R L, Rubin A, Zwick W, Zywiak W, Bellino L
Brown University, Providence, RI, USA.
Addict Behav. 1999 Jan-Feb;24(1):17-35. doi: 10.1016/s0306-4603(98)00029-x.
There has been much research on and debate about the appropriate length of acute treatment for alcohol problems. In the United States, the lengthy and costly treatment programs of only a few years ago have been supplanted by ever-shorter and less intensive protocols, with little evidence that this trend will end soon. In this paper, we argue that, because of the chronic, recurrent nature of alcohol problems, an optimal system for delivering treatment services to alcoholics needs to focus on long-term engagement with clients. There is evidence from studies on research reactivity and telephone follow-up protocols that a low-intensity long-term protocol for maintaining contact with clients over time spans measured in years may result in better long-term clinical outcomes and reduced long-term health care utilization and costs. We describe a flexible long-term low-intensity follow-up protocol for alcohol abusers we call "case monitoring." This protocol is specifically designed to minimize long-term health-care use. We predict that such an intervention should be especially efficacious for women, persons with comorbid Axis I disorders, and persons lower in sociopathy. The design of a study to determine the clinical and health service effects of this intervention is also described.
关于酒精问题急性治疗的适当时长，已有大量研究和讨论。在美国，仅仅几年前那些冗长且昂贵的治疗项目，已被越来越短且强度越来越低的方案所取代，几乎没有证据表明这一趋势会很快结束。在本文中，我们认为，由于酒精问题具有慢性、复发性的特点，为酗酒者提供治疗服务的最佳系统需要专注于与客户的长期接触。有关于研究反应性和电话随访方案的研究证据表明，一种低强度的长期方案，即在数年时间跨度内与客户保持联系，可能会带来更好的长期临床效果，并降低长期医疗保健利用率和成本。我们描述了一种针对酗酒者的灵活的长期低强度随访方案，我们称之为“病例监测”。该方案专门设计用于尽量减少长期医疗保健的使用。我们预测，这种干预措施对女性、患有共病轴I障碍的人以及社会病态程度较低的人尤其有效。本文还描述了一项研究的设计，以确定这种干预措施的临床和卫生服务效果。
