Thornton Charles C, Patkar Ashwin A, Murray Heather W, Mannelli Paolo, Gottheil Edward, Vergare Michael J, Weinstein Stephen P
Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvannia 19107, USA.
Am J Drug Alcohol Abuse. 2003 Aug;29(3):567-84. doi: 10.1081/ada-120023459.
We studied whether pretreatment levels of learned helplessness (LH) were related to outcomes for substance-dependent individuals receiving high-structure, behaviorally oriented (HSB) or low-structure, facilitative (LSF) treatment. The subjects were 120 substance-dependent patients randomly assigned to the HSB or the LSF treatment style for up to 12 weeks of weekly individual counseling. The two groups were compared across pretreatment characteristics as well as in-treatment, end-of- treatment, and 9-month postadmission follow-up outcome measures. Outcomes reflected reduction in problem severity, abstinence, retention, dropout rate, and ratings of treatment benefit. Significant and comparable reductions in symptoms occurred for the HSB and LSF patients both during treatment and at follow-up. Comparisons of other outcomes also did not consistently favor either treatment style. However, significant and consistent interactions were observed between LH and treatment styles with respect to several outcome measures, and these effects were independent of pretreatment levels of depression, addiction severity, and readiness for treatment. Specifically, the more "helpless" patients did significantly better in HSB treatment, whereas the less "helpless" patients had better outcomes in LSF treatment. A matching approach that assigns patients to high- and low-structure treatments based on pretreatment levels of LH might improve treatment outcomes for substance-dependent patients.
我们研究了习得性无助（LH）的预处理水平是否与接受高结构化、行为导向型（HSB）或低结构化、促进型（LSF）治疗的物质依赖个体的治疗结果相关。研究对象为120名物质依赖患者，他们被随机分配到HSB或LSF治疗方式中，接受为期12周的每周一次的个体咨询。对两组患者的预处理特征、治疗期间、治疗结束时以及入院后9个月随访的结果指标进行了比较。结果指标包括问题严重程度的降低、戒断情况、留存率、脱落率以及治疗效益评分。在治疗期间和随访时，HSB组和LSF组患者的症状均有显著且相当程度的减轻。对其他结果的比较也并未始终表明哪种治疗方式更具优势。然而，在几项结果指标方面，观察到LH与治疗方式之间存在显著且一致的交互作用，并且这些效应独立于抑郁的预处理水平、成瘾严重程度和治疗意愿。具体而言，“无助”程度较高的患者在HSB治疗中表现明显更好，而“无助”程度较低的患者在LSF治疗中效果更佳。根据LH的预处理水平将患者分配到高结构化和低结构化治疗的匹配方法，可能会改善物质依赖患者的治疗结果。
