Moos Rudolf H
Center for Health Care Evaluation, Department of Veterans Affairs and Stanford University, Palo Alto, CA, USA.
Drug Alcohol Depend. 2007 May 11;88(2-3):109-21. doi: 10.1016/j.drugalcdep.2006.10.010. Epub 2006 Nov 28.
This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients' life contexts, and how much their influence varies depending upon clients' demographic and personal characteristics.
本文描述了四种相关理论，这些理论明确了能保护个体不发展成物质使用障碍的常见社会过程，且可能是针对这些障碍的有效心理社会治疗的基础：社会控制理论、行为经济学与行为选择理论、社会学习理论以及压力与应对理论。接着，本文概述了针对物质使用障碍的四种有效心理社会治疗的基本原理和证据：动机性访谈与动机强化疗法、12步促进疗法、认知行为疗法与行为家庭咨询，以及权变管理与社区强化方法。这些治疗的假定有效成分是根据它们如何体现这四种理论所强调的社会过程来描述的。已确定的有效治疗的共同成分包括支持、目标导向和结构；强调与物质使用相竞争的奖励，关注以禁欲为导向的规范和榜样，并尝试培养自我效能感和应对技能。文中讨论了为增进我们对有效治疗中涉及的有效成分的理解而需要解决的几个问题，包括如何制定这些成分的测量方法，这些成分对结果的预测效果如何以及对客户生活背景中概念上类似方面的影响如何，以及它们的影响因客户的人口统计学和个人特征而异的程度。
