Humphreys Keith, Moos Rudolf H
Veterans Affairs and Stanford University Medical Centers, Palo Alto, California.
Alcohol Clin Exp Res. 2007 Jan;31(1):64-8. doi: 10.1111/j.1530-0277.2006.00273.x.
Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients' health care costs in the first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.
A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs. The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs. The 2-year follow-up assessed patients' substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.
As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).
Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.
越来越多的证据表明，积极促进自助小组参与的成瘾和精神治疗项目能够在治疗后的第一年降低患者的医疗保健成本，但这种最初令人印象深刻的效果可能会随着时间的推移而减弱。本文探讨了在强烈鼓励参加12步自助小组的药物依赖患者中，治疗1年后明显的积极临床结果和降低的医疗保健成本在2年随访时是否得以维持。
对在基于12步（n = 887例患者）或认知行为（CB，n = 887例患者）治疗项目中接受治疗的男性药物依赖患者匹配样本进行为期2年的准实验分析。基于12步的项目更加强调12步概念，有更多“康复中”的工作人员，有更具精神导向的治疗环境，并且比CB项目更广泛地促进自助小组参与。2年随访评估了患者的药物使用、精神功能、自助小组归属以及心理健康服务利用情况和成本。
如同该样本1年随访时的情况一样，临床结果的唯一差异是接受12步治疗（49.5%）的患者与接受CB治疗（37.0%）的患者相比，戒酒率显著更高。12步治疗患者在12步自助小组参与指标上的得分比CB项目的患者高出50%至100%。相比之下，CB项目的患者更多地依赖门诊和住院心理健康服务，导致12步治疗项目的成本降低了30%。这比1年时确定的成本差异要小，但仍然显著（每位患者2440美元，p = 0.01）。
促进自助小组参与似乎可以改善治疗后结果，同时降低持续护理的成本。即使从长期来看成本抵消有所减少，也能节省大量费用。因此，在财政资源有限的时候，积极促进自助小组参与可能是帮助成瘾患者康复的一种有用的临床实践。
