Witkiewitz Katie, Marlatt G Alan
Addictive Behaviors Research Center, Department of Psychology, University of Washington, Box 351525, Seattle, Washington 98103, USA.
Clin Psychol Rev. 2007 Jul;27(6):724-38. doi: 10.1016/j.cpr.2007.01.002. Epub 2007 Jan 18.
The most widely cited road block to successful treatment outcomes for psychological and substance use disorders has been described as the return to the previous behavior, or "relapse." The operational definition of "relapse" varies from study to study and between clinicians, but in general the term is used to indicate the return to previous levels of symptomatic behavior. One explanation for the variation in the operationalization of relapse is the wide variety of behaviors for which the term is applied, including (but not limited to): depression, substance abuse, schizophrenia, mania, sexual offending, risky sexual behavior, dieting, and the anxiety disorders. A second explanation for the multitude of definitions for relapse is the inherent complexity in the process of behavior change. In this paper we present the most recent treatment outcome research evaluating relapse rates, with a special focus on the substance use disorders. Following this review of the literature we present an argument for the operationalization of relapse as a dynamic process, which can be empirically characterized using dynamical systems theory. We support this argument by presenting results from the analysis of alcohol treatment outcomes using catastrophe modeling techniques. These results demonstrate the utility of catastrophe theory in modeling the alcohol relapse process. The implications of these analyses for the treatment of alcohol use disorders, as well as a discussion of future research incorporating nonlinear dynamical systems theory is provided.
对于心理和物质使用障碍而言，成功治疗结果最常被提及的障碍是恢复到先前的行为状态，即“复发”。“复发”的操作性定义因研究和临床医生而异，但总体而言，该术语用于表示症状性行为恢复到先前水平。复发操作性定义存在差异的一个原因是该术语所适用的行为种类繁多，包括（但不限于）：抑郁症、物质滥用、精神分裂症、躁狂症、性犯罪、危险的性行为、节食以及焦虑症。复发定义众多的另一个原因是行为改变过程本身具有复杂性。在本文中，我们展示了评估复发率的最新治疗结果研究，特别关注物质使用障碍。在对文献进行综述之后，我们提出将复发作为一个动态过程进行操作性定义的观点，这一过程可以使用动力系统理论进行实证描述。我们通过展示使用突变模型技术分析酒精治疗结果所得出的结果来支持这一观点。这些结果证明了突变理论在模拟酒精复发过程中的实用性。本文还提供了这些分析对酒精使用障碍治疗的启示，以及对纳入非线性动力系统理论的未来研究的讨论。
