Witkiewitz Katie, van der Maas Han L J, Hufford Michael R, Marlatt G Alan
Department of Psychology, University of Illinois at Chicago, Chicago, IL 60607, USA.
J Abnorm Psychol. 2007 May;116(2):378-94. doi: 10.1037/0021-843X.116.2.378.
Alcohol lapses are the modal outcome following treatment for alcohol use disorders, yet many alcohol researchers have encountered limited success in the prediction and prevention of relapse. One hypothesis is that lapses are unpredictable, but another possibility is the complexity of the relapse process is not captured by traditional statistical methods. Data from Project Matching Alcohol Treatments to Client Heterogeneity (Project MATCH), a multisite alcohol treatment study, were reanalyzed with 2 statistical methodologies: catastrophe and 2-part growth mixture modeling. Drawing on previous investigations of self-efficacy as a dynamic predictor of relapse, the current study revisits the self-efficacy matching hypothesis, which was not statistically supported in Project MATCH. Results from both the catastrophe and growth mixture analyses demonstrated a dynamic relationship between self-efficacy and drinking outcomes. The growth mixture analyses provided evidence in support of the original matching hypothesis: Individuals with lower self-efficacy who received cognitive behavior therapy drank far less frequently than did those with low self-efficacy who received motivational therapy. These results highlight the dynamical nature of the relapse process and the importance of the use of methodologies that accommodate this complexity when evaluating treatment outcomes.
饮酒失误是酒精使用障碍治疗后的常见结果，但许多酒精研究人员在预测和预防复发方面取得的成功有限。一种假设是失误是不可预测的，但另一种可能性是传统统计方法未能捕捉到复发过程的复杂性。对多地点酒精治疗研究“将酒精治疗与客户异质性相匹配项目”（项目MATCH）的数据，采用两种统计方法重新进行了分析：突变理论和两部分增长混合模型。基于先前将自我效能作为复发动态预测指标的研究，本研究重新审视了自我效能匹配假说，该假说在项目MATCH中未得到统计学支持。突变分析和增长混合分析的结果均表明自我效能与饮酒结果之间存在动态关系。增长混合分析为最初的匹配假说提供了支持证据：接受认知行为疗法的自我效能较低的个体饮酒频率远低于接受动机疗法的自我效能较低的个体。这些结果凸显了复发过程的动态性质，以及在评估治疗结果时使用能够适应这种复杂性的方法的重要性。
