Timko Christine, DeBenedetti Anna
Center for Health Care Evaluation, VA HSR&D Center of Excellence, Department of Veterans Affairs Health Care System, and Stanford University Medical Center, 3801 Miranda Avenue, Palo Alto, CA 94304, United States.
Drug Alcohol Depend. 2007 Oct 8;90(2-3):270-9. doi: 10.1016/j.drugalcdep.2007.04.007. Epub 2007 May 24.
This study implemented and evaluated procedures to help clinicians make effective referrals to 12-step self-help groups (SHGs).
In this randomized controlled trial, individuals with substance use disorders (SUDs) entering a new outpatient treatment episode (N=345; 96% had previous SUD treatment) were randomly assigned to a standard referral or an intensive referral-to-self-help condition and provided self-reports of 12-step group attendance and involvement and substance use at baseline and at six-month and one-year follow-ups (93%). In standard referral, patients received a schedule for local 12-step SHG meetings and were encouraged to attend. Intensive referral had the key elements of counselors linking patients to 12-step volunteers and using 12-step journals to check on meeting attendance.
Compared with patients who received standard referral, patients who received intensive referral were more likely to attend and be involved with 12-step groups during both the first and second six-month follow-up periods, and improved more on alcohol and drug use outcomes over the year. Specifically, during both follow-up periods, patients in intensive referral were more likely to attend at least one meeting per week (70% versus 61%, p=.049) and had higher SHG involvement (mean=4.9 versus 3.7, p=.021) and abstinence rates (51% versus 41%, p=.048). Twelve-step involvement mediated the association between referral condition and alcohol and drug outcomes, and was associated with better outcomes above and beyond group attendance.
The intensive referral intervention was associated with improved 12-step group attendance and involvement and substance use outcomes. To most benefit patients, SUD treatment providers should focus 12-step referral procedures on encouraging broad 12-step group involvement, such as reading 12-step literature, doing service at meetings, and gaining self-identity as a SHG member.
本研究实施并评估了相关程序，以帮助临床医生有效地将患者转介至十二步自助小组（SHG）。
在这项随机对照试验中，进入新的门诊治疗阶段的物质使用障碍（SUD）患者（N = 345；96%曾接受过SUD治疗）被随机分配至标准转介组或强化自助转介组，并在基线、六个月和一年随访时（93%）提供关于参加十二步小组的情况、参与度以及物质使用情况的自我报告。在标准转介组中，患者收到当地十二步SHG会议的日程安排，并被鼓励参加。强化转介组的关键要素包括咨询师将患者与十二步志愿者联系起来，并使用十二步日志检查会议出勤情况。
与接受标准转介的患者相比，接受强化转介的患者在第一个和第二个六个月随访期内更有可能参加并参与十二步小组，且在一年中酒精和药物使用结果改善更多。具体而言，在两个随访期内，强化转介组的患者更有可能每周至少参加一次会议（70%对61%，p = 0.049），SHG参与度更高（平均分为4.9对3.7，p = 0.021），戒酒率更高（51%对41%，p = 0.048）。十二步参与度介导了转介条件与酒精和药物结果之间的关联，并且与超出小组出席情况的更好结果相关。
强化转介干预与十二步小组出席率、参与度以及物质使用结果的改善相关。为使患者获得最大益处，SUD治疗提供者应将十二步转介程序重点放在鼓励广泛参与十二步小组上，例如阅读十二步文献、在会议中提供服务以及获得SHG成员的自我认同。
