Bogenschutz Michael P
UNM Health Sciences Center, Department of Psychiatry and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87131, USA.
Alcohol Clin Exp Res. 2007 Oct;31(10 Suppl):64s-66s. doi: 10.1111/j.1530-0277.2007.00496.x.
Existing data indicate that 12-step program involvement is associated with improved outcomes in the dually diagnosed, but there are questions concerning the magnitude and mechanisms of this effect in various dually diagnosed populations.
Publications identified in a comprehensive review of the literature pertaining to 12-step programs and patients with addictions and co-occurring psychiatric disorders were reviewed for any content relevant to understanding the process of change involving dually diagnosed patients involved with 12-step programs.
Dually diagnosed individuals attend 12-step programs at rates comparable to the nondually diagnosed, although specific diagnoses may have some effect on attendance. The benefits of 12-step attendance do not appear to be markedly different for those with psychiatric disorders. Specialized 12-step programs could have benefits for the dually diagnosed over and above those of traditional 12-step programs. Existing data suggest that nonspecific change mechanisms (self-efficacy, social support) are similar to those found in the general AA literature.
Based on existing data, the change mechanisms are broadly similar to those found in the general 12-step literature, but additional factors related to mental illness may also play a significant role. Further work is necessary to test the components of this model and to achieve a firm empirical foundation for understanding the processes of 12-step recovery in the dually diagnosed.
现有数据表明，参与12步项目与双重诊断患者改善的预后相关，但对于这种效应在不同双重诊断人群中的程度和机制存在疑问。
对有关12步项目以及成瘾和共病精神障碍患者的文献进行全面综述时所确定的出版物，审查其中任何与理解涉及参与12步项目的双重诊断患者的改变过程相关的内容。
双重诊断个体参加12步项目的比例与非双重诊断个体相当，尽管特定诊断可能对参与率有一定影响。对于患有精神障碍的人来说，参加12步项目的益处似乎没有明显差异。专门的12步项目可能比传统的12步项目给双重诊断患者带来更多益处。现有数据表明，非特定的改变机制（自我效能感、社会支持）与一般戒酒互助会文献中发现的机制相似。
基于现有数据，改变机制与一般12步文献中发现的机制大致相似，但与精神疾病相关的其他因素也可能起重要作用。有必要开展进一步工作来检验该模型的各个组成部分，并为理解双重诊断患者12步康复过程奠定坚实的实证基础。
