Muench Frederick, Morgenstern Jon
Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1775 Broadway, New York, NY 10019, USA.
Alcohol Clin Exp Res. 2007 Oct;31(10 Suppl):67s-70s. doi: 10.1111/j.1530-0277.2007.00497.x.
Appraisals of the past harm from substance use have been associated with increased motivation and treatment seeking behaviors. Harm appraisals are subjective evaluations of the harm caused by substance use and differ from traditional consequences measures which assess the occurrence of adverse events related to substance use. Although influencing these appraisals is a central component to most treatments, no studies have examined how changes in these appraisals during treatment influence outcome. The present study examined how changes in appraisals of the past harm from substance use over the course of treatment influence short- and long-term substance use outcomes.
Participants were 252 individuals seeking outpatient treatment for a substance use problem. Participants were assessed at treatment entry, end of treatment (13 weeks), and 9 months post-baseline. All participants were given a battery of measures that assessed substance use, consequences, self-efficacy, motivation, treatment intensity, 12-step affiliation, and appraisals of harm. Past harm change scores from baseline to end of treatment recoded into 3 groups: increased, remained the same, and decreased (reduced their perception of the harm from substance use).
Reductions in appraisals of past harm from baseline to end of treatment predicted lower PDA and higher objective consequences at end of treatment and 9-month follow-up. There were no significant differences in outcome between those who increased versus maintained harm appraisals from baseline to end of treatment. Higher treatment intensity and 12-step affiliation were associated with fewer reductions in past harm appraisals.
Results of the present study suggest subjective appraisals of the past harm from substance use wane for some people during treatment and that helping clients maintain or increase their perceptions of the past harm from substance use over the course of treatment is associated with better short- and long-term outcomes.
对过去物质使用造成的伤害的评估与动机增强和寻求治疗行为有关。伤害评估是对物质使用所造成伤害的主观评价，不同于传统的后果测量方法，后者评估与物质使用相关的不良事件的发生情况。尽管影响这些评估是大多数治疗的核心组成部分，但尚无研究考察治疗期间这些评估的变化如何影响治疗结果。本研究考察了治疗过程中对过去物质使用造成的伤害的评估变化如何影响短期和长期的物质使用结果。
参与者为252名因物质使用问题寻求门诊治疗的个体。在治疗开始时、治疗结束时（13周）以及基线后9个月对参与者进行评估。所有参与者都接受了一系列测量，包括物质使用、后果、自我效能感、动机、治疗强度、12步戒断参与度以及伤害评估。从基线到治疗结束的过去伤害变化分数被重新编码为3组：增加、保持不变和减少（降低了他们对物质使用伤害的认知）。
从基线到治疗结束时对过去伤害的评估降低，预示着治疗结束时和9个月随访时较低的药物渴求及较高的客观后果。从基线到治疗结束时伤害评估增加与维持不变的参与者在结果上无显著差异。较高的治疗强度和12步戒断参与度与过去伤害评估减少较少有关。
本研究结果表明，在治疗过程中，一些人对过去物质使用造成的伤害的主观评估会减弱，并且在治疗过程中帮助客户维持或增强他们对过去物质使用伤害的认知与更好的短期和长期结果相关。
