McKellar John, Ilgen Mark, Moos Bernice S, Moos Rudolf
Department of Veterans Affairs, Center for Health Care Evaluation, Palo Alto Health Care System, Menlo Park, CA 94025, USA.
J Subst Abuse Treat. 2008 Sep;35(2):148-55. doi: 10.1016/j.jsat.2007.09.003. Epub 2007 Nov 26.
Self-efficacy is a robust predictor of short- and long-term remission after treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later. A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years. Predictors of self-efficacy at 1 year included improvement from baseline to 1 year in heavy drinking, alcohol-related problems, depression, impulsivity, avoidance coping, social support from friends, and longer duration of participation in Alcoholics Anonymous (AA). Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years. Clinicians should focus on keeping patients engaged in AA, addressing depressive symptoms, improving patient's coping, and enhancing social support during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.
自我效能感是治疗后短期和长期缓解的有力预测指标。本研究考察了治疗后一年及15年后自我效能感的预测因素。对420名酒精使用障碍患者进行了为期16年的五次评估。治疗后1年时自我效能感的预测因素包括从基线到1年期间重度饮酒、与酒精相关问题、抑郁、冲动性、回避应对、来自朋友的社会支持的改善，以及参加戒酒互助会（AA）的时间更长。女性、受教育程度更高、物质使用问题变化较小以及第一年的冲动性预测了16年间自我效能感的改善。临床医生应在第一年重点关注让患者持续参与戒酒互助会、解决抑郁症状、改善患者应对方式以及增强社会支持，并通过监测酒精问题和冲动性改善异常迅速的个体来降低复发风险。
