Santa Ana Elizabeth J, Martino Steve, Ball Samuel A, Nich Charla, Frankforter Tami L, Carroll Kathleen M
Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
J Subst Abuse Treat. 2008 Dec;35(4):369-79. doi: 10.1016/j.jsat.2008.01.003. Epub 2008 Mar 12.
Despite increased emphasis on broadening the implementation of empirically supported therapies (ESTs) to improve standard clinical practice and patient outcomes, objective descriptions of what actually constitutes standard practice in community-based drug abuse treatment do not exist. We present data from independent ratings of 379 audiotapes drawn from the "treatment-as-usual" arm of two multisite randomized effectiveness trials in the National Institute on Drug Abuse Clinical Trials Network. As expected, the most frequently occurring strategies involved assessing the participant's substance use and social functioning, asking open-ended questions, discussing problems and feedback, and giving advice and direction. However, a number of interventions associated with ESTs were very rarely implemented in these early sessions. These data suggest missed opportunities for optimally engaging patients in the early stages of treatment and enhancing substance use outcomes and only moderate success to date of efforts to bridge the gap between research and practice.
尽管人们越来越强调扩大实证支持疗法（ESTs）的应用范围以改善标准临床实践和患者治疗效果，但对于社区药物滥用治疗中实际构成标准实践的内容，目前尚无客观描述。我们展示了从美国国立药物滥用研究所临床试验网络的两项多中心随机有效性试验的“常规治疗”组中抽取的379份录音带的独立评级数据。不出所料，最常出现的策略包括评估参与者的药物使用情况和社会功能、提出开放式问题、讨论问题和反馈，以及提供建议和指导。然而，一些与实证支持疗法相关的干预措施在这些早期治疗环节中很少实施。这些数据表明，在治疗早期使患者最佳参与以及改善药物使用效果方面存在错失的机会，并且迄今为止在弥合研究与实践之间差距的努力仅取得了一定程度的成功。
