McKellar John D, Harris Alexander H, Moos Rudolf H
Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, United States.
Drug Alcohol Depend. 2009 Jan 1;99(1-3):115-22. doi: 10.1016/j.drugalcdep.2008.07.005. Epub 2008 Sep 7.
Studies measuring the effectiveness of 12-step self-help group attendance have yielded mixed results but none of the prior studies have accounted for the potential impact of interim abstinence status.
Participants were 1683 patients with substance use disorders (SUD) from 88 community residential facilities. Self-report data were collected at baseline and 1- and 4-year follow-ups, and included measures of SUD severity, social resources, coping, and 12-step self-help group attendance. We tested the hypothesis that 12-step self-help group attendance is more effective for non-abstinent patients than for abstinent patients. We also controlled for self-selection effects by using propensity score analyses and we cross-validated our results in a second sample of patients (N=2173).
Sample 1. Patients abstinent at 1-year post-treatment who attended 12-step self-help group meetings were no more likely to be abstinent at 4 years than abstinent patients who did not attend. However, for patients not abstinent at 1 year, a significant improvement in abstinence rates at 4 years emerged for those who attended 12-step self-help groups compared to those who did not (42% vs. 28.9%). A similar pattern emerged for SUD problems. There were no benefits from 12-step self-help group attendance for patients abstinent at 1 year, but non-abstinent patients who attended 12-step self-help groups had significantly fewer problems at 4 years. Sample 2. The cross-validation yielded consistent results as 12-step self-help group attendance led to higher abstinence rates and fewer SUD problems only among patients non-abstinent at interim assessment.
Individual's abstinence status should be considered when evaluating the potential influence of 12-step self-help group attendance on SUD outcomes. In addition, increased clinical resources should focus on assessing patients after discharge and on improving linkage of non-abstinent patients to self-help groups.
评估12步自助小组参与效果的研究结果不一，但之前的研究均未考虑到临时戒酒状态的潜在影响。
研究对象为来自88个社区居住设施的1683名物质使用障碍（SUD）患者。在基线、1年和4年随访时收集自我报告数据，包括SUD严重程度、社会资源、应对方式以及12步自助小组参与情况的测量指标。我们检验了以下假设：12步自助小组参与对未戒酒患者比对已戒酒患者更有效。我们还通过倾向得分分析控制了自我选择效应，并在另一组患者样本（N = 2173）中对结果进行了交叉验证。
样本1。治疗后1年已戒酒且参加12步自助小组会议的患者在4年时戒酒的可能性并不高于未参加的已戒酒患者。然而，对于1年时未戒酒的患者，与未参加者相比，参加12步自助小组的患者在4年时戒酒率有显著提高（42%对28.9%）。SUD问题也出现了类似模式。1年时已戒酒的患者参加12步自助小组并无益处，但1年时未戒酒且参加12步自助小组的患者在4年时问题显著减少。样本2。交叉验证得出了一致的结果，因为12步自助小组参与仅在中期评估时未戒酒的患者中导致了更高的戒酒率和更少的SUD问题。
在评估12步自助小组参与对SUD结果的潜在影响时，应考虑个体的戒酒状态。此外，增加临床资源应侧重于出院后对患者的评估，以及改善未戒酒患者与自助小组的联系。
