Locastro Joseph S, Potter Jennifer Sharpe, Donovan Dennis M, Couper David, Pope Kimberly W
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, and Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
J Stud Alcohol Drugs. 2008 Nov;69(6):885-95. doi: 10.15288/jsad.2008.69.885.
The current study compared alcoholics who entered treatment for the first time with those who had reported one or more prior treatment experiences using a large sample (N = 1,362) of alcoholics who entered the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE (Combining Medications and Behavioral Interventions) Study of pharmacological and behavioral treatment efficacy.
Participants were categorized into three prior-treatment groups: (1) treatment naive (n = 691, 50.73%), (2) one to two prior treatments (n = 380, 27.90%), or (3) three or more prior treatments (n = 291, 21.37%). Groups were compared at baseline on multiple drinking and psychosocial variables.
The treatment-naive group was more likely to be female, educated, married, and employed. They reported the lowest levels of drinks per drinking day, average drinks per day, alcohol dependence, craving, and alcohol-related consequences; but, they had the oldest age at onset of alcohol problems. Both the treatment-naive group and the one-to-two prior-treatment group had lower percentage days abstinent within the prior 30 days, compared with the three-or-more group (22% and 25% vs 32%, respectively). The treatment-naive group reported the least commitment to an abstinence goal (43% vs 70% and 80%, respectively) and the lowest mean number of Alcoholics Anonymous meetings attended (0.86 vs 3.10 vs 6.91, respectively). They also reported fewer psychological symptoms, less distress, and higher levels of quality of life on physical, emotional, and environmental domains, as well as social relationships.
Results suggest that a greater understanding of treatment-naive versus treatment-experienced clients may provide a better profile of help-seeking behavior and may suggest different approaches to treatment.
本研究使用一大群（N = 1362）进入美国国立酒精滥用与酒精中毒研究所资助的药物与行为干预联合（COMBINE）药物治疗与行为治疗疗效研究的酗酒者样本，比较首次接受治疗的酗酒者与那些报告有一次或多次先前治疗经历的酗酒者。
参与者被分为三个先前治疗组：（1）首次接受治疗者（n = 691，50.73%），（2）有过一至两次先前治疗者（n = 380，27.90%），或（3）有过三次或更多先前治疗者（n = 291，21.37%）。在基线时比较各组在多个饮酒及心理社会变量方面的情况。
首次接受治疗组女性、受过教育、已婚及就业的可能性更大。他们报告的每次饮酒日饮酒量、日均饮酒量、酒精依赖、渴望及与酒精相关后果的水平最低；但是，他们出现酒精问题的起始年龄最大。与有三次或更多先前治疗组相比，首次接受治疗组和有过一至两次先前治疗组在前30天内戒酒天数的百分比更低（分别为22%和25%，而三次或更多先前治疗组为32%）。首次接受治疗组报告对戒酒目标的承诺最少（分别为43%，而其他两组为70%和80%），参加戒酒互助会会议的平均次数最低（分别为0.86次，而其他两组为3.10次和6.91次）。他们还报告心理症状较少、痛苦较少，在身体、情感、环境领域以及社会关系方面的生活质量水平较高。
结果表明，更深入了解首次接受治疗者与有治疗经历的来访者，可能有助于更好地了解求助行为，并可能提示不同的治疗方法。
