Kaminer Yifrah, Burleson Joseph A, Burke Rebecca H
Alcohol Research Center, University of Connecticut Health Center, Farmington, CT 06030-2103, USA.
J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1405-12. doi: 10.1097/CHI.0b013e318189147c.
Relapse rates for treated adolescents with alcohol use disorders (AUDs) amount to approximately 60% at 3 to 6 months after treatment completion. This randomized controlled study tested the hypothesis that active aftercare may maintain treatment gains better than no active aftercare (NA).
A total of 177 adolescents, 13 to 18 years of age, diagnosed with DSM-IV AUD, participated in nine weekly outpatient cognitive behavioral therapy group sessions. The 144 treatment completers were randomized into a 5-session in-person, brief telephone, or NA condition. Three alcohol use variables were the main outcome measures for 130 aftercare completers.
At the end of aftercare, the likelihood of relapse increased significantly compared with end of treatment outcomes. The likelihood of relapse for youths in NA, however, increased significantly more for youths in combined active aftercare (AA) conditions (p =.008). This effect was driven primarily by a significant sex x active aftercare interaction: girls showed no significant relapse under AA but relapsed significantly in NA. Youths enrolled in AA also showed significantly fewer drinking days (p =.044) and fewer heavy drinking days (p =.035) per month relative to NA.
In general, active aftercare interventions showed certain efficacy in slowing the expected posttreatment relapse process for alcohol use, with maintenance of treatment gains only for girls. Frequency of interventions, dose-response, duration of aftercare phase, and mediators of behavior change should be examined further to optimize aftercare for youths with AUD.
酒精使用障碍（AUDs）青少年患者经治疗后的复发率在治疗结束后3至6个月约为60%。这项随机对照研究检验了以下假设：积极的后续照护在维持治疗效果方面可能优于无积极后续照护（NA）。
共有177名年龄在13至18岁、被诊断为DSM-IV酒精使用障碍的青少年参加了为期九周的门诊认知行为治疗小组课程。144名完成治疗的患者被随机分为接受5次面对面、简短电话干预或无干预（NA）的情况。三个酒精使用变量是130名完成后续照护患者的主要结局指标。
在后续照护结束时，与治疗结束时的结果相比，复发可能性显著增加。然而，在联合积极后续照护（AA）情况下，NA组青少年的复发可能性增加得更为显著（p = 0.008）。这种效应主要由显著的性别×积极后续照护交互作用驱动：女孩在AA组下无显著复发，但在NA组中显著复发。相对于NA组，参加AA组的青少年每月饮酒天数也显著减少（p = 0.044），重度饮酒天数也显著减少（p = 0.035）。
总体而言，积极的后续照护干预在减缓酒精使用预期的治疗后复发过程中显示出一定疗效，仅对女孩维持了治疗效果。应进一步研究干预频率、剂量反应、后续照护阶段持续时间以及行为改变的中介因素，以优化对酒精使用障碍青少年的后续照护。
