Carroll K M, Rounsaville B J, Gawin F H
Department of Psychiatry, Yale University, New Haven, Connecticut 06519.
Am J Drug Alcohol Abuse. 1991 Sep;17(3):229-47. doi: 10.3109/00952999109027549.
Despite the widespread use of psychotherapy as treatment for cocaine abuse, the effectiveness of psychotherapy has not been explored through clinical trials. Forty-two outpatients who met DSM-III criteria for cocaine abuse were randomly assigned to one of two forms of purely psychotherapeutic treatments of cocaine abuse, either relapse prevention (RPT) or interpersonal psychotherapy (IPT). Subjects assigned to relapse prevention were more likely than subjects in IPT to attain three or more continuous weeks of abstinence (57 versus 33%), be classified as recovered at the point of treatment termination (43 versus 19%), and complete treatment (67 versus 38%). Whereas these differences did not reach statistical significance, significant differences by treatment group did emerge when subjects were stratified by severity of substance use: Among the subgroup of more severe users, subjects who received RPT were significantly more likely to achieve abstinence (54 versus 9%) and be classified as recovered (54 versus 0%). Among the subgroups of subjects with lower severity of substance abuse, outcome was comparable for both treatment types. Comparison of results from this investigation with historical controls from a structurally similar pharmacotherapy trial suggests that purely psychotherapeutic treatments may be both viable and effective approaches for many ambulatory cocaine abusers.
尽管心理治疗被广泛用于治疗可卡因滥用，但尚未通过临床试验探索心理治疗的有效性。42名符合《精神疾病诊断与统计手册》第三版（DSM-III）可卡因滥用标准的门诊患者被随机分配到两种纯心理治疗可卡因滥用方法中的一种，即预防复发治疗（RPT）或人际心理治疗（IPT）。被分配到预防复发治疗组的受试者比人际心理治疗组的受试者更有可能实现连续三周或更长时间的戒断（57%对33%），在治疗结束时被归类为康复（43%对19%），并完成治疗（67%对38%）。虽然这些差异未达到统计学显著性，但当根据物质使用严重程度对受试者进行分层时，治疗组之间出现了显著差异：在更严重使用者的亚组中，接受预防复发治疗的受试者显著更有可能实现戒断（54%对9%）并被归类为康复（54%对0%）。在物质滥用严重程度较低的受试者亚组中，两种治疗类型的结果相当。将本研究结果与一项结构相似的药物治疗试验的历史对照进行比较表明，对于许多门诊可卡因滥用者来说，纯心理治疗可能是可行且有效的方法。
