Kavanagh David, Connolly Jennifer M
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
Drug Alcohol Rev. 2009 Jan;28(1):73-80. doi: 10.1111/j.1465-3362.2008.00011.x.
Remote delivery of interventions is needed to address large numbers of people with alcohol use disorders who are spread over large areas. Previous correspondence trials typically examined its effects as stand-alone treatment. This study aimed to test whether adding postal treatment to general practitioner (GP) support would lower alcohol use more than GP intervention alone.
A single-blind, randomised controlled trial with a crossover design was conducted over 12 months on 204 people with alcohol use disorders. Participants in an immediate correspondence condition received treatment over the first 3 months; those receiving delayed treatment received it in months 3-6.
Few participants were referred from GPs, and little intervention was offered by them. At 3 months, 78% of participants remained in the study. Those in immediate treatment showed greater reductions in alcohol per week, drinking days, anxiety, depression and distress than those in the delayed condition. However, post-treatment and follow-up outcomes still showed elevated alcohol use, depression, anxiety and distress. Greater baseline anxiety predicted better alcohol outcomes, although more mental distress at baseline predicted dropout.
The study gave consistent results with those from previous research on correspondence treatments, and showed that high levels of participant engagement over 3 months can be obtained. Substantial reductions in alcohol use are seen, with indications that they are well maintained. However, many participants continue to show high-risk alcohol use and psychological distress.
需要通过远程干预来解决大量分布在广大地区的酒精使用障碍患者的问题。以往的通信试验通常将其效果作为单独的治疗方法进行研究。本研究旨在测试在全科医生（GP）的支持下增加邮寄治疗是否比单纯的全科医生干预更能降低酒精使用量。
对204名酒精使用障碍患者进行了为期12个月的单盲、交叉设计随机对照试验。处于即时通信条件下的参与者在头3个月接受治疗；接受延迟治疗的参与者在第3至6个月接受治疗。
很少有参与者由全科医生转诊，且全科医生提供的干预很少。3个月时，78%的参与者仍留在研究中。即时治疗组的参与者每周饮酒量、饮酒天数、焦虑、抑郁和痛苦程度的降低幅度大于延迟治疗组。然而，治疗后和随访结果仍显示酒精使用量、抑郁、焦虑和痛苦程度较高。基线焦虑程度较高预示着酒精使用结果较好，尽管基线时更多的心理痛苦预示着退出研究。
该研究结果与以往关于通信治疗的研究一致，表明在3个月内可以实现高水平的参与者参与度。酒精使用量大幅下降，且有迹象表明这种下降得到了很好的维持。然而，许多参与者仍表现出高风险的酒精使用和心理痛苦。
