Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale SE, MSC11-6280, Albuquerque, NM 87106, USA.
Psychol Addict Behav. 2012 Jun;26(2):246-54. doi: 10.1037/a0026917. Epub 2012 Jan 30.
A large proportion of emerging adults treated for substance use disorder (SUD) present with symptoms of negative affect and major depressive disorder (MDD). However, little is known regarding how these comorbidities influence important mechanisms of treatment response, such as increases in abstinence self-efficacy (ASE). This study tested the degree to which MDD and/or depressive symptoms interacted with during-treatment changes in ASE and examined these variables' relation to outcome at 3 months' posttreatment. Participants (N = 302; 74% male) completed measures at intake, midtreatment, end-of-treatment, and at 3-month follow-up. ASE was measured with the Alcohol and Drug Use Self-Efficacy (ADUSE) scale; depressive symptoms were assessed with the Brief Symptom Inventory 18 (BSI 18) Depression scale; and current MDD diagnoses were deduced from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Random coefficient regression analyses focused on during-treatment changes in ASE, with BSI 18 scores and MDD diagnosis included as moderators. At intake, individuals with MDD or high levels of depressive symptoms had significantly lower ASE, particularly in negative affect situations. No evidence for moderation was found: ASE significantly increased during treatment regardless of MDD status. There was a main effect of BSI 18 Depression scores: those with lower BSI 18 scores had lower ASE scores at each time point. MDD and BSI 18 Depression did not predict 3-month outcome, but similar to previous findings ASE did predict abstinence status at 3 months. Treatment-seeking emerging adults with MDD merit particular clinical attention because of their lower reported self-efficacy throughout treatment.
相当大比例的接受物质使用障碍（SUD）治疗的成年初期患者表现出负面情绪和重度抑郁障碍（MDD）的症状。然而，对于这些合并症如何影响治疗反应的重要机制，例如戒酒自我效能感（ASE）的增加，知之甚少。本研究检验了 MDD 和/或抑郁症状与治疗期间 ASE 变化的相互作用程度，并研究了这些变量与治疗后 3 个月的结果的关系。参与者（N=302；74%为男性）在入组时、治疗中期、治疗结束时和 3 个月随访时完成了测量。ASE 采用酒精和药物使用自我效能量表（ADUSE）进行测量；抑郁症状采用Brief Symptom Inventory 18（BSI 18）抑郁量表进行评估；目前的 MDD 诊断是从《精神障碍诊断与统计手册》第四版（DSM-IV）的结构化临床访谈中推断出来的。随机系数回归分析集中在 ASE 的治疗期间变化上，BSI 18 评分和 MDD 诊断作为调节剂。在入组时，患有 MDD 或抑郁症状严重的个体的 ASE 明显较低，特别是在负面情绪情况下。没有发现调节的证据：无论 MDD 状态如何，ASE 在治疗期间都显著增加。BSI 18 抑郁评分存在主要效应：BSI 18 评分较低的个体在每个时间点的 ASE 评分都较低。MDD 和 BSI 18 抑郁评分不能预测 3 个月的结果，但与之前的发现相似，ASE 确实预测了 3 个月的戒酒状态。由于在整个治疗过程中报告的自我效能感较低，患有 MDD 的寻求治疗的成年初期患者值得特别关注。
