Stein Judith A, Zane Jazmin I, Grella Christine E
Department of Psychology, University of California, Los Angeles, (
J Dual Diagn. 2012 Feb 13;8(1):64-73. doi: 10.1080/15504263.2012.647470.
Physical health problems are pervasive among patients with co-occurring substance use and mental disorders. Yet, drug treatment programs often ignore tobacco use and its association with health. Abstinence self-efficacy has been associated with improved outcomes for co-occurring disorders, which in turn may also impact physical health. This study had the goal of assessing whether abstinence self-efficacy for drugs and alcohol, and provision and use of services would influence tobacco use and other health-related outcomes among 351 individuals with co-occurring disorders in residential drug treatment. METHODS: Structural models tested the impact of baseline abstinence self-efficacy and treatment service characteristics on 6-month outcomes of health problems, functional limitations, health perceptions, and cigarette and heavy alcohol use. Demographics and baseline values for outcome variables were included as covariates. RESULTS: Correlations within time for poor health, cigarette use, and heavy alcohol use were substantial. A longer time in drug treatment was associated with less cigarette and heavy alcohol use at a 6-month follow-up. Baseline health problems were associated with more cigarette use and functional limitations at 6-months. Abstinence self-efficacy did not predict less cigarette use, but predicted less heavy alcohol use and fewer functional limitations. Availability of specialized dual-diagnosis groups and more on-site psychological services were not directly associated with outcomes, but had an impact through indirect effects on more psychological service utilization which predicted better subjective health. CONCLUSIONS: Improving overall treatment retention and services utilization among patients with co-occurring disorders may generalize to improved health perceptions, but specific health promotion and smoking-cessation interventions are warranted to improve health outcomes.
物质使用与精神障碍共病患者普遍存在身体健康问题。然而，药物治疗项目常常忽视烟草使用及其与健康的关联。戒断自我效能与共病障碍的改善结果相关，而这反过来也可能影响身体健康。本研究旨在评估药物和酒精的戒断自我效能以及服务的提供与使用，是否会影响351名接受住院药物治疗的共病障碍患者的烟草使用及其他与健康相关的结果。方法：结构模型测试了基线戒断自我效能和治疗服务特征对健康问题、功能受限、健康认知以及香烟和大量饮酒使用的6个月结果的影响。人口统计学特征和结果变量的基线值作为协变量纳入。结果：健康状况不佳、吸烟和大量饮酒在不同时间点的相关性很强。在6个月随访时，接受药物治疗的时间越长，吸烟和大量饮酒的情况越少。基线健康问题与6个月时更多的吸烟和功能受限相关。戒断自我效能并未预测吸烟减少，但预测了大量饮酒减少和功能受限减少。专门的双重诊断小组的可获得性和更多的现场心理服务与结果没有直接关联，但通过对更多心理服务利用的间接影响产生作用，而更多心理服务利用预测了更好的主观健康。结论：改善共病障碍患者的总体治疗保留率和服务利用率可能会推广至改善健康认知，但有必要采取具体的健康促进和戒烟干预措施来改善健康结果。
