San Diego State University/University of California Joint Doctoral Program in Clinical Psychology, University of California-San Diego, La Jolla, CA 92093, USA.
Subst Abus. 2013;34(1):43-50. doi: 10.1080/08897077.2012.691451.
Among substance-dependent individuals, comorbid major depressive disorder (MDD) is associated with greater severity and poorer treatment outcomes, but little research has examined mediators of posttreatment substance use outcomes within this population. Using latent growth curve models, the authors tested relationships between individual rates of change in 12-step involvement and substance use, utilizing posttreatment follow-up data from a trial of group Twelve-Step Facilitation (TSF) and integrated cognitive-behavioral therapy (ICBT) for veterans with substance dependence and MDD. Although TSF patients were higher on 12-step affiliation and meeting attendance at end-of-treatment as compared with ICBT, they also experienced significantly greater reductions in these variables during the year following treatment, ending at similar levels as ICBT. Veterans in TSF also had significantly greater increases in drinking frequency during follow-up, and this group difference was mediated by their greater reductions in 12-step affiliation and meeting attendance. Patients with comorbid depression appear to have difficulty sustaining high levels of 12-step involvement after the conclusion of formal 12-step interventions, which predicts poorer drinking outcomes over time. Modifications to TSF and other formal 12-step protocols or continued therapeutic contact may be necessary to sustain 12-step involvement and reduced drinking for patients with substance dependence and MDD.
在物质依赖个体中，共病的重度抑郁症（MDD）与更严重的病情和更差的治疗结果相关，但很少有研究在该人群中检查治疗后物质使用结果的中介因素。作者使用潜在增长曲线模型，利用一项针对有物质依赖和 MDD 的退伍军人的团体十二步促进（TSF）和整合认知行为治疗（ICBT）试验的治疗后随访数据，检验了 12 步参与和物质使用个体变化率之间的关系。虽然与 ICBT 相比，TSF 患者在治疗结束时的 12 步联系和出席会议的比例更高，但在治疗后的一年中，他们的这些变量也显著减少，最终与 ICBT 相似。TSF 中的退伍军人在随访期间的饮酒频率也显著增加，而这种组间差异是由他们在 12 步联系和出席会议方面的显著减少所介导的。患有共病性抑郁症的患者在正式的 12 步干预结束后似乎难以维持高水平的 12 步参与，这预示着随着时间的推移，饮酒结果会更差。可能需要对 TSF 和其他正式的 12 步方案进行修改或保持持续的治疗接触，以维持有物质依赖和 MDD 的患者的 12 步参与和减少饮酒。
