Kelly John F, Greene M Claire, Bergman Brandon G
Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, USA
Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, USA.
Alcohol Alcohol. 2014 Nov;49(6):645-53. doi: 10.1093/alcalc/agu066. Epub 2014 Oct 7.
Alcoholics Anonymous (AA) is the most prevalent 12-step mutual-help organization (MHO), yet debate has persisted clinically regarding whether patients whose primary substance is not alcohol should be referred to AA. Narcotics Anonymous (NA) was created as a more specific fit to enhance recovery from drug addiction; however, compared with AA, NA meetings are not as ubiquitous. Little is known about the effects of a mismatch between individuals' primary substance and MHOs, and whether any incongruence might result in a lower likelihood of continuation and benefit. More research would inform clinical recommendations.
Young adults (N = 279, M age 20.4, SD 1.6, 27% female; 95% White) in a treatment effectiveness study completed assessments at intake, and 3, 6, and 12 months post-treatment. A matching variable was created for 'primary drug' patients (i.e. those reporting cannabis, opiates or stimulants as primary substance; n = 198/279), reflecting the proportion of total 12-step meetings attended that were AA. Hierarchical linear models (HLMs) tested this variable's effects on future 12-step participation and percent days abstinent (PDA).
The majority of meetings attended by both alcohol and drug patients was AA. Drug patients attending proportionately more AA than NA meetings (i.e. mismatched) were no different than those who were better matched to NA with respect to future 12-step participation or PDA.
Drug patients may be at no greater risk of discontinuation or diminished recovery benefit from participation in AA relative to NA. Findings may boost clinical confidence in making AA referrals for drug patients when NA is less available.
戒酒互助会(AA)是最普遍的12步自助组织(MHO),然而临床上对于主要物质不是酒精的患者是否应转介至AA一直存在争议。匿名戒毒会(NA)是为更专门地促进戒毒康复而设立的;然而,与AA相比,NA会议并不那么普遍。对于个体的主要物质与互助组织不匹配的影响,以及这种不一致是否可能导致持续参与和受益的可能性降低,人们知之甚少。更多的研究将为临床建议提供依据。
在一项治疗效果研究中,年轻成年人(N = 279,年龄中位数20.4,标准差1.6, 27%为女性;95%为白人)在入组时以及治疗后3个月、6个月和12个月完成评估。为“主要药物”患者(即那些报告大麻、阿片类药物或兴奋剂为主要物质的患者;n = 198/279)创建了一个匹配变量,反映参加的12步会议总数中属于AA的比例。分层线性模型(HLMs)测试了该变量对未来12步参与和戒酒天数百分比(PDA) 的影响。
酒精和药物患者参加的会议大多数是AA。在未来12步参与或PDA方面,参加AA会议比例高于NA会议(即不匹配)的药物患者与更适合NA的患者没有差异。
相对于NA,药物患者参加AA可能不会有更高的退出风险或康复益处减少。当NA难以获得时,这些发现可能会增强临床医生将药物患者转介至AA 的信心。