Kelly John F, Yeterian Julie D, Cristello Julie V, Kaminer Yifrah, Kahler Christopher W, Timko Christine
Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
University of Connecticut Department of Psychiatry, Farmington, CT, USA.
Subst Abuse. 2016 Jun 13;10:55-64. doi: 10.4137/SART.S39635. eCollection 2016.
Adolescent substance use disorder treatment programs are often based on the 12-step philosophy of Alcoholics Anonymous and/or link adolescents to these free resources. Despite this, no studies have developed and rigorously tested a twelve-step facilitation (TSF) intervention for young people, leaving a significant evidence gap. This study describes the first systematic development of an outpatient adolescent TSF treatment. An integrated twelve-step facilitation (iTSF) treatment incorporated TSF, motivational enhancement therapy, and cognitive behavioral therapy elements and was developed in an iterative manner with weekly feedback provided by 36 adolescents (M age 17 years [SD = 1.4]; 52.8% white) with DSM-IV substance use disorder recruited from the community. Assessments were conducted at baseline and at three and six months. Participants completed 6 of 10 sessions on average (8 participants completed all 10). Notable treatment developments were the inclusion of "in-services" led by Marijuana Anonymous members, including parents in a portion of individual sessions to provide a rationale for TSF, and use of a Socratic therapeutic interaction style. Acceptability and feasibility of the treatment were excellent (treatment satisfaction was 4.29 [SD = 0.59] out of 5). In keeping with TSF theory, the intervention substantially increased 12-step participation, and greater participation related to greater abstinence. iTSF is a replicable manualized treatment that can be implemented and tested in outpatient settings. Given the widespread compatibility of iTSF with the current adolescent treatment, if found efficacious, iTSF could be relatively easily adopted, implemented, and sustained and could provide an evidence-based option that could undergird current practice.
青少年物质使用障碍治疗项目通常基于匿名戒酒会的12步理念，和/或将青少年与这些免费资源联系起来。尽管如此，尚无研究针对年轻人开发并严格测试12步促进（TSF）干预措施，这留下了显著的证据空白。本研究描述了门诊青少年TSF治疗的首次系统开发。一种综合12步促进（iTSF）治疗纳入了TSF、动机增强疗法和认知行为疗法元素，并通过迭代方式开发，每周从社区招募的36名患有《精神疾病诊断与统计手册》第四版（DSM-IV）物质使用障碍的青少年（平均年龄17岁[标准差=1.4]；52.8%为白人）提供反馈。在基线、三个月和六个月时进行评估。参与者平均完成了10节课程中的6节（8名参与者完成了全部10节）。显著的治疗进展包括纳入由匿名大麻使用者协会成员主导的“在职培训”，在部分个体治疗中让家长参与以提供TSF的基本原理，以及采用苏格拉底式治疗互动方式。该治疗的可接受性和可行性极佳（治疗满意度在5分中为4.29[标准差=0.59]）。与TSF理论一致，该干预措施大幅增加了12步参与度，且更多的参与与更高的戒酒率相关。iTSF是一种可复制的手册化治疗方法，可在门诊环境中实施和测试。鉴于iTSF与当前青少年治疗方法具有广泛的兼容性，如果被证明有效，iTSF可能相对容易被采用、实施和维持，并可提供一种基于证据的选择，为当前实践提供支持。
