Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
University of Connecticut Health Sciences Center, Farmington, CT, USA.
Addiction. 2017 Dec;112(12):2155-2166. doi: 10.1111/add.13920. Epub 2017 Aug 1.
The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF.
Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n = 30) or a novel integrated TSF (iTSF; n = 29), with follow-up assessments at 3, 6 and 9 months following treatment entry.
Out-patient addiction clinic in the United States.
Adolescents [n = 59; mean age = 16.8 (1.7) years; range = 14-21; 27% female; 78% white].
The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD.
Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms.
Primary outcome: PDA was not significantly different across treatments [b = 0.08, 95% confidence interval (CI) = -0.08 to 0.24, P = 0.33; Bayes' factor = 0.28).
during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b = -0.87; 95% CI = -1.67 to 0.07, P = 0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b = -0.42; 95% CI = -0.80 to -0.04, P < 0.05; effect size range d = 0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r = 0.39, P = 0.008), and early following (r = 0.30, P = 0.049), treatment.
Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.
12 步哲学和实践的整合在青少年物质使用障碍（SUD）治疗计划中很常见，特别是在北美。然而，尽管许多实验研究已经测试了成人的 12 步促进（TSF）治疗，但没有研究测试过针对青少年的特定 TSF 治疗。我们测试了一种新的综合 TSF 的疗效。
解释性、平行组、随机临床试验，比较了 10 节动机增强治疗/认知行为治疗（MET/CBT；n=30）或一种新的综合 TSF（iTSF；n=29），在治疗开始后 3、6 和 9 个月进行随访评估。
美国门诊成瘾诊所。
青少年[n=59；平均年龄 16.8（1.7）岁；范围 14-21；27%女性；78%白人]。
iTSF 将 12 步与动机和认知行为策略相结合，并与 SUD 的最新技术 MET/CBT 进行比较。
主要结局：禁欲天数百分比（PDA）；次要结局：12 步出席率、物质相关后果、最长禁欲期、禁欲/主要禁欲比例、精神症状。
主要结局：治疗期间，两种治疗方法的 PDA 无显著差异[b=0.08，95%置信区间（CI）=0.08-0.24，P=0.33；贝叶斯因子=0.28]。
在治疗期间，iTSF 患者的 12 步出席率显著增加，但此后这一优势下降（b=-0.87；95%CI=-1.67 至 0.07，P=0.03）。在所有随访点，iTSF 在物质相关后果方面均表现出显著优势（b=-0.42；95%CI=-0.80 至-0.04，P<0.05；效应量范围 d=0.26-0.71）。其他次要结局在治疗之间没有显著差异，但效应大小倾向于有利于 iTSF。在整个样本中，更高的 12 步会议出席率与治疗期间（r=0.39，P=0.008）和早期（r=0.30，P=0.049）的更长禁欲期显著相关。
与动机增强治疗/认知行为治疗（MET/CBT）相比，一种新的综合 12 步促进治疗青少年物质使用障碍（iTSF）在禁欲方面没有显示出更大的益处，但在 12 步出席率和后果方面显示出益处。鉴于北美青少年社区门诊环境中广泛使用 12 步、MET 和 CBT 的组合，iTSF 可能提供一种与现有实践兼容的综合循证选择。
