From the, Recovery Research Institute (JFK, BGB, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Columbia University (MCG), New York, New York.
Alcohol Clin Exp Res. 2019 Jul;43(7):1533-1544. doi: 10.1111/acer.14067. Epub 2019 May 15.
Alcohol and other drug (AOD) problems are commonly depicted as chronically relapsing, implying multiple recovery attempts are needed prior to remission. Yet, although a robust literature exists on quit attempts in the tobacco field, little is known regarding patterns of cessation attempts related to alcohol, opioid, stimulant, or cannabis problems. Greater knowledge of such estimates and the factors associated with needing fewer or greater attempts may have utility for health policy and clinical communication efforts and approaches.
Cross-sectional, nationally representative survey of U.S. adults (N = 39,809) who reported resolving a significant AOD problem (n = 2,002) and assessed on number of prior serious recovery attempts, demographic variables, primary substance, clinical histories, and indices of psychological distress and well-being.
The statistical distribution of serious recovery attempts was highly skewed with a mean of 5.35 (SD = 13.41) and median of 2 (interquartile range [IQR] = 1 to 4). Black race, prior use of treatment and mutual-help groups, and history of psychiatric comorbidity were associated with higher number of attempts, and more attempts were associated independently with greater current distress. Number of recovery attempts did not differ by primary substance (e.g., opioids vs. alcohol).
Estimates of recovery attempts differed substantially depending on whether the mean (5.35 recovery attempts) or median (2 recovery attempts) was used as the estimator. Implications of this are that the average may be substantially lower than anticipated because cultural expectations are often based on AOD problems being "chronically relapsing" disorders implicating seemingly endless tries. Depending on which one of these estimates is reported in policy documents or communicated in public health announcements or clinical settings, each may elicit varying degrees of help-seeking, hope, motivation, and the use of more assertive clinical approaches. The more fitting, median estimate of attempts should be used in clinical and policy communications given the distribution.
酒精和其他药物（AOD）问题通常被描述为慢性复发，这意味着在缓解之前需要多次尝试恢复。然而，尽管在烟草领域有大量关于戒烟尝试的文献，但对于与酒精、阿片类药物、兴奋剂或大麻问题相关的戒烟尝试模式知之甚少。更多地了解这些估计以及与需要更少或更多尝试相关的因素，可能对卫生政策和临床沟通工作和方法有用。
横断面、全国代表性的美国成年人调查（N=39809），报告解决了严重的 AOD 问题（n=2002），并评估了先前严重恢复尝试的次数、人口统计学变量、主要物质、临床史以及心理困扰和幸福感指数。
严重恢复尝试的统计分布高度偏态，平均为 5.35（SD=13.41），中位数为 2（四分位距[IQR]=1 至 4）。黑种人、先前使用治疗和互助团体以及精神共病史与尝试次数较多有关，而尝试次数较多与当前痛苦程度较高独立相关。尝试次数与主要物质（如阿片类药物与酒精）无关。
根据使用均值（5.35 次恢复尝试）还是中位数（2 次恢复尝试）作为估计值，恢复尝试的估计值有很大差异。这意味着，平均水平可能远低于预期，因为文化期望通常基于 AOD 问题是“慢性复发”的障碍，暗示似乎无休止的尝试。根据这些估计值中的哪一个在政策文件中报告或在公共卫生公告或临床环境中传达，每个估计值都可能引起不同程度的寻求帮助、希望、动机和使用更积极的临床方法。鉴于分布情况，应在临床和政策沟通中使用更合适的中位数尝试估计值。
