Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America.
Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America.
J Subst Abuse Treat. 2019 Sep;104:83-96. doi: 10.1016/j.jsat.2019.06.016. Epub 2019 Jun 29.
Brief reinforcement-based psychosocial interventions such as behavioral activation (BA) and behavioral economics (BE) address imbalances in the reinforcement system that are strongly implicated in substance use. The present study reviewed a growing body of intervention studies that tested the efficacy of BA or BE in addressing substance use outcomes. The study also reviewed a smaller body of evidence exploring mechanisms of action and moderators of treatment efficacy for substance use outcomes.
A comprehensive literature search of four databases was conducted to identify studies that tested either BA or BE interventions targeting outcomes and/or mechanisms of action specific to substance use. The search yielded 12 studies that met these criteria. Ten studies reported main outcomes of BA/BE interventions targeting substance use outcomes (N = 7 BA; N = 3 BE). Two additional studies addressed mechanisms of change by conducting secondary analyses of data from one of the other ten studies. Eight of the twelve studies tested mechanisms of change and/or moderators related to substance use.
Among all ten outcome studies, 100% provided evidence suggesting efficacy of BA/BE in targeting substance use and/or use-related problems. In 90% (9/10) of studies, the BA/BE intervention condition evidenced significantly higher abstinence rates compared to controls and/or significant decreases in substance use from baseline. Most studies that assessed substance use-related problems (83%; 5/6) reported significant decreases in use-related problems. The majority of studies (80%; 8/10) reported medium to large effect sizes. The pattern of findings was similar for BA and BE interventions. Eight studies assessed change in mechanism of action and 38% (3/8) identified mechanisms of action, however, only two conducted a formal test of whether this variable mediated the relationship between condition and outcome. Two studies tested and identified significant moderators of treatment efficacy.
Preliminary evidence supports the efficacy of reinforcement-based interventions in targeting substance use outcomes. The mechanisms driving BA/BE efficacy and factors that may moderate treatment effects are not sufficiently clear from the studies available and require further examination, although existing data does suggest promise and provides clues for next steps.
简短的基于强化的心理社会干预，如行为激活（BA）和行为经济学（BE），可以解决强化系统中的不平衡，而这些不平衡与物质使用密切相关。本研究回顾了越来越多的干预研究，这些研究测试了 BA 或 BE 在解决物质使用结果方面的功效。该研究还回顾了一小部分探索物质使用结果的作用机制和治疗效果调节剂的证据。
对四个数据库进行了全面的文献检索，以确定测试针对物质使用结果和/或特定于物质使用的作用机制的 BA 或 BE 干预措施的研究。该搜索产生了符合这些标准的 12 项研究。其中 10 项研究报告了针对物质使用结果的 BA/BE 干预措施的主要结果（N=7BA；N=3BE）。另外两项研究通过对其他十项研究中的一项数据进行二次分析，解决了变化机制。其中八项研究测试了与物质使用相关的变化机制和/或调节剂。
在所有十种结果研究中，100%提供了证据表明 BA/BE 对物质使用和/或使用相关问题具有治疗效果。在 90%（9/10）的研究中，BA/BE 干预组的戒酒率明显高于对照组，且与基线相比，物质使用量明显减少。大多数评估物质使用相关问题的研究（83%；5/6）报告了使用相关问题的显著减少。大多数研究（80%；10/10）报告了中等至大的效应量。BA 和 BE 干预的研究结果模式相似。八项研究评估了作用机制的变化，其中 38%（3/8）确定了作用机制，但只有两项进行了正式测试，以确定该变量是否调节了条件与结果之间的关系。两项研究测试并确定了治疗效果的显著调节剂。
初步证据支持基于强化的干预措施在针对物质使用结果方面的功效。BA/BE 功效的作用机制以及可能调节治疗效果的因素尚不清楚，需要进一步研究，尽管现有数据确实有希望并提供了下一步的线索。
