De Salis Henry F, Martin Rachelle, Mansoor Zara, Newton-Howes Giles, Bell Elliot
Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.
Drug Alcohol Rev. 2023 May;42(4):827-842. doi: 10.1111/dar.13615. Epub 2023 Feb 6.
Completion of residential treatment for substance use disorder (SUD) relates to improvements in substance use and mental health. Findings from systematic reviews have been equivocal about which interventions work best for clients. There has been limited attention to the theories that explain the effectiveness of residential treatment.
We conducted a realist review of the literature to identify program theories that would explain successful and unsuccessful outcomes from residential treatment for SUD. The unit of analysis was context-mechanism-outcome (CMO). Inclusion criteria were studies of residential treatment of more than 30 days for adults with SUD. Pharmacological studies were excluded.
We identified 24 studies from 5748 screened. The studies were from settings comprising Indigenous programs, faith-based programs, psycho-social interventions and therapeutic communities and were conducted in North America, Scandinavia, Continental Europe and Australasia. We chose six CMO configurations as the best explanations for outcomes from residential treatment. Theories that best explained the mechanisms of change were the need to belong, meaning in life, and self-determination theory.
Previous research has noted similar outcomes from different residential treatment interventions, but has not been able to explain these similarities. In contrast, our findings suggest that the outcomes can be explained by causal mechanisms that apply across all programs, regardless of the philosophy of treatment.
We identified six CMO configurations whose mechanisms of change could be explained by three overarching theories-the need to belong, meaning in life and self-determination theory. The findings apply across ethnicities and genders.
物质使用障碍（SUD）住院治疗的完成与物质使用和心理健康的改善有关。系统评价的结果对于哪种干预措施对患者最有效尚无定论。对于解释住院治疗有效性的理论关注有限。
我们对文献进行了实证性综述，以确定能够解释SUD住院治疗成功和失败结果的项目理论。分析单位是情境-机制-结果（CMO）。纳入标准是对成年SUD患者进行超过30天住院治疗的研究。排除药理学研究。
我们从5748项筛选的研究中确定了24项研究。这些研究来自包括原住民项目、基于信仰的项目、心理社会干预和治疗社区在内的环境，在北美、斯堪的纳维亚、欧洲大陆和澳大拉西亚进行。我们选择了六种CMO配置作为住院治疗结果的最佳解释。最能解释变化机制的理论是归属感需求、生活意义和自我决定理论。
先前的研究指出不同住院治疗干预措施有相似的结果，但无法解释这些相似之处。相比之下，我们的研究结果表明，这些结果可以由适用于所有项目的因果机制来解释，无论治疗理念如何。
我们确定了六种CMO配置，其变化机制可以由三种总体理论来解释——归属感需求、生活意义和自我决定理论。这些发现适用于不同种族和性别。
