Longabaugh R, Rubin A, Malloy P, Beattie M, Clifford P R, Noel N
Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island 02912.
Alcohol Clin Exp Res. 1994 Aug;18(4):778-85. doi: 10.1111/j.1530-0277.1994.tb00040.x.
Clinical research and wisdom suggest that alcoholics with antisocial personality (ASPs) disorders have poorer drinking outcomes after treatment than alcoholics without this disorder. The present study challenges this wisdom, suggesting that poor prognosis and response to treatment have been confounded by not covarying on pretreatment drinking measures. Thirty-one ASPs are compared with 118 non-ASPs randomly assigned to extended cognitive behavioral and relationship enhancement treatments. Thirteen to 18 months after treatment initiation, ASPs average more abstinent days than do non-ASPs. Drinking intensity is a function of a patient-treatment matching effect: ASPs treated with cognitive behavioral treatment (CB) drink less/drinking day than do either non-ASPs treated in CB or ASPs treated in relationship enhancement. This finding is supportive of a comparable matching effect for CB and ASP found by Kadden et al. (1989). Examination of the process indicates that, irrespective of drinking index, ASPs respond poorly when they experience high posttreatment support for abstinence, whereas non-ASPs respond better with support. We conclude that early pessimism for successful treatment of ASP alcoholic drinking outcome may be unwarranted.
临床研究和经验表明，患有反社会人格障碍（ASPs）的酗酒者在治疗后的饮酒预后比没有这种障碍的酗酒者更差。本研究对这一观点提出了质疑，认为预后不良和对治疗的反应受到了未对治疗前饮酒量进行协变量分析的影响。将31名患有反社会人格障碍的患者与118名未患该障碍的患者进行比较，后者被随机分配接受强化认知行为治疗和人际关系改善治疗。在治疗开始后的13至18个月，患有反社会人格障碍的患者的戒酒天数平均比未患该障碍的患者更多。饮酒强度是患者与治疗匹配效应的一个函数：接受认知行为治疗（CB）的患有反社会人格障碍的患者比接受认知行为治疗（CB）的未患该障碍的患者或接受人际关系改善治疗的患有反社会人格障碍的患者每天饮酒量更少。这一发现支持了卡登等人（1989年）发现的认知行为治疗（CB）与反社会人格障碍（ASPs）之间类似的匹配效应。对过程的研究表明，无论饮酒指数如何，当患有反社会人格障碍的患者在治疗后获得高度的戒酒支持时，他们的反应较差，而未患该障碍的患者在获得支持时反应更好。我们得出结论，早期对成功治疗患有反社会人格障碍的酗酒者饮酒结果的悲观态度可能是没有根据的。
