Kadden R M
Department of Psychiatry, University of Connecticut School of Medicine, Farmington 06030-2103, USA.
Addiction. 1996 Dec;91 Suppl:S139-45.
The Relapse Replication and Extension Project (RREP) has failed to provide empirical support for Marlatt's relapse taxonomy. Neither the reliability of the original Marlatt coding system nor its predictive or construct validity was supported by this group of studies. The present commentary explores a number of possible reasons for the generally negative outcomes. These findings should certainly lead to a re-evaluation of Marlatt's relapse taxonomy and its operationalization. Nevertheless, despite the negative results, there are a number of reasons why the general Relapse Prevention concept is likely to survive in some form: it has been widely adopted and imitated clinically, key elements of the taxonomy are often focal points of treatment, and clinical research studies have repeatedly supported some elements of the taxonomy (e.g. negative emotional states, social pressure, interpersonal conflict, positive emotional states and temptations/urges). The RREP also evaluated some modifications of the original taxonomy as well as the use of more structured assessment instruments, and some of these provided more promising results. Further developments will need to take into account both research needs for greater precision, most likely through the use of more structured assessment instruments, and clinical needs for richness of detail and sensitivity to a wide variety of life circumstances.
复发复制与扩展项目(RREP)未能为马尔拉特的复发分类法提供实证支持。这组研究既未支持原始马尔拉特编码系统的可靠性,也未支持其预测效度或结构效度。本评论探讨了导致总体负面结果的一些可能原因。这些发现无疑应促使对马尔拉特的复发分类法及其实施方式进行重新评估。然而,尽管结果为负面,但一般复发预防概念仍可能以某种形式存续,原因有若干:它已在临床上被广泛采用和模仿,分类法的关键要素往往是治疗的重点,并且临床研究反复支持了分类法的一些要素(例如负面情绪状态、社会压力、人际冲突、正面情绪状态以及诱惑/冲动)。RREP还评估了原始分类法的一些修改以及更结构化评估工具的使用,其中一些产生了更有前景的结果。未来的进一步发展需要兼顾对更高精确性的研究需求(很可能通过使用更结构化的评估工具来实现)以及对丰富细节和对各种生活情境敏感性的临床需求。