Marlatt G A
Department of Psychology, University of Washington, Seattle 98195-1525, USA.
Addiction. 1996 Dec;91 Suppl:S147-53.
In this commentary on the Relapse Replication and Extension Project, several points are addressed. First, the selection of the pretreatment "baseline relapse" as the key predictor variable for post-treatment relapse in the predictive and construct validity studies is questioned. It is doubtful whether retrospective accounts of drinking episodes after 4 days of abstinence qualify as relapse episodes for the following reasons: clients may not have been committed to abstinence (e.g. weekend binge drinkers); treatment may have included coping skill training for pretreatment high-risk situations (i.e. treatment intervention is viewed as a "nuisance variable"). By assuming that a client's retrospective report of a poorly defined pretreatment "relapse" is predictive of the type of relapse episode experienced during the post-treatment follow-up assessment is to commit an error of "taxidermy" in evaluating the reliability and validity of the taxonomy; i.e. the tendency for researchers to "stuff and permanently mount" distal baseline episodes as static predictor variables, thereby depriving them of their dynamic and fluid role as proximal determinants in the relapse process. The difference between researchers who assess distal trait predictors of relapse and clinicians who focus more on proximal state predictors in conducting relapse prevention therapy is discussed and illustrated by means of a case study. Finally, the metaphor of relapse as "falling off the wagon" is described as an example of a systems approach to relapse prevention.
在这篇关于复发复制与扩展项目的评论中,讨论了几个要点。首先,在预测性和结构效度研究中,将治疗前的“基线复发”选为治疗后复发的关键预测变量这一做法受到质疑。由于以下原因,禁欲4天后对饮酒事件的回顾性描述是否可被视为复发事件值得怀疑:客户可能并未致力于禁欲(例如周末狂饮者);治疗可能包括针对治疗前高风险情况的应对技能培训(即治疗干预被视为一个“干扰变量”)。假设客户对定义不明确的治疗前“复发”的回顾性报告能够预测治疗后随访评估期间经历的复发类型,这在评估分类法的可靠性和有效性时犯了“标本制作”错误;也就是说,研究人员倾向于将远端基线事件“填充并永久固定”为静态预测变量,从而剥夺了它们在复发过程中作为近端决定因素的动态和灵活作用。文中通过一个案例研究讨论并说明了评估复发远端特质预测因素的研究人员与在进行复发预防治疗时更关注近端状态预测因素的临床医生之间的差异。最后,将复发比喻为“从马车上掉下来”,作为复发预防系统方法的一个例子进行了描述。