Olson D H, Mylan M M, Fletcher L A, Nugent S M, Lynch J W, Willenbring M L
Minneapolis Veterans Affairs Medical Center, Minnesota 55417, USA.
Psychiatr Serv. 1997 Oct;48(10):1317-22. doi: 10.1176/ps.48.10.1317.
The objectives of this study were to develop a measure to assess patients' response to civil commitment, to test this measure on two groups of dually diagnosed patients (medically ill alcoholics and patients with dual mental and substance use disorders), and to identify patient characteristics associated with a positive response to commitment.
The outcome of 38 male veterans civilly committed to inpatient substance abuse treatment for an average of six months was rated by their treating clinicians. Raters used the Commitment Response Form (CRF), a scale anchored to behavioral descriptions that was developed for the study and that measures outcome in five areas: patients' attitude toward recovery, substance use, medical condition, engagement in substance abuse treatment, and independence of functioning. Each patient's medical records were reviewed by two clinical staff members who made independent retrospective ratings and a joint rating using the CRF. They also made independent and joint dichotomous ratings of whether the patient was a positive responder or a nonresponder to civil commitment.
The CRF showed superior reliability when compared with the dichotomous rating of outcome. The scale demonstrated reasonable psychometric properties. Mean scale scores did not differ significantly by patient group; slightly more than half were rated as having a good to excellent overall response. Better outcome was associated with longer periods of previous abstinence from alcohol and a higher level of education.
Use of a scale anchored to behavioral descriptions improved reliability of outcome determinations by clinical staff. Civil commitment resulted in good to excellent outcome in many but not all committed patients.
本研究的目的是开发一种评估患者对民事强制治疗反应的方法，在两组双重诊断患者（患有内科疾病的酗酒者以及患有精神和物质使用双重障碍的患者）中测试该方法，并确定与对强制治疗产生积极反应相关的患者特征。
38名男性退伍军人被民事强制住院接受物质滥用治疗，平均为期6个月，由负责治疗的临床医生对其治疗结果进行评分。评分者使用了承诺反应表（CRF），这是一种基于行为描述制定的量表，专为该研究设计，用于衡量五个方面的结果：患者对康复的态度、物质使用情况、医疗状况、参与物质滥用治疗的情况以及功能独立性。两名临床工作人员审查了每位患者的病历，他们分别进行回顾性评分，并使用CRF进行联合评分。他们还分别和联合对患者是否是民事强制治疗的积极反应者或非反应者进行二分法评分。
与结果的二分法评分相比，CRF显示出更高的可靠性。该量表显示出合理的心理测量特性。量表平均得分在不同患者组之间没有显著差异；略超过一半的患者被评为总体反应良好至优秀。更好的结果与之前更长时间的戒酒以及更高的教育水平相关。
使用基于行为描述的量表提高了临床工作人员对结果判定的可靠性。民事强制治疗在许多但并非所有被强制治疗的患者中产生了良好至优秀的结果。
