Moos R H, King M J, Burnett E B, Andrassy J M
Veterans Affairs Medical Center, Palo Alto, CA 94304, USA.
J Subst Abuse. 1997;9:171-87. doi: 10.1016/s0899-3289(97)90015-8.
The study sought to identify community residential program characteristics that predict patients' participation in treatment and to examine the association between these characteristics, participation, and outcomes at discharge from treatment. A sample of 2,790 patients with substance abuse disorders was assessed at entry into and discharge from 87 community residential facilities (CRFs). The CRFs were assessed using a survey that obtained information about program size and staffing, policies and services, and treatment orientation. High expectations for patients' functioning, clear policies, structured programming, a high proportion of staff in recovery from substance abuse problems, and more emphasis on psychosocial treatment were associated with patients' participation in program services and activities. Higher expectations for functioning and a strong treatment orientation enhanced participation more among better functioning patients; program support and structure enhanced participation more among impaired patients. Participation in treatment independently predicted outcomes at discharge even after both patient and program characteristics were controlled. These findings show that community residential program policies, services, and treatment orientations play a key role in influencing patients' engagement in treatment, which, in turn, improves patients' outcomes at discharge.
该研究旨在确定能够预测患者参与治疗情况的社区居住项目特征，并考察这些特征、参与度以及治疗出院时的结果之间的关联。对2790名患有物质使用障碍的患者在进入87个社区居住设施（CRF）时和出院时进行了评估。使用一项调查对CRF进行评估，该调查获取了有关项目规模和人员配备、政策和服务以及治疗方向的信息。对患者功能的高期望、明确的政策、结构化的项目安排、从物质滥用问题中康复的工作人员比例较高以及对心理社会治疗的更多强调，都与患者参与项目服务和活动有关。对功能的更高期望和强烈的治疗方向在功能较好的患者中更能促进参与；项目支持和结构在受损患者中更能促进参与。即使在控制了患者和项目特征之后，参与治疗也能独立预测出院时的结果。这些发现表明，社区居住项目的政策、服务和治疗方向在影响患者参与治疗方面起着关键作用，而这反过来又改善了患者出院时的结果。
