Peteet J R, Brenner S, Curtiss D, Ferrigno M, Kauffman J
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Gen Hosp Psychiatry. 1998 Sep;20(5):267-73. doi: 10.1016/s0163-8343(98)00033-4.
Despite recent advances in its understanding and treatment, addiction remains a difficult challenge for clinicians within medical settings such as the general hospital. The use of single, traditional paradigms (disciplinary, therapeutic, educational, or libertarian) for approaching addiction-related problems have often failed to embrace the complexity of the patients' motivation to change. Prochaska and DiClemente's [7] stage of change model offers a realistic, practical, and broadly applicable means by which clinicians can facilitate behavioral change from the stage of denial (precontemplation) through that of sustained recovery (maintenance). Clinicians can help addicted individuals to move from precontemplation to contemplation by enhancing their ambivalence; from contemplation to preparation by considering their history of change; from preparation to action by flexibly intervening based on this understanding; and from action to maintenance by evaluating the outcomes of these interventions. A stage of change model is also useful in understanding the process of change in clinicians' own approaches to patients with substance use disorders.
尽管在成瘾的理解和治疗方面最近取得了进展，但成瘾对于综合医院等医疗环境中的临床医生来说仍然是一项艰巨的挑战。使用单一的传统模式（学科、治疗、教育或自由主义模式）来处理成瘾相关问题，往往无法涵盖患者改变动机的复杂性。普罗查斯卡和迪克莱门特的改变阶段模型提供了一种现实、实用且广泛适用的方法，临床医生可以通过该方法促进行为从否认阶段（前 contemplation）转变为持续康复阶段（维持阶段）。临床医生可以通过增强成瘾个体的矛盾心理，帮助他们从否认阶段进入思考阶段；通过考虑他们的改变历史，帮助他们从思考阶段进入准备阶段；基于这种理解进行灵活干预，帮助他们从准备阶段进入行动阶段；通过评估这些干预的结果，帮助他们从行动阶段进入维持阶段。改变阶段模型对于理解临床医生自身处理物质使用障碍患者方法的改变过程也很有用。
