12-Step Facilitation for the Dually Diagnosed

为双重诊断患者提供 12 步便利

• 批准号: 6970257
• 负责人: Michael Parks Bogenschutz
• 金额: $ 35.88万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6970257
• 关键词: alcoholism /alcohol abuse therapy; behavior therapy; behavioral /social science research tag; clinical research; comorbidity; drug abuse therapy; human subject; human therapy evaluation; major depression; mental disorders; mental health counseling; outcomes research; patient care management; patient oriented research; self help; social support network; substance abuse related disorder; therapy compliance

DESCRIPTION (provided by applicant): Although there has been relatively little work on 12-step treatment for seriously mentally ill patients, extant literature indicates that dually diagnosed individuals attend traditional 12-step programs such as AA, NA, and CA at rates comparable to singly diagnosed substance abusers, and that participation is associated with decreases in substance use. Specialized 12-step programs for the dually diagnosed, developed over the past 10 years, may offer additional benefits. In order to maximize the effectiveness of specialized and traditional 12-step programs for dually diagnosed individuals, specially adapted 12-step facilitation (TSF) treatment for the dually diagnosed should be developed and tested. Standard TSF should be modified to address the special needs of dually diagnosed individuals, mesh with specialized 12-step programs available in the area, and address barriers to attendance, participation, and engagement experienced by the dually diagnosed. We have developed a modified TSF based on the Project MATCH TSF manual. Modifications to this 12 week individual therapy include: emphasis on specialized 12-step program attendance; readings primarily from specialized 12-step program literature; participation in the second session by a community specialized 12-step program member; case management to assist participants in finding and attending meetings; omission of work on the fourth step; and the addition of topics covering medication compliance and specific social skills needed to negotiate 12-step meetings. In a pilot study with 10 dually diagnosed individuals, participants showed significant decreases in substance use and significant increases in 12-step attendance after receiving the specialized TSF. Building on this pilot study, the proposed study is a larger Stage Ib study of the modified TSF for seriously mentally ill patients engaged in dual diagnosis treatment. Participants with a psychotic or major affective disorder will be randomized to modified TSF (n=90) vs. treatment as usual (n=45). Participants will be followed for a total of 48 weeks. Assessments will include rigorous diagnosis and measures of alcohol and other drug use, consequences, psychiatric symptoms, 12-step behaviors, 12-step specific and non-specific change mechanisms, and social support. Specific Aims of the study include assessment of the integrity of the planned intervention and assessment battery; tests of the effectiveness of the adapted TSF relative to treatment as usual; determination of whether psychiatric diagnosis moderates treatment response; and investigation of causal mechanisms of response to treatment.

描述（由申请人提供）：虽然针对严重精神疾病患者的 12 步治疗的工作相对较少，但现有文献表明，双重诊断的个体参加传统 12 步治疗方案（如 AA、NA 和 CA）的比例与单一诊断的药物滥用者，参与与药物使用的减少有关。过去 10 年来针对双重诊断患者制定的专门 12 步计划可能会带来额外的好处。为了最大限度地提高针对双重诊断个体的专业和传统 12 步计划的有效性，应开发和测试专门针对双重诊断患者的 12 步促进 (TSF) 治疗。 应修改标准 TSF，以满足双重诊断个体的特殊需求，与该地区可用的专门 12 步计划相结合，并解决双重诊断患者在出席、参与和参与方面遇到的障碍。我们根据 Project MATCH TSF 手册开发了修改后的 TSF。 对这一 12 周个体治疗的修改包括： 强调参加专门的 12 步计划；主要阅读专门的 12 步程序文献；由社区专业 12 步计划成员参加第二次会议；案例管理，协助参与者寻找和参加会议；遗漏了第四步的工作；并添加了涵盖药物依从性和谈判 12 步骤会议所需的特定社交技能的主题。在一项针对 10 名双重诊断个体的试点研究中，参与者在接受专门的 TSF 后，药物使用显着减少，12 步出勤率显着增加。在这项试点研究的基础上，拟议的研究是针对接受双重诊断治疗的严重精神疾病患者进行改良 TSF 的更大规模的 Ib 期研究。患有精神病或严重情感障碍的参与者将被随机分配接受改良 TSF（n=90）与常规治疗（n=45）。参与者将被跟踪总共 48 周。评估将包括对酒精和其他药物使用、后果、精神症状、12步行为、12步特定和非特定改变机制以及社会支持的严格诊断和测量。该研究的具体目标包括评估计划干预和评估组合的完整性；测试调整后的 TSF 相对于常规治疗的有效性；确定精神病学诊断是否会调节治疗反应；以及对治疗反应的因果机制的调查。