AA与戒酒的十二个步骤——访美国嗜酒者互诫协会札记

ＡＡ(ＡｌｃｏｈｏｌｉｃｓＡｎｏｎｙｍｏｕｓ)的戒酒方案见诸于几乎所有有关药物依赖的教科书。在世界范围内 ,采纳ＡＡ十二个步骤的治疗原则来实现戒除成瘾性障碍的组织 (如ＮＡ :ＮａｒｃｏｔｉｃｓＡｎｏｎｙｍｏｕｓ ,ＣＡ :ＣｏｃａｉｎｅＡｎｏｎｙｍｏｕｓ等 )已超过 2 5 0个。据ＡＡ 2 0 0 0年公布的统计结果显示 ,ＡＡ目前共有会员 2 16万 ,10万多个小组 ,分布在世界 15 0多个国家。尽管有些人士认为ＡＡ不是一个科学的治疗方法 ,但其影响之广 ,会员之众已引起越来越多人士的注意。ＡＡ的中文名称有“嗜酒者互诫协会”、“匿名戒…     

嗜酒者互诫协会（Alcoholics Anonymous,A.A）介绍

嗜酒者互诫协会（ＡｌｃｏｈｏｌｉｃｓＡｎｏｎｙｍｏｕｓ，Ａ．Ａ）介绍仇剑崟，王祖承（上海第二医科大学精神医学教研室）酒类饮料的酿造和饮用已有数千年历史。人类的适量饮酒是一种可以接受的公开行为，但如果长期酗酒将导致酒精依赖和酒中毒。因此，酗酒对个人健康...     

协助开办AA小组会的体会

互诫协会（AlcoholicsAnonymous，AA）的戒酒方案几乎被所有药物依赖相关书刊所介绍，其影响是世界性的。所有分会全部采纳“十二个传统”与“十二个步骤”来开展活动并以此为原则帮助嗜酒者控制酒瘾、保持清醒。2002年10月17日，我院在美国健康促进中心BillArcher先生、北京大学精神卫生研究所李冰博士和北京的三名AA成员的帮助下，成立了河北省“嗜酒者互诫协会”。协会每周活动一次，每次活动1—2h，已有23名会员。现将3年来的活动体会以及改良意见介绍如下：     

团队心理护理结合运动疗法在酒依赖患者治疗中的应用研究

目的：探讨团队心理护理结合运动疗法在酒依赖患者治疗中的临床疗效及其作用机制。方法：选取2020年1月—2021年6月在我院治疗的100例酒依赖患者作为研究对象,采用随机数字表法将其分为对照组（n=50）和联合组（n=50）。对照组采用团队心理护理,联合组采用团队心理护理结合运动疗法,比较两组治疗前后饮酒渴求度（VAS）、酒精依赖程度（CIWA-Ar）及治疗后1个月、6个月复饮率。结果：两组治疗后VAS、CIWA-Ar评分低于治疗前,且联合组低于对照组,差异有统计学意义（P<0.05）;治疗后1个月,联合组复饮率为4%,低于对照组的10%,差异无统计学意义（P>0.05）;治疗后6个月,联合组复饮率为8.0%,低于对照组的26.0%,差异有统计学意义（P<0.05）。结论：团队心理护理结合运动疗法可以更好地减轻患者饮酒渴求度、酒精依赖程度,降低复饮率,改善患者生活质量。     

心理疗法对酒依赖患者戒酒的影响

目的:研究心理疗法对有酒依赖症的患者的戒酒情况的干预效果。方法:选取2010年1月～2012年12月来我院接受戒酒治疗的患者63例,均为住院治疗,将其随机分组,分别为33例实验组和30例对照组。对对照组实行常规药物治疗,实验组在对照组的基础上采用心理疗法。经过为期两个月的治疗,在其后的随访中了解两组酒依赖情况和复饮率,比较分析。结果:在其后的随机访问中实验组有1例未获得成功随访,对照组有4例发生此类情况。故实际纳入对比分析的病例为32例实验组和26例对照组。随访中调查的复饮率数据:对照组为77%,实验组为25%,实验组明显优于对照组,比较差异具有统计学意义(P<0.05)。结论:心理疗法对酒依赖患者戒酒有较好疗效,值得在实际临床中推广。     

内观疗法治疗酒依赖及随访

目的 :探讨内观疗法治疗酒依赖患者的疗效及复发率。方法 :采用明尼苏达多项人格调查测试了 2 3例酒依赖患者 ,并与全国常模对照 ,住院期间应用集中内观 ,出院后定期随访 ,认真操练 ,使患者保持内心体验。结果 :通过随访治疗 ,3个月有 1 7例完全戒酒 ,6个月有1 3例完全戒酒。结论 :内观疗法是一种治疗酒依赖较为有效的方法。     

中医药方法戒酒的研究

在医学上，我们称酗酒无度造成各种不良后果者为酒滥用(alcohol abuse)；称无法摆脱酒的纠缠，对酒已形成心理及／或躯体依赖者为酒依赖(alcohol dependence)。对个体而言，酒滥用和酒依赖均会造成各种危害。酒滥用和酒依赖是当今世界的严重社会问题和医学问题，据统计，仅美国就有1300万人酗酒成瘾，而酒依赖及其相关问题是仅次于心血管疾病、肿瘤，居于第3位的公共卫生问题。     

阅读治疗对酒依赖患者心理康复的影响

目的探讨阅读治疗对酒依赖患者心理康复的效果。方法介绍阅读治疗的方法并提供书籍,对68例住院酒依赖患者开展阅读治疗。结论阅读治疗可起到了解酒依赖患者心理状况,促进心理康复的作用。     

群体性康复训练在酒依赖患者治疗中的研究应用

酒依赖是目前世界较严重的社会问题和医学问题,所涉及的原因较复杂,既与社会文化有关又与个体的生活及心理素质有关[1]。群体性康复训练是将住院接受治疗的酒依赖患者集中在一起,以群体形式通过讲座、讨论问题,技能训练,问题解答等方式来达到治疗疾病的一种康复训练方法,酒依赖患者有明显的人格障碍[2],具有易冲动,自控能力差,     

家庭心理干预对酒依赖者患者复饮率的影响

目的探讨家庭心理干预对酒依赖者患者复饮率的影响。方法将2004年1月至2006年1月住我院的酒依赖者患者65例随机分为干预组(n=30)和对照组(n=35),干预组进行心理治疗,并对家属进行系统健康教育,对照组单纯药物替代疗法,两组疗程均为2个月,随访6个月,比较复饮率。结果干预组复饮率(26.7%,8/30),低于对照组(74.3%,26/35),差异有显著性(P<0.05)。结论对酒依赖者患者进行家庭心理干预可降低患者复饮率。     

Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffiliation after treatment?

Twelve Steps (TS) has demonstrated effectiveness; induction into Alcoholics Anonymous (AA) is a primary objective of TS and is a pivotal mechanism explaining its effectiveness. However, evidence suggests that, after treatment, dropout from AA is high. This study investigated whether alcohol problem severity predicted both AA affiliation and disaffiliation among clients receiving TS. This study of a Project MATCH sample included 453 alcohol-dependent clients randomly assigned to TS who reported AA attendance during treatment. Greater alcohol problem severity predicted AA attendance; opposite to prediction, less alcohol-impaired clients were more than twice as likely to discontinue AA attendance after treatment. When sustained AA attendance is desired, the evaluation of client pretreatment alcohol involvement may be useful for identifying potential AA dropout after TS treatment. Findings also indicate that, among treatment-seeking problem drinkers, AA dropout and disaffiliation are distinct, albeit correlated, constructs that require future investigation.     

Recovery: With and Without Self-Help

Although self-help/mutual-help groups, like Alcoholics Anonymous, are important factors in the recovery of many chemically dependent individuals, the large dropout rates from such groups and the awareness that many who drop out do not return to dependent behavior raises interesting questions about other paths to sustained abstinence and recovery. Current emphasis on treatment outcome studies provides a means for researching factors in both those who recover with and without the assistance of self-help/mutual-help groups. The authors suggest some questions which might be investigated.     

Predictors of Membership in Alcoholics Anonymous in a Sample of Successfully Remitted Alcoholics

Abstract

This study identifies factors associated with Alcoholics Anonymous (AA) membership in a sample of 81 persons who have achieved at least one year of total abstinence from alcohol and other drugs. Forty-four were AA members, 37 were not. Logistic regression was used to test the cross-sectional associations of baseline demographic, substance-related, spiritual and religious, and personality variables with AA membership. Significant variables from the bivariate analyses were included in a multivariate model controlling for previous AA involvement. Having more positive views of God and more negative consequences of drinking were significantly associated with AA membership. This information can be used by clinicians to identify clients for whom AA might be a good fit, and can help others overcome obstacles to AA or explore alternative forms of abstinence support.     

Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders

AIMS: This study examined changes over a 16-year interval and predictors of stable remission among previously untreated individuals with alcohol-use disorders who did not obtain help or who entered either alcoholics anonymous (AA) or professional treatment in the first year after initially seeking help. DESIGN AND MEASURES: A sample of individuals (N = 461) who initiated help-seeking was surveyed at baseline and 1, 3, 8, and 16 years later. In addition to providing information on life history of drinking at each contact point, participants described their current alcohol-related and psychosocial functioning and life context, and coping responses. FINDINGS: Irrespective of whether or not individuals obtained help, their alcohol-related functioning, life context, and coping improved. However, individuals who obtained help (AA or treatment) in the first year improved more and were more likely to achieve stable remission than those who did not. Nevertheless, the factors associated with stable remission were comparable for individuals who did and those who did not obtain timely help. CONCLUSIONS: Compared with individuals who do not obtain timely help, those who enter either AA or treatment relatively soon after initiating help-seeking improve more quickly and achieve higher long-term remission rates.     

Treating Chemical Dependency: The Need for Including the Family

Regression analysis was used to test Family Systems Therapy as a fruitful approach in chemical dependency treatment. Results indicate that the concerned person's perceptions of family life are critical in determining whether a family completes therapy or terminates early. Using both family and individual level variables, the significance and direction of the coefficients are consistent with the Family Systems Therapy model. Results support the importance of including the family in chemical dependency treatment     

The Role of Religion and Spirituality in Recovery from Drink Problems: A Qualititative Study of Alcoholics Anonymous Members and South Asian Men

Aim: The purpose of this study was to explore the spiritual aspect of recovery for people with drink problems through carrying out a comparative analysis of South Asian men recovering from drink problems and White members of AA. Method: In-depth semi-structured interviews were carried out with participants to explore significant factors that assisted recovery. Interviews were analysed using grounded theory. Participants: Ten participants in total were interviewed, five were South Asian men receiving individual and/or group counselling with South Asian therapists either in an NHS or non-statutory specialist alcohol treatment service, five were white members of AA. Findings and Conclusions: Models of recovery for the two groups were developed and are presented. Spirituality and religion played an important role in the experiences of recovery described by AA and South Asian participants respectively. For AA participants their experiences reflected those described in AA's Big Book although concepts such as that of a Higher Power were complex and multi-layered, with spirituality just one, albeit significant, aspect. South Asian participants generally underwent a re-affirmation of existing beliefs rather than the conversion type of experience described by AA participants. The findings are discussed in relation to implications for service delivery and development and directions for future research.     

Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation

Participation in 12-step groups (12SG) during and after formal treatment has been associated with positive outcome among substance users. However, the effectiveness of 12SG may be limited by high attrition rates and by low participation, areas on which there has been little research. Clinicians play an important role in fostering 12-step participation, and the insights which they develop in their practice can greatly contribute to informing the research process. Yet, little is known about clinicians’ attitudes about 12-step groups or about their experiences in referring clients. This study surveyed clients (N = 101) and clinicians (N = 102) in outpatient treatment programs to examine 12-step-related attitudes and to identify potential obstacles to participation. Data collection was conducted between 05, 2001 and 01, 2002 in New York City. Both client and clinician samples were primarily African-American and Hispanic; 32% of clients reported substance use in the previous month, with crack and marijuana cited most frequently as the primary drug problem. On average, clinicians had worked in the treatment field for 8 years. Both staff and clients viewed 12SG as a helpful recovery resource. Major obstacles to participation centered on motivation and readiness for change and on perceived need for help, rather than on aspects of the 12-step program often cited as points of resistance (e.g., religious aspect and emphasis on powerlessness). Clinicians also frequently cited convenience and scheduling issues as possible obstacles to attending 12SG. Clinical implications of these findings are discussed, including the importance of fostering motivation for change, the need to assess clients’ beliefs about and experiences with 12SG on a case-by-case basis, and to find a good fit between clients’ needs and inclinations on the one hand, and the tools and support available within 12-step groups on the other.     

Young People in Alcoholics Anonymous: The Role of Spiritual Orientation and AA Member Affiliation

Empirical findings characterizing long-term, committed Alcoholics Anonymous (AA) members are limited, particularly among younger members. The authors studied a sample of 266 highly committed attendees (mean age, 27 years) at an annual conference of Young People in Alcoholics Anonymous (YPAA), whose first encounter with AA was 6 years previously. Most (72%) had abused drugs and alcohol, and 36% had never received substance abuse treatment. They now reported a mean duration of abstinence of 44 months and had attended an average of 233 AA meetings in the previous year; 66% had served as AA sponsors, and 92% reported experiencing an AA “spiritual awakening,” itself associated with a decreased likelihood of alcohol craving. Scores on AA beliefs, affiliation to other members, and the experience of spiritual awakening were associated with lower depression scores. These findings are discussed to clarify the nature of long-term AA membership.     

Pharmacy Students’ Attitudes About Treating Patients With Alcohol Addiction After Attending a Required Mutual Support Group

Objective. To implement required attendance at mutual support groups for addiction recovery as a pharmacy skills laboratory exercise, and to evaluate how attendance affected pharmacy students’ attitudes about caring for patients with addiction.Design. Third-year (P3) pharmacy students enrolled in a Pharmacy Skills Laboratory course were required to watch an introductory video about Alcoholics Anonymous (AA) and then attend 2 “open meetings” during the semester. Students submitted a written reflection as proof of attendance.Assessment. Pharmacy students who agreed to participate in the study completed the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) during the course orientation and again at the end of the semester. Mutual support group attendance significantly affected the students’ attitudes within the domains of role adequacy, task specific self-esteem, and work satisfaction. Significant changes were not observed within the domains of motivation and role legitimacy.Conclusion. Mutual support group attendance exposed pharmacy students to the negative effects of alcohol abuse and increased their self-confidence to provide care to patients with alcohol addiction.     

Effectiveness of Making Alcoholics Anonymous Easier: A group format 12-step facilitation approach

Most treatment programs recommend clients attend 12-step groups, but many drop out posttreatment. The effectiveness of Making Alcoholics Anonymous [AA] Easier (MAAEZ ), a manual-guided intervention designed to help clients connect with individuals encountered in AA, was tested using an “OFF/ON” design (n = 508). MAAEZ effectiveness was determined by comparing abstinence rates of participants recruited during ON and OFF conditions and by studying the effect of the number of MAAEZ sessions attended. At 12 months, more clients in the ON condition (vs. OFF) reported past 30-day abstinence from alcohol (p = .012), drugs (p = .009), and both alcohol and drugs (p = .045). In multivariate analyses, ON condition participants had significantly increased odds of abstinence from alcohol (odds ratio [OR] = 1.85) and from drugs (OR = 2.21); abstinence odds also increased significantly for each additional MAAEZ session received. MAAEZ appeared especially effective for those with more prior AA exposure, severe psychiatric problems, and atheists/agnostics. MAAEZ represents an evidence-based intervention that is easily implemented in existing treatment programs.