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1.
We conducted a survey of the attitudes of postgraduate medical trainees in Australia on the management of drug and alcohol problems and examined the medical practitioner's role in managing drug and alcohol problems, factors influencing prognosis and beliefs about the efficacy of a number of treatment interventions. Of 2461 trainees enrolled in specially training programmes in internal medicine, psychiatry and general practice 1361 (55%) participated. There was a high level of acceptance of responsibility for management of alcohol and drug problems, with the strongest support observed among psychiatry trainees. However, views of the efficacy of various treatment interventions were less positive. Alcoholics Anonymous was considered to be an approach well supported by the research literature. Dynamic psychotherapy was less well supported, and there was considerable uncertainty about the evidence for brief advice and cognitive-behaviour therapies. The opinions expressed on treatment efficacy were in many cases in striking contrast to the research evidence. The implications for future training in drugs and alcohol in specialty programmes are discussed.  相似文献   

2.
AIMS: Over the last three decades, the randomized controlled trial or 'psychotherapy technology' approach has been the dominant model of inquiry in research on addiction treatment. This period has yielded impressive discoveries, but recent failures to confirm core research hypotheses such as occurred in Project MATCH and the Cocaine Collaborative Treatment Study have raised questions about future research directions. The paper identifies several testable assumptions of the psychotherapy technology model. METHODS: A review is conducted on four substance use disorder behavioral interventions--motivational interviewing, cognitive-behavioral treatment, behavioral couples treatment and 12-Step-oriented treatment--to determine whether these assumptions are supported by research findings. RESULTS: Overall, the review suggests weak support for the technology model of psychotherapy research. Lack of support is interpreted as indicating flaws in several model assumptions about how to conceptualize and measure patient responsivity and the interaction of non-specific and specific therapeutic factors. The paper offers alternative strategies for addressing these issues drawn from the general psychotherapy process literature and provides illustrative examples of how these could be used to spur innovation in addiction treatment research. CONCLUSIONS: The addiction treatment research field is coming up against the limitations of the psychotherapy technology model as the dominant paradigm guiding treatment research. It is important for addiction treatment researchers to explore alternative conceptualizations and methodologies in order to understand more clearly how treatment works.  相似文献   

3.
Although participation in 12-step programs is now widely utilized as a treatment aftercare resource by individuals with drug and alcohol problems, little is known about the effectiveness of such a practice. This paper identifies gaps in the existing literature and articulates methodological concerns that may compromise investigations of 12-step programs. It highlights the need for additional after-treatment studies, and it presents findings from a 24-month longitudinal after-treatment study that suggests the effectiveness of 12-step programs. Rather than a behavioral indicator of recovery motivation or a spurious relationship confounded by additional treatment, aftercare, or alumni activities that occur simultaneously with 12-step participation, the findings suggest that weekly or more frequent 12-step participation is associated with drug and alcohol abstinence. Less-than-weekly participation is not associated with favorable drug and alcohol use outcomes, and participation in 12-step programs seems to be equally useful in maintaining abstinence from both illicit drug and alcohol use. These findings point to the wisdom of a general policy that recommends weekly or more frequent participation in a 12-step program as a useful and inexpensive aftercare resource for many clients.  相似文献   

4.
毕洪钟 《胃肠病学》2012,17(10):636-638
精神心理因素在肠易激综合征(IBS)发病机制中的作用越来越引起广大临床医师的重视。随着社会竞争压力的增大,仅靠药物治疗已无法完全改善IBS患者的临床症状,行为心理学疗法的疗效目前已得到认可。行为心理学疗法的目的并不是为了完全治愈疾病,而是为了缓解临床症状,节省医疗开支,提高患者生活质量。本文就行为心理学疗法治疗IBS的研究进展作一综述。  相似文献   

5.
BACKGROUND Screening for substance abuse and mental health in primary care can improve detection. One way to advance screening is for health plans to require it. OBJECTIVES We developed national estimates of the prevalence and type of mental and substance-use condition screening health plans require of primary care practitioners. DESIGN In 1999 (N = 434, response rate = 92%) and 2003 (N = 368, response rate = 83%), we conducted a nationally representative health plan survey regarding alcohol, drug, and mental health services, including screening requirements. PARTICIPANTS Health plans reported on screening requirements of their top three private insurance products. Products were categorized by type (HMO, POS, or PPO), behavioral health contracting arrangements, tax status, market area population, and region. MEASUREMENTS We asked whether primary care practitioners are required to use a general health screening questionnaire (including mental health, alcohol, or drugs items) and/or a screening questionnaire focused on mental health, alcohol, or drug problems. RESULTS By 2003, 34% of products had any behavioral health screening requirements. Although there was no increase from 1999 to 2003 in requirements for any kind of behavioral health screening, requirements for using a standard screening instrument declined for mental health but increased for alcohol and drug screening. PPOs showed the largest increase in prevalence of behavioral health screening requirements. Products contracting with managed behavioral health organizations were more likely to require screening. CONCLUSIONS Most products do not require behavioral health screening in primary care. More screening could help to improve identification of behavioral health conditions, a first step towards effective treatment.  相似文献   

6.
Aims. To evaluate disulfiram and three forms of manual guided psychotherapy for individuals with cocaine dependence and concurrent alcohol abuse or dependence. Design. Randomized controlled trial. Setting. Urban substance abuse treatment center. Participants. One hundred and twenty-two cocaine/alcohol abusers (27% female; 61% African-American or Hispanic). Interventions. One of five treatments delivered over 12 weeks: cognitive behavioral treatment (CBT) plus disulfiram; Twelve Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT plus no medication; TSF plus no medication. Measurements. Duration of continuous abstinence from cocaine or alcohol; frequency and quantity of cocaine and alcohol use by week, verified by urine toxicology and breathalyzer screens. Findings. Disulfiram treatment was associated with significantly better retention in treatment, as well as longer duration of abstinence from alcohol and cocaine use. The two active psychotherapies (CBT and TSF) were associated with reduced cocaine use over time compared with supportive psychotherapy (CM). Cocaine and alcohol use were strongly related throughout treatment, particularly for subjects treated with disulfiram. Conclusions. For the large proportion of cocaine-dependent individuals who also abuse alcohol, disulfiram combined with outpatient psychotherapy may be a promising treatment strategy. This study underlines (a) the significance of alcohol use among treatment-seeking cocaine abusers, (b) the promise of the strategy of treating co-morbid disorders among drug-dependent individuals, and (c) the importance of combining psychotherapy and pharmacotherapy in the treatment of drug use disorders.  相似文献   

7.
Although participation in 12-step programs is now widely utilized as a treatment aftercare resource by individuals with drug and alcohol problems, little is known about the effectiveness of such a practice. This paper identifies gaps in the existing literature and articulates methodological concerns that may compromise investigations of 12-step programs. It highlights the need for additional after-treatment studies, and it presents findings from a 24-month longitudinal after-treatment study that suggests the effectiveness of 12-step programs. Rather than a behavioral indicator of recovery motivation or a spurious relationship confounded by additional treatment, aftercare, or alumni activities that occur simultaneously with 12-step participation, the findings suggest that weekly or more frequent 12-step participation is associated with drug and alcohol abstinence. Less-than-weekly participation is not associated with favorable drug and alcohol use outcomes, and participation in 12-step programs seems to be equally useful in maintaining abstinence from both illicit drug and alcohol use. These findings point to the wisdom of a general policy that recommends weekly or more frequent participation in a 12-step program as a useful and inexpensive aftercare resource for many clients.  相似文献   

8.
BACKGROUND: Individuals with comorbid alcohol and drug use disorders are at particularly high risk for a variety of problems, including other psychiatric disorders. In general, patients with comorbid alcohol and drug dependence tend to have more severe dependence problems and often have poorer treatment outcomes than individuals with single disorders. For treatment-seeking pregnant women, psychiatric comorbidity can lead to relapse and premature treatment dropout, with adverse consequences to mother and infant. METHODS: Psychopathology, as measured by the Minnesota Multiphasic Personality Inventory-Revised (MMPI-2), was examined in 170 pregnant women admitted to a comprehensive treatment program for cocaine or opiate dependence. Most were single (75%) and African American (80%), with a mean age of 29 years. Thirty-six met DSM-III-R criteria for both alcohol and drug dependence (alcohol positive), whereas 134 were drug dependent only (alcohol negative). RESULTS: Alcohol-positive women had higher levels of psychopathology than alcohol-negative women, with higher scores on scales 2 (Depression), 4 (Psychopathic Deviance), 8 (Schizophrenia), and 0 (Social Introversion; p < 0.05). The mean MMPI-2 profile for alcohol-positive women was 2-4-8 (Depression-Psychopathic Deviance-Schizophrenia; all T-scores > 65), whereas alcohol-negative women had only a scale 4 increase. CONCLUSIONS: Results suggest that pregnant, drug-dependent women with comorbid alcohol dependence present for treatment with greater psychopathology and thus may require more intense interventions than pregnant, drug-dependent women without comorbid alcohol dependence. Alcohol use by pregnant women is particularly important to address in treatment, because alcohol is a known teratogen associated with mental retardation and behavioral problems.  相似文献   

9.
Alcohol and other drug problems experienced by adolescents who use only alcohol compared to those who use both alcohol and marijuana (A+M) is studied. Using the national longitudinal survey of youth 1994 data, forward multiple regression analyses revealed that impulsivity, A+M use (compared to alcohol-only use), age, sex, religiosity, frequency of substance use were associated with a higher number of behavioral problems. Youth with more alcohol problems were found to be binge drinkers, impulsive, more frequent alcohol users, and nonHispanic. Implications and future research needs are discussed.  相似文献   

10.
Aims To compare representative treatment and untreated samples of alcohol‐dependent individuals in rates of abstinence and non‐problematic use at 1‐year follow‐up. Participants and design A total of 482 alcohol‐dependent adults in a northern California county identified through a probability survey of problem drinkers in the general population (n = 111) or a survey of consecutive admissions to public and private substance abuse programs (n = 371) were interviewed in person at baseline and by telephone at 1 year. Measurements Logistic regression models were used to predict 30‐day abstinence and 12‐month non‐problematic alcohol use. Results At follow‐up, alcohol‐dependent individuals in the treatment sample had higher abstinence rates and non‐problematic use outcomes than those in the untreated general population sample. In logistic regression models of the merged samples, being in the treatment sample was related strongly and positively to abstinence and non‐problematic use. Having more drug users and heavy drinkers in one's social network, higher psychiatric comorbidity, and more social consequences were inversely related to abstinence and non‐problematic use in the treatment sample. The number of drug users and heavy drinkers in one's social network was also inversely related to abstinence in both the treatment and untreated general population samples. Results predicting non‐problematic use were similar. Conclusions These results are consistent with other studies that examine treatment effectiveness in the absence of a controlled trial. Although natural recovery also occurs, alcohol‐dependent individuals benefit from treatment. Co‐occurring psychiatric problems continue to be major barriers to treatment effectiveness. An emphasis on changing social networks to be conducive to recovery could heighten both clinical effectiveness and prevention efforts within communities.  相似文献   

11.
Alcohol and other drug problems experienced by adolescents who use only alcohol compared to those who use both alcohol and marijuana (A + M) is studied. Using the national longitudinal survey of youth 1994 data, forward multiple regression analyses revealed that impulsivity, A + M use (compared to alcohol-only use), age, sex, religiosity, frequency of substance use were associated with a higher number of behavioral problems. Youth with more alcohol problems were found to be binge drinkers, impulsive, more frequent alcohol users, and nonHispanic. Implications and future research needs are discussed.  相似文献   

12.
A content analysis was done on 1,239 articles published from 1984 to 1987 in seven leading alcohol and addiction journals to ascertain the frequency of articles on psychotherapeutic treatment published relative to other treatments for alcohol and drug dependence. Therapeutic intervention articles account for less than 10% and psychotherapy treatment articles for less than 3% of the articles analyzed. Postulations such as the effects of a prevailing acceptance of the disease model to level of practitioner sophistication are made about this relatively small number. Nontherapeutic treatment articles are classified according to research methodology. Suggestions for research are made.  相似文献   

13.
Background:  In addictions treatment research, there has been a relative paucity of work on mechanisms of action that account for observed treatment effects. In studies that have been done, there is little evidence that the purported active ingredients of behavioral interventions such as cognitive-behavioral treatment or motivational interviewing actually mediate treatment effects. This suggests that new approaches are needed to study the process of change in behavioral treatments for addiction.
Method:  This article reviews several approaches that have been taken by psychotherapy researchers to identify mechanisms of change, including studies of critical sessions, change across sessions, and the relative importance of general vs. specific therapeutic factors.
Results:  These approaches all involve careful assessment of both therapist and patient behaviors during treatment sessions and study the relation of these factors to improvements or deteriorations in symptoms over the following weeks.
Conclusions:  Suggestions are offered for how these methods could be used in addiction treatment research to generate hypotheses regarding mechanisms of change that could subsequently be tested in controlled studies.  相似文献   

14.
Issues in clinical trials with the depressed elderly   总被引:1,自引:0,他引:1  
Despite the fact that there is a high prevalence of depression among the elderly, little research on the efficacy of psychotherapy or pharmacotherapy with the elderly has been reported in the literature. This paper describes a sample of 18 elderly patients who received both psychotherapy and pharmacotherapy for the treatment of depression. Psychotherapy involved weekly 30-50 minutes sessions of interpersonal psychotherapy with a treating psychiatrist. The drug treatment consisted of random assignment, double-blind, to either alprazolam, imipramine, or pill-placebo for six weeks. The focus of therapy was on the attendance, compliance, and symptomatic relief in elderly depressed patients, as well as on the major life problems identified by these patients in psychotherapy. Results indicated that elderly patients respond to community publicity regarding a psychotherapy treatment program. However, the majority are inappropriate referrals for diagnostic reasons. If accepted, elderly patients showed good compliance with drugs, and attendance was comparable to that in younger populations. The elderly patients responded well to treatment, with immediate and marked improvement on the Hamilton and Raskin Depression Scales, which was maintained after treatment. Grief and role transitions specific to life changes were frequent antecedents to depression in this elderly population and thus were the major foci in psychotherapy.  相似文献   

15.
From a comparison of the literature concerning treatment outcome in general psychotherapy and alcoholism it is argued that there are substantial similarities in predictive factors. It is suggested that therapist factors may be as important in the treatment of alcoholism as in general psychotherapy, and that future alcoholism treatment research ought to be designed in a way which would make it possible to evaluate this possibility.  相似文献   

16.
Abstract. This article should be considered not in isolation but in a context of private health provision in general, and examined from an international standpoint. In the UK there has been a growth of private health care and as pan of this growth, it is likely that patients with problems of alcohol and drug misuse will choose private facilities, which now increasingly exist. Patterns of treatment in any country are based on historical traditions. Thus in the UK the principle NHS response has been to provide specialised alcoholism treatment units, which increasingly provide out-patient and day facilities, as well as in-patients. Although there has been criticism of these units, they remain the principle approach. In West Germany in-patient treatment has been the norm. In other countries in Northern Europe emphasis has been on out-patient treatment with a strong social bias. More important, however, is that clearly patients with alcohol or drug problems, once they recognise such problems, wish to attend a treatment facility where they feel they will receive expert treatment. Their experience with non-specialized agencies is often said to be negative and it is not surprising if they turn towards such specialized units, in the same way as patients with other medical conditions all seek specialist expertise. Patients are hardly likely to have analyzed research studies on effectiveness of treatment and it is questionable whether many studies alleging failure of treatment take into account poor compliance. Both on historical, traditional and common sense lines it is, therefore, likely that people will pursue private treatment, despite what so called experts say.  相似文献   

17.
Medication treatment for alcohol use disorders often includes a psychotherapy component. The most appropriate psychotherapy to use may depend upon characteristics of the patient, the medication, the setting, and the experiences of the provider. To date, little empirical research has investigated these issues with respect to outcomes in clinical trials that combine pharmacotherapy and psychotherapy. This paper reviews seven major types of psychotherapy for treatment of alcohol use disorders: brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, cue exposure therapy, behavioral treatments, behavioral marital therapy, and twelve-step therapy. The theoretical basis for and empirical evidence supporting the efficacy of the therapies are reviewed, with an emphasis on studies that provided pharmacotherapy in conjunction with psychotherapy. Directions for future research in this area are also suggested.  相似文献   

18.
The present study examined the effects of general and specific psychotherapy role induction on return rates and attendance in psychotherapy for substance-abusing clients. The subjects were 111 of 129 consecutive applicants to a community outpatient drug treatment center. Following a standard intake interview, clients received either a general psychotherapy role induction or a drug treatment specific role induction, or were placed in one of two control conditions. Results indicated that clients who received role induction procedures were more likely than controls to return after the intake interview. Furthermore, clients who received the drug treatment specific role induction returned at a significantly higher rate than all other clients. Analysis of attendance rates after 3 months showed that role induction had no effect on continuation in treatment.  相似文献   

19.
Treatment entry and predictors among opiate-using injection drug users   总被引:3,自引:0,他引:3  
This study examines entry into drug treatment among 491 street-recruited injection drug users in Denver, Colorado. The primary outcome was treatment entry within 6 months. Univariate tests were run using chi-square t-test analyses. Significant variables were included in a multiple logistic regression. Results showed that having more outreach contacts, not being homeless, having fewer problems with alcohol but more problems with drugs, and the contemplation or determination stage of change were associated with entering treatment. The identification of predictors of treatment entry may be useful for treatment centers in engaging certain populations of drug users. Behavioral interventions are an important tool in recruiting drug injectors into treatment.  相似文献   

20.
AIM: To develop a model of change during and following professional treatment for drinking problems, grounded in clients' accounts. PARTICIPANTS: Subsets of consecutively selected clients of the UK Alcohol Treatment Trial (UKATT), followed-up at 3 months (n = 211) and 12 months (n = 198) after randomization. Location Five statutory and non-statutory alcohol problems treatment agencies in three areas of England and Wales. Data Open-ended interviews conducted according to a brief interview guide, leading to 400-800-word post-interview reports used for analysis (tape-recordings used for auditing purposes). ANALYSIS: Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive batch of data. FINDINGS: A model of change from the clients' perspective was developed. Treatment was seen by clients as facilitating various changes in ways of thinking and/or increased support of various kinds from family and friends, along with new ways of acting in relation to drinking or more generally. For many those changes had led to an appreciation of the benefits accruing to them. Treatment was seen as part of a broader treatment system which included pretreatment assessment, forms of help additional to the trial treatment, plus an element of self-directed change during and following treatment. Taken with awareness of worsening alcohol-related harms, triggering events and external influence to seek treatment (the catalyst system), to which clients continued to refer following treatment, the change process is depicted as a complex, ongoing set of systems in which a trial treatment is embedded. CONCLUSIONS: Models of change should be broadened so that treatment is seen as a complex system of parts, facilitating a nexus of cognitive, social and behavioural changes, embedded within a broader system of events and processes catalysing change. Such a model helps explain the relative absence of between-treatments outcome differences in UKATT and in the alcohol problems treatment and more general psychotherapy research literatures.  相似文献   

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