目的:在青少年物质使用障碍(SUD)治疗计划中,12步哲学和实践的整合很常见,特别是在北美。然而,尽管许多实验研究已经在成年人中测试了12步促进(TSF)治疗方法,尚无研究测试针对青少年的TSF特异性治疗.我们测试了新型综合TSF的功效。
方法:解释性,平行组,随机临床试验比较动机增强疗法/认知行为疗法(MET/CBT;n=30)或新型综合TSF(iTSF;n=29)的10个疗程,在进入治疗后3、6和9个月进行随访评估。
方法:美国的门诊成瘾诊所。
方法:青少年[n=59;平均年龄=16.8(1.7)岁;范围=14-21;女性占27%;白人占78%]。
■iTSF将12步与动机和认知行为策略相结合,并与SUD的最新MET/CBT进行了比较。
方法:主要结果:戒断天数百分比(PDA);次要结果:12步出勤,与物质相关的后果,最长的禁欲期,比例禁欲/主要是禁欲,精神症状。
结果:主要结果:各治疗组PDA无显著差异[b=0.08,95%置信区间(CI)=-0.08至0.24,P=0.33;贝叶斯因子=0.28)。
结果:治疗期间,iTSF患者的12步出勤率明显更高,但这一优势随后下降(b=-0.87;95%CI=-1.67至0.07,P=0.03)。iTSF在与物质相关的所有随访点都显示出明显的优势(b=-0.42;95%CI=-0.80至-0.04,P<0.05;效应大小范围d=0.26-0.71)。其他次要结果在治疗之间没有显着差异,但效果大小倾向于支持iTSF。在整个样本中,更高的12步会议出勤率与更长的禁欲显着相关(r=0.39,P=0.008),和早期随访(r=0.30,P=0.049),治疗。
结论:与动机增强疗法/认知行为疗法(MET/CBT)相比,在禁欲方面,一种针对青少年物质使用障碍(iTSF)的新型综合12步促进治疗没有更大的益处,但在12步出勤和后果方面表现出了优势。鉴于12步组合的广泛使用,北美青少年社区门诊设置中的MET和CBT,iTSF可以提供与现有实践兼容的基于证据的集成选项。
OBJECTIVE: The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF.
METHODS: Explanatory, parallel-group, randomized clinical
trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n = 30) or a novel integrated TSF (iTSF; n = 29), with follow-up assessments at 3, 6 and 9 months following treatment entry.
METHODS: Out-patient addiction clinic in the United States.
METHODS: Adolescents [n = 59; mean age = 16.8 (1.7) years; range = 14-21; 27% female; 78% white].
UNASSIGNED: The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD.
METHODS: Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms.
RESULTS: Primary outcome: PDA was not significantly different across treatments [b = 0.08, 95% confidence interval (CI) = -0.08 to 0.24, P = 0.33; Bayes\' factor = 0.28).
RESULTS: during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b = -0.87; 95% CI = -1.67 to 0.07, P = 0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b = -0.42; 95% CI = -0.80 to -0.04, P < 0.05; effect size range d = 0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r = 0.39, P = 0.008), and early following (r = 0.30, P = 0.049), treatment.
CONCLUSIONS: Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.