Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study
Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study
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DOI：
10.15288/jsad.2014.75.438
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发表时间：
2014-05-01
影响因子：
3.4
通讯作者：
O'Malley, Stephanie S.
中科院分区：
文献类型：
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作者：
DeMartini, Kelly S.;Devine, Eric G.;O'Malley, Stephanie S.
目的：进入酒精问题治疗的患者没有统一的治疗目标，预处理饮酒目标对治疗结果有显著影响。本研究的目的是更好地了解在联合药物和行为干预联合研究中，在开始酒精治疗之前，一系列个体特征，包括影响治疗的因素，是如何与治疗目标相关的。方法：参与者是酒精依赖个体（N= 1156； 357名女性），从美国11个门诊酒精治疗学术诊所招募，参加一项随机、双盲、安慰剂对照的试验，该试验将行为干预与阿坎普罗酸和/或纳曲酮相结合。治疗目标被编码为控制饮酒、条件戒酒或完全戒酒。多项逻辑回归评估预测变量与预处理目标选择之间是否存在显著关系。结果：较低水平的酒精相关后果、较低的改变意愿、较高的家庭收入、社交网络中更多的日常饮酒者、缺乏先前治疗或匿名戒酒会的参与预测了控制饮酒目标的选择，而不是完全戒酒目标。更少的酒精相关后果，更低的改变意愿，以及更多的日常饮酒者在网络中预测有条件的戒酒目标比完全戒酒目标的选择。结论：较高的功能水平，较低的后果水平，之前没有参与治疗和戒酒互助会，以及饮酒更饱和的社会环境与非戒酒目标的选择有关。
Objective: Patients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a significant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals before beginning alcohol treatment in the COMBINE (Combining Medications and Behavioral Interventions) Study. Method: Participants were alcohol-dependent individuals (N=1,156; 357 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States to participate in a randomized, double-blind, placebo-controlled trial that combined behavioral intervention with acamprosate and/or naltrexone. Treatment goal was coded as controlled drinking, conditional abstinence, or total abstinence. Multinomial logistic regressions assessed whether there were significant relationships between predictor variables and pretreatment goal selection. Results: Lower levels of alcohol-related consequences, lower readiness to change, higher family income, more daily drinkers in social network, and lack of prior treatment or Alcoholics Anonymous engagement predicted choice of a controlled drinking goal over a total abstinence goal. Fewer alcohol-related consequences, lower readiness to change, and more daily drinkers in-network predicted choice of a conditional abstinence goal over a total abstinence goal. Conclusions: Higher levels of functioning, lower levels of consequences, no prior involvement in treatment and Alcoholics Anonymous, and a more drinking-saturated social environment are associated with the choice of a non-abstinence goal.