Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes.
Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes.
复制标题
将酗酒治疗与客户异质性相匹配：MATCH 项目三年饮酒结果。
DOI：
10.1111/j.1530-0277.1998.tb03912.x
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
Ommega Internationals
中科院分区：
文献类型：
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作者：
L. Coleman;Ommega Internationals
这项研究报告了在Project Match的五个门诊地点接受治疗的客户的3年结果，Project Match是一项多点临床试验，旨在测试与假设匹配的先验客户治疗。这项研究的主要目的是在3年的随访中描述匹配假设的状态。这需要调查在3年的研究期间，哪些匹配的发现是持续的，甚至是加强的，以及是否有任何先前不被支持的假设最终在3年后出现，或者相反，先前发现的匹配结果是否在稍后的时间消失。这项研究还考察了客户匹配属性对预后的影响，描述了37至39个月的总体结果，并探索了三种治疗方法在延长的随访中的不同效果。在配对效应方面，客户愤怒在试验中表现出最一致的交互作用，在1年和3年的随访中都有显著的配对效应。正如预测的那样，愤怒情绪高涨的客户在动机增强疗法(MET)中的表现好于其他两种匹配疗法：认知行为疗法(CBT)和十二步促进疗法(TSF)。在愤怒变量最高的三分之一的受试者中，接受MET治疗的客户平均有76.4%的禁欲天数，而接受其他两种治疗(CBT和TSF)的客户平均有66%的禁欲天数。相反，低愤怒的患者在CBT和TSF治疗后的表现好于MET。在3年的结果分析中出现了支持饮酒变量的显著匹配效应，即其社交网络更支持饮酒的客户从TSF治疗中获得的好处比从MET治疗中获得的更多。在支持饮酒变量最高的三分之一的受试者中，TSF参与者的戒酒天数比MET参与者多16.1%。在这个变量的较低端，MET和TSF之间的禁欲天数百分比差异为3%，MET患者的禁欲天数更多。在治疗后第一年出现的精神严重程度的显著匹配效果在三年后没有观察到。在用于检验匹配假设的21个客户属性中，11个在3年后具有预后价值。其中，乐于改变和自我效能感是长期饮酒结果的最强预测因子。关于总体结果，在治疗后第一年观察到的饮酒减少在3年的随访期内持续：近30%的受试者在第37至39个月完全戒酒，而那些确实饮酒的人仍然保持戒酒的平均三分之二的时间。正如在1年的随访中一样，尽管TSF继续显示出可能的轻微优势，但三种治疗方法之间几乎没有差异。
This study reports 3-year outcomes for clients who had been treated in the five outpatient sites of Project MATCH, a multisite clinical trial designed to test a priori client treatment matching hypotheses. The main purpose of this study was to characterize the status of the matching hypotheses at the 3-year follow-up. This entailed investigating which matching findings were sustained or even strengthened across the 3-year study period, and whether any hypotheses that were not supported earlier eventually emerged at 3 years, or conversely, whether matching findings discerned earlier dissipated at this later time. This research also examines the prognostic effects of the client matching attributes, characterizes the overall outcomes at 37 to 39 months, and explores differential effects of the three treatments at extended follow-up. With regard to the matching effects, client anger demonstrated the most consistent interaction in the trial, with significant matching effects evident at both the 1-year and 3-year follow-ups. As predicted, clients high in anger fared better in Motivational Enhancement Therapy (MET) than in the other two MATCH treatments: Cognitive-Behavioral Therapy (CBT) and Twelve-Step Facilitation (TSF). Among subjects in the highest third of the anger variable, clients treated in MET had on average 76.4% abstinent days, whereas their counterparts in the other two treatments (CBT and TSF) had on average 66% abstinent days. Conversely, clients low in anger performed better after treatment in CBT and TSF than in MET. Significant matching effects for the support for drinking variable emerged in the 3-year outcome analysis, such that clients whose social networks were more supportive of drinking derived greater benefit from TSF treatment than from MET. Among subjects in the highest third of the support for drinking variable, TSF participants were abstinent 16.1% more days than MET participants. At the lower end of this variable, difference in percent days abstinent between MET and TSF was 3%, with MET clients having more abstinent days. A significant matching effect for psychiatric severity that appeared in the first year posttreatment was not observed after 3 years. Of the 21 client attributes used in testing the matching hypotheses, 11 had prognostic value at 3 years. Among these, readiness-to-change and self-efficacy emerged as the strongest predictors of long-term drinking outcome. With regard to the overall outcomes, the reductions in drinking that were observed in the first year after treatment were sustained over the 3-year follow-up period: almost 30% of the subjects were totally abstinent in months 37 to 39, whereas those who did report drinking nevertheless remained abstinent an average of two-thirds of the time. As in the 1-year follow-up, there were few differences among the three treatments, although TSF continued to show a possible slight advantage.