A randomized trial of treatment options for alcohol-abusing workers.
A randomized trial of treatment options for alcohol-abusing workers.
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针对酗酒工人的治疗方案的随机试验。
DOI：
10.1056/nejm199109123251105
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Hamilton,SK
中科院分区：
文献类型：
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作者：
Walsh,DC;Hingson,RW;Merrigan,DM;Levenson,SM;Cupples,LA;Heeren,T;Coffman,GA;Becker,CA;Barker,TA;Hamilton,SK
背景：由公司或工会发起的酒精援助计划识别酗酒的工人，并将他们转介到护理中心，通常是住院康复计划。然而，住院治疗的有效性，与各种不太密集的替代品相比，一再受到质疑。在这项研究中，锚定在工作现场，我们比较了强制性的住院治疗的有效性，需要出席会议的自助小组和治疗方案的选择。方法。我们随机分配了一系列的227名工人新确定为滥用酒精的三个康复方案之一：强制住院治疗，强制参加匿名酗酒者（AA）会议，以及选择。如有需要，提供住院病人支援。两组进行了比较，在12个工作绩效变量和12个措施的饮酒和药物使用在为期两年的follow-up period. Results.All三组改善，并没有显着差异，发现各组之间的工作相关的结果变量。然而，在饮酒和药物使用的七项措施中，我们在几次随访评估中发现了显着差异。医院组表现最好，AA组表现最差;那些被允许选择一个项目的人有中间结果。AA组（63%）和选择组（38%）需要额外住院治疗的频率明显高于（P <0.0001）分配到医院接受初始治疗的受试者（23%）。对于在进入研究前六个月内使用可卡因的工人来说，各组之间的差异尤其明显。AA和选择组的住院治疗的估计费用平均只有10%，低于医院组的费用，因为他们的额外treatment.Conclusions较高的利率。即使是就业的问题饮酒者谁不滥用药物，谁没有严重的医疗问题，最初转介到AA单独或选择的程序，虽然比住院治疗费用低，比强制住院治疗的风险更大，应密切监测复发的迹象。（N Engl J Med 1991; 325：775 - 82.）
Background.Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care, often to inpatient rehabilitation programs. Yet the effectiveness of inpatient treatment, as compared with a variety of less intensive alternatives, has repeatedly been called into question. In this study, anchored in the work site, we compared the effectiveness of mandatory in-hospital treatment with that of required attendance at the meetings of a self-help group and a choice of treatment options.Methods.We randomly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at Alcoholics Anonymous (AA) meetings, and a choice of options. Inpatient backup was provided if needed. The groups were compared in terms of 12 job-performance variables and 12 measures of drinking and drug use during a two-year follow-up period.Results.All three groups improved, and no significant differences were found among the groups in job-related outcome variables. On seven measures of drinking and drug use, however, we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well; those allowed to choose a program had intermediate outcomes. Additional inpatient treatment was required significantly more often (P<0.0001) by the AA group (63 percent) and the choice group (38 percent) than by subjects assigned to initial treatment in the hospital (23 percent). The differences among the groups were especially pronounced for workers who had used cocaine within six months before study entry. The estimated costs of inpatient treatment for the AA and choice groups averaged only 10 percent less than the costs for the hospital group because of their higher rates of additional treatment.Conclusions.Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse. (N Engl J Med 1991; 325: 775–82.)