Does diagnosis matter? Differential effects of 12-step participation and social networks on abstinence.
Does diagnosis matter? Differential effects of 12-step participation and social networks on abstinence.
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诊断重要吗？
DOI：
10.1081/ada-68486
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Kaskutas,LeeAnn
中科院分区：
文献类型：
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作者：
Witbrodt,Jane;Kaskutas,LeeAnn
以前的研究已经检查了12步参与和社会网络组成的具体方面对禁欲的影响，主要集中在酒精相关的结果，并筛选出药物依赖者。本文探讨这些预测因素是否差异影响戒酒的基础上DSM-III-R物质依赖障碍（酒精依赖，药物依赖，酒精和药物依赖）。在6个月和12个月时，随访了一个异质性社区样本的治疗寻求者（N = 302），随机分配到日间治疗方案。双变量和多变量回归模型被用来测试是否参与12步的做法和社会网络的影响，饮酒或使用药物预测总戒酒和药物依赖性障碍的差异。然后进行卡方自动交互检测器（CHAID）分割分析，以确定特定的12步活动和社交网络阈值，最好地区分每个依赖类别中的较高戒断率。结果表明，参加12步会议的次数和从事类似的规定12步活动的次数预测了酗酒者、吸毒者和既依赖酒精又依赖毒品的人的戒酒率。然而，具体的活动与依赖性障碍的禁欲差异。虽然许多活动区分了吸毒者和既依赖酒精又依赖毒品的人的戒酒，但对于酗酒者来说，只有两个匿名戒酒会的活动区分了戒酒（有赞助人和提供服务）。戒断的关键预测因子（CHAID）因随访和依赖性障碍而异，除了在AA和/或麻醉品匿名服务，这是唯一一个特定的12步活动，是治疗后一年所有三个类别中戒断的最佳预测因子。因此，通过服务工作“回馈”同龄人社区，这是一个重要的12步信念，在康复后期似乎具有普遍价值。至于社会网络的影响，多变量回归模型显示，有较高比例的禁欲的个人在网络中与戒酒的酗酒者在6个月和药物依赖的人在12个月的禁欲。CHAID模型支持这些结果，并为12步措施提供了具体的阈值（例如，> 20次酗酒者会议，社交网络中有2个或更多的非饮酒者，3个或更多的人支持酒精和药物依赖者的减少，以及2个或更多的非饮酒者只依赖药物）。这些结果支持治疗提供者根据其客户依赖概况优先考虑某些12步相关实践和社会网络变化的价值。在早期，那些被诊断患有酒精的人需要承诺参加会议并获得赞助商;此外，他们需要将自己置于一个鼓励清醒的网络中。在早期，那些药物依赖者特别需要与12步计划建立联系，直到他们认为自己是一个成员，然后，在一个高度支持和主要不喝酒的环境中饱和自己。酒精和药物依赖的客户需要更强烈的持续12步参与（赞助商和会议），以及在他们的网络中有不喝酒的人和支持禁欲的人。对于所有客户来说，在较长的12个月治疗后时间段内提供服务尤为重要。
Previous studies that have examined the effects of specific aspects of 12-step participation and social network composition on abstinence have focused mostly on alcohol-related outcomes and have screened out drug dependent persons. This article explores whether these predictors differentially affect abstinence based on DSM-III-R substance dependence disorder (alcohol dependence, drug dependence, and both alcohol and drug dependence). A heterogeneous community sample of treatment seekers (N = 302) randomized to day treatment programs were followed at 6 and 12 months. Bivariate and multivariate regression models were used to test whether engagement in 12-step practices and social network influences to drink or use drugs predicted total abstinence from alcohol and drugs differentially by dependence disorder. Chi-square automatic interaction detector (CHAID) segmentation analyses were then conducted to identify the specific 12-step activities and social network thresholds that best distinguished higher rates of abstinence in each dependence category. Results showed that the number of 12-step meetings attended and number of prescribed 12-step activities engaged in similarly predicted abstinence for alcoholics, drug addicts, and those dependent on both alcohol and drugs. However, specific activities were associated with abstinence differentially by dependence disorder. While many activities differentiated abstinence for drug addicts and those dependent on both alcohol and drugs, for alcoholics only two Alcoholics Anonymous (AA) activities distinguished abstinence (having a sponsor and doing service). Key predictors of abstinence (CHAID) varied by follow-up and dependence disorder, except for doing service in AA and/or Narcotics Anonymous, which was the only specific 12-step activity that was a best predictor of abstinence in all three categories one year following treatment. Thus, “giving back” to one's peer community through service work, an important 12-step belief, seems to be universally valuable later in recovery. As for social network influences, a multivariate regression model showed that having a higher proportion of abstinent individuals in the network was associated with abstinence for alcoholics at 6 months only and for drug dependent persons at 12 months only. CHAID models supported these results and provided specific thresholds for 12-step measures (e.g., >20 meetings for alcoholics, 2 or more nondrinkers in the social network, 3 or more persons supporting reduction for those dependent on both alcohol and drugs, and having 2 or more nondrinkers for those dependent on drugs only). These results support the value of treatment providers prioritizing certain 12-step-related practices and social network changes based on their client dependence profiles. Early on, those with an alcohol diagnosis need to make a commitment to meetings and obtain a sponsor; also, they need to place themselves in a network that encourages sobriety. Early on, those who are drug-dependent-only especially need to become connected with 12-step programs to the extent that they consider themselves a member, and, later, saturate themselves in a highly supportive and predominantly nondrinking environment. Alcohol and drug dependent clients need more intense ongoing 12-step involvement (sponsor and meetings) as well as having nondrinking individuals and people supportive of abstinence in their network. For all clients, doing service is especially important at the longer 12-month posttreatment timeframe.