Is the Counselor an “Active Ingredient” in Substance Abuse Rehabilitation?: An Examination of Treatment Success among Four Counselors
Is the Counselor an “Active Ingredient” in Substance Abuse Rehabilitation?: An Examination of Treatment Success among Four Counselors
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辅导员是药物滥用康复中的“活性成分”吗？：四位辅导员治疗成功的检验
DOI：
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发表时间：
1988
影响因子：
1.9
通讯作者：
L. Goehl
中科院分区：
文献类型：
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作者：
A. Mclellan;G. Woody;L. Luborsky;L. Goehl
辅导员在药物滥用康复中的影响受到质疑。两名辅导员的意外辞职提供了一个自然的机会，可以在药物理念、计划规则和补充服务保持不变的情况下，检查美沙酮维持治疗计划中辅导员分配的效果。被分配给这两名咨询师的 61 名患者实际上以随机的方式分配给了另外四名咨询师。理由是，如果新辅导员的影响相对较小，那么调任前到调任后或调任后 6 个月内四个案件量之间的绩效差异不大。绩效衡量包括尿液分析结果、美沙酮剂量、精神药物处方、就业和逮捕率。结果表明，四个病例的转移后表现存在统计学显着性和临床意义的差异。一名辅导员显着减少了他/她的病例中美沙酮的平均剂量以及服用辅助药物的患者数量，同时减少了尿检阳性、失业和逮捕。相比之下，另一位辅导员显着增加了他/她的案件量中的平均美沙酮剂量，但尿检阳性和失业率仍然有所增加。正如之前的研究发现，辅导员之间的背景和正规教育差异与观察到的绩效差异无关。然而，咨询师之间咨询内容和过程的差异与患者结果的差异相关。这些过程差异是与专业心理治疗的早期研究相关的。
The impact of the counselor in substance abuse rehabilitation has been questioned. The unexpected resignations of two counselors provided a natural opportunity to examine the effects of counselor assignment in a methadone maintenance treatment program with the effects of the medication philosophy, program rules, and supplementary services held constant. Sixty-one patients who had been assigned to these two counselors were assigned to four other counselors in a virtually random manner. It was reasoned that if the new counselor had relatively little impact, then there would be little difference in performance from pre to posttransfer or among the four caseloads during the 6-month period following the transfer. Performance measures included urinalysis results, methadone dosage, prescriptions for psychotropic medications, employment, and arrest rates. Results indicated statistically significant and clinically meaningful differences in the posttransfer performance of the four caseloads. One counselor significantly reduced the average methadone dose of his/her caseload as well as the number of patients prescribed ancillary medications, while concurrently reducing positive urine tests, unemployment and arrests. In contrast, another counselor significantly increased the average methadone dose in his/ her caseload but still showed increases in positive urine tests and unemployment. As has been found in prior studies, background and formal education differences among the counselors were not related to the observed performance differences. However, differences in the content and process of counseling among the counselors were associated with the differences in patient outcome. These process differences are discussed in relation to earlier studies of professional psychotherapy.