Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers.
Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers.
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DOI：
10.1093/alcalc/agaa050
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发表时间：
2020-10-20
期刊：
影响因子：
--
通讯作者：
Humphreys K
中科院分区：
文献类型：
--
作者：
Kelly JF;Abry A;Ferri M;Humphreys K
最近完成的一项Cochrane审查评估了戒酒互助会(AA)和临床提供的酒精使用障碍(AUD)12步促进(TSF)干预的有效性和成本效益。本文总结了主要发现，并讨论了对实践和政策的影响。采用Cochrane评价法。从最初到2019年8月2日在所有主要数据库(例如Cochrane药物和酒精组专门注册、PubMed、Embase、QicINFO和ClinicalTrials.gov)上进行搜索，包括非英语语言研究。包括随机对照试验(RCT)和比较AA/TSF与其他干预措施(如动机增强疗法(MET)或认知行为疗法(CBT)、TSF治疗变体或不治疗)的准实验。医疗成本抵消研究也包括在内。研究按设计(RCT/准实验；非随机；经济)、机械化程度(所有干预措施与部分/无干预措施)和比较干预类型(即AA/TSF与不同理论取向的干预措施或风格或强度不同的AA/TSF干预措施进行比较)进行分类。随机效应荟萃分析用于在可能的情况下使用连续结果的标准平均差(SMD)(例如戒酒天数百分比(PDA))和二分性的相对危险比(RR)来汇集效应。共纳入27项研究(21项随机对照试验/准实验，5项非随机研究和1项纯经济学研究)，包括10,565名参与者。AA/TSF干预措施在所有结果上的表现至少与已建立的积极比较治疗(例如CBT)一样好，但禁欲方面的效果往往优于其他治疗。与其他AUD治疗相比，AA/TSF还显示出更高的医疗成本节约。AA/TSF干预在所有与饮酒相关的结果上产生与其他治疗类似的益处，但持续戒酒和缓解除外，其中AA/TSF优于其他治疗。AA/TSF还降低了医疗成本。在临床上实施这些经过验证的人工AA/TSF干预措施之一可能会改善AUD患者的预后，同时产生健康经济效益。在截至2019年8月的数据库中搜索酒精使用障碍参与者的随机对照和其他研究，这些研究比较了促进使用AA的治疗的疗效和成本与使用其他方法的治疗，如认知行为治疗和动机增强治疗。搜索发现了27项研究，涉及10565人。Meta分析显示，AA和方便使用AA(‘TSF’)在所有与饮酒相关的结果上与其他治疗方法产生的益处相似，但持续戒酒和缓解，AA/TSF优于其他治疗方法。分析成本计算的研究发现，使用AA/TSF也倾向于降低医疗成本。
A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous. A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments. AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits. Data bases up till August 2019 were searched for randomized controlled and other studies in participants with alcohol use disorders that compared the efficacy and costs of treatment that facilitated use of AA versus treatment using other methods such as cognitive behavior therapy and motivational enhancement therapy. The search revealed 27 studies pertaining to 10,565 persons. Meta-analyses showed that AA and facilitating use of AA (‘TSF’) produced similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF was superior. Studies analyzing costing found that use of AA/TSF also tended to reduce healthcare costs.
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