Efficacy of "Dual Focus" Mutual Aid for Persons with Co-occurring Disorders

“双焦点”互助对共病患者的功效

• 批准号: 8061649
• 负责人: Stephen Magura
• 金额: $ 41.77万
• 依托单位: WESTERN MICHIGAN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8061649
• 关键词: Abstinence; Admission activity; Alcohol consumption; Alcohol or Other Drugs use; Ambulatory Care Facilities; Attitude; Behavioral; Belief; Clinic; Counseling; Data; Dependency; Development; Diagnosis; Disease; Emotional; Evaluation; Evidence based intervention; Group Processes; Health Policy; Hospitalization; Individual; Intake; Intervention; Interview; Lead; Learning; Mediating; Mental Health; Mental disorders; Modeling; Motivation; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Process; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Readiness; Recommendation; Recovery; Reporting; Research; Research Personnel; Self Efficacy; Services; Site; Social support; Spirituality; Substance abuse problem; Symptoms; Therapeutic; base; cohort; coping; coping mechanism; design; drug/alcohol abstinence; follow-up; improved; medication compliance; meetings; member; peer; primary outcome; programs; research study; satisfaction; secondary outcome; self help; social; standard care; theories; therapeutic effectiveness; treatment as usual; treatment duration; treatment program; treatment site

DESCRIPTION (provided by investigator): This proposal builds on two previous studies by the investigator, which found that participation in an established and growing "dual-focus" mutual aid model (Double Trouble in Recovery; DTR) by persons with co-occurring substance use and psychiatric disorders was associated with drug/alcohol abstinence and improved psychiatric outcomes. However, these findings are limited as they are based on studies using an observational design with existing DTR groups and a pre-post design with a historical control. This new application seeks to confirm and significantly extend this research by conducting a randomized clinical trial (RCT) of DTR at multiple treatment sites. The specific study aims are: 1. To conduct a multi-site RCT to determine the efficacy of "dual focus" 12-step mutual aid groups for persons with co-occurring substance use and mental disorders. Substance-using patients who are admitted to six psychiatric outpatient clinics will be randomly assigned within each clinic to (i) DTR group participation plus standard treatment, or (ii) standard treatment as usual. Primary outcomes are drug/alcohol use; psychiatric medication adherence; psychiatric symptoms; quality of life; treatment retention; and re-hospitalization. Major assessments will occur at intake and 6 and 12 months later. 2. To determine the therapeutic mechanisms mediating between DTR participation and behavioral outcomes. Mediating variables will include both "common process" factors across treatments, e.g., coping, self-efficacy and social support; and factors relatively unique to mutual aid, e.g., mutual aid group processes, 12-step attitudes and spirituality. 3. To determine the personal, social/environmental and treatment-related variables that predict DTR affiliation. 4. To describe the development of DTR groups and the conditions needed to sustain them. Federal substance abuse and mental health policy encourages the use of evidence-based interventions, yet rigorous evaluation data are scant for mutual aid groups. In particular, this research will lead to recommendations for improving the integration of formal treatment with mutual aid for persons with co-occurring disorders. Moreover, by conducting the proposed RCT, the study will substantially raise the standard by which mutual aid is evaluated.

描述（由研究者提供）：该提案建立在研究者之前的两项研究基础上，该研究发现，同时存在物质使用和精神疾病的人参与已建立和不断发展的“双焦点”互助模式（恢复中的双重麻烦; DTR）与药物/酒精戒断和改善精神疾病结局相关。然而，这些发现是有限的，因为它们是基于使用现有DTR组的观察性设计和具有历史对照的前后设计的研究。这项新的申请旨在通过在多个治疗部位进行DTR的随机临床试验（RCT）来确认并显著扩展这项研究。具体的研究目的是：1.进行一项多中心随机对照试验，以确定“双焦点”12步互助小组对同时存在物质使用和精神障碍的人的疗效。在6家精神科门诊接受药物治疗的患者将在每家门诊随机分配（i）DTR组参与加标准治疗，或（ii）常规标准治疗。主要结局是药物/酒精使用;精神病药物治疗依从性;精神病症状;生活质量;治疗保留;和再住院。主要评估将在入组时以及6个月和12个月后进行。2.确定DTR参与和行为结果之间的治疗机制。中介变量将包括治疗中的“共同过程”因素，例如，应对、自我效能和社会支持;以及互助相对独特的因素，例如，互助小组进程、12步态度和灵性。3.确定预测DTR从属关系的个人、社会/环境和治疗相关变量。4.描述DTR团体的发展和维持它们所需的条件。联邦药物滥用和心理健康政策鼓励使用循证干预措施，但互助团体缺乏严格的评估数据。特别是，这项研究将导致建议，以改善整合的正式治疗与互助的人共同发生的疾病。此外，通过进行拟议的随机对照试验，这项研究将大大提高评估互助的标准。

项目成果

Efficacy of dual focus mutual aid for persons with mental illness and substance misuse.

双焦点互助对精神疾病和药物滥用患者的功效。

• DOI: 10.1016/j.drugalcdep.2013.11.012
• 发表时间: 2014
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Rosenblum,Andrew;Matusow,Harlan;Fong,Chunki;Vogel,Howard;Uttaro,Thomas;Moore,ThomasL;Magura,Stephen
• 通讯作者: Magura,Stephen

Risk factors for medication non-adherence among psychiatric patients with substance misuse histories.

有药物滥用史的精神病患者不遵守药物治疗的危险因素。

• DOI: 10.1080/17523281.2013.839574
• 发表时间: 2014
• 期刊: Mental health and substance use : dual diagnosis
• 作者: Magura,Stephen;Mateu,PedroF;Rosenblum,Andrew;Matusow,Harlan;Fong,Chunki
• 通讯作者: Fong,Chunki

Consumers' Experiences in Dual Focus Mutual Aid for Co-occurring Substance Use and Mental Health Disorders.

消费者在针对同时发生的药物使用和心理健康障碍的双焦点互助中的体验。

• DOI: 10.4137/sart.s11006
• 发表时间: 2013
• 期刊: Substance abuse : research and treatment
• 作者: Matusow,Harlan;Guarino,Honoria;Rosenblum,Andrew;Vogel,Howard;Uttaro,Thomas;Khabir,Sadiqua;Rini,Martin;Moore,Thomas;Magura,Stephen
• 通讯作者: Magura,Stephen

Factors associated with mental health clinicians' referrals to 12-Step groups.

与心理健康临床医生转介至 12 步小组相关的因素。

• DOI: 10.1080/10550887.2012.694605
• 发表时间: 2012
• 期刊: Journal of addictive diseases
• 影响因子: 2.3
• 作者: Matusow,Harlan;Rosenblum,Andrew;Fong,Chunki;Laudet,Alexandre;Uttaro,Thomas;Magura,Stephen
• 通讯作者: Magura,Stephen