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

描述（由研究者提供）：该建议建立在研究者之前的两项研究的基础上，这两项研究发现，同时存在物质使用和精神疾病的人参与一个已建立并不断发展的“双焦点”互助模式（双重康复问题；DTR）与药物/酒精戒欲和改善精神预后有关。然而，这些发现是有限的，因为它们是基于使用现有DTR组的观察设计和历史对照的前后设计的研究。这项新申请旨在通过在多个治疗点进行DTR的随机临床试验（RCT）来证实并显著扩展这项研究。具体的研究目的是：1。通过多点随机对照试验，确定“双焦点”12步互助小组对物质使用和精神障碍患者的治疗效果。六家精神科门诊收治的药物滥用患者将在每家诊所内随机分配(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；精神科药物依从性；精神症状;生活质量；治疗保留;和接受。主要的评估将在入学时以及6个月和12个月后进行。2. 确定DTR参与与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，如应对、自我效能和社会支持；以及互助中相对独特的因素，例如互助小组过程，12步态度和灵性。3. 确定预测DTR归属的个人、社会/环境和治疗相关变量。4. 描述DTR群体的发展和维持它们所需的条件。联邦药物滥用和精神健康政策鼓励使用基于证据的干预措施，但对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，以改善与共同发生的疾病的人的正式治疗与互助的整合。此外，通过实施拟议的RCT，该研究将大大提高评估互助的标准。

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.