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

描述(由调查员提供)：这项建议建立在调查员之前的两项研究的基础上，这两项研究发现，同时使用药物和精神障碍的人参与已建立的和日益增长的“双焦点”互助模式(康复中的双重困难；DTR)与戒毒/戒酒和改善精神结果有关。然而，这些发现是有限的，因为它们是基于使用现有DTR组的观察性设计和具有历史对照的事后设计的研究。这一新的应用试图通过在多个治疗地点进行DTR的随机临床试验(RCT)来证实并显著扩展这项研究。具体的研究目标是：1.进行多点随机对照试验，以确定“双焦点”12步互助小组对同时发生物质使用和精神障碍的人的疗效。在六间精神科门诊接受治疗的滥用药物者，会在每间诊所内被随机分配到(I)DTR小组参与加标准治疗，或(Ii)如常接受标准治疗。主要结果是药物/酒精使用；精神科用药依从性；精神科症状；生活质量；治疗保留；以及再次住院。主要评估将在招生时以及6个月和12个月后进行。2.确定DTR参与与行为结局之间的治疗机制。中介变量将包括跨治疗的“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，例如互助小组过程、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集团的发展和维持这些集团所需的条件。联邦药物滥用和精神卫生政策鼓励使用循证干预措施，但缺乏针对互助团体的严格评估数据。特别是，这项研究将为改善共病患者的正规治疗与互助的结合提出建议。此外，通过进行拟议的区域合作研究，这项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.