Trial of Self-Help Groups for Dually-Diagnosed Persons

描述（由申请人提供）： 这项新的研究直接建立在申请人之前的一项研究的基础上，该研究发现，参与专门为双重诊断的人设计的12步小组（康复中的双重麻烦; DTR）与药物戒断和改善精神病学结果有关。本申请建议通过进行一项准实验性干预研究（1年前瞻性随访）来扩展先前的有效性研究（仅招募了活跃的DTR参与者，没有比较样本）。具体目标是： 1.确定在常规治疗中加入双焦点12步自助小组，对双重诊断为吸毒和精神健康障碍的患者进行治疗，是否可以改善行为结果。在引入DTR组之前，将对参加门诊或日间治疗心理健康计划的双重诊断人员（N=126）进行为期一年的随访。引入DTR组后，将对第二个新入组患者队列（N=150）进行随访。主要结果变量是物质使用;次要结果是药物依从性、治疗利用率和精神症状。 2.确定接触DTR小组是否增加了参加和参与基于社区的传统12步小组的可能性和一致性（例如，AA、NA）。 3.确定是否与DTR相关的恢复结果是通过参与传统的12步组来介导的。 4.研究DTR从属行为和DTR治疗过程对物质使用和其他行为结果的中介作用。该研究纳入了未接受DTR组的受试者，这将提供一个机会来确定个人、治疗和环境变量：a）预测DTR从属关系的水平; B）在DTR从属关系和随后的行为结果之间起中介作用。根据理论驱动的模型，将研究一套全面的中介变量，包括假定的“共同过程”因素，如动机，以及与自助特别相关的因素，如，相互学习和12步的态度和信念。 5.进行过程评价，重点关注DTR组（在研究诊所中）的实施和持续增长和发展，以及DTR组氛围。

DESCRIPTION (provided by applicant): This new study builds directly on a previous study by the applicant, which found that participation in 12-step groups specially designed for dually diagnosed persons (Double Trouble in Recovery; DTR), was associated with drug abstinence and improved psychiatric outcomes. This application proposes to extend the previous effectiveness study (which recruited active DTR participants only and had no comparison sample) by conducting a quasi-experimental intervention study with a 1-year prospective follow-up. The Specific Aims are: 1. To determine whether adding dual-focus 12-step self-help groups to regular treatment for patients dually-diagnosed with drug use and mental health disorders can improve behavioral outcomes. Dually-diagnosed persons (N=126) enrolling in an outpatient or a day treatment mental health program will be followed for one year prior to the introduction of DTR groups. After the introduction of DTR groups, a second cohort of newly enrolled patients (N=150) will be followed. The primary outcome variable is substance use; secondary outcomes are medication adherence, treatment utilization and psychiatric symptoms. 2. To determine whether exposure to DTR groups increases the likelihood and consistency of attendance and involvement in community-based traditional 12-step groups (e.g., AA, NA). 3. To determine whether the recovery outcomes postulated to be associated with DTR are mediated by participation in traditional 12-step groups. 4. To examine DTR affiliation behaviors and the mediating role that DTR therapeutic processes have on substance use and other behavioral outcomes. The study's inclusion of subjects naive to DTR groups will provide an opportunity to determine the personal, treatment and environmental variables that: a) Predict the level of DTR affiliation and; b) mediate between DTR affiliation and subsequent behavioral outcomes. Drawing upon a theory-driven model, a comprehensive set of mediating variables will be investigated, including both putative "common process" factors e.g. motivation, and factors especially pertinent to self-help e.g., reciprocal learning and 12 step attitudes and beliefs. 5. To conduct a process evaluation focusing on the implementation and on-going growth and development of the DTR groups (in the study clinics), as well as DTR group climate.