Control Trial of Self-Help for Dually-Diagnosed Persons

描述(由申请人提供)：这项新研究直接建立在申请人之前的一项研究基础上，该研究发现，参加专门为双重诊断患者设计的12步小组(康复中的双重困难；DTR)与戒毒和改善精神结果有关。这项申请建议扩展先前的有效性研究(只招募积极的DTR参与者，没有比较样本)，进行一项准实验性干预研究，并进行为期1年的前瞻性随访。具体目标是： 1.确定在药物使用和精神健康双重诊断的患者常规治疗的基础上增加双焦点12步自助小组是否能改善行为结果。双重诊断的人(N=126)参加门诊或日间治疗精神健康计划将在引入DTR小组之前跟踪一年。在引入DTR组之后，将跟随第二组新登记的患者(N=150)。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(例如，AA、NA)的可能性和一致性。 3.确定被认为与DTR相关的恢复结果是否通过参与传统的12步小组进行调节。 4.考察DTR的从属行为，以及DTR治疗过程对物质使用和其他行为结果的中介作用。这项研究将幼稚的受试者纳入DTR组，将提供一个机会来确定个人、治疗和环境变量，这些变量：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。在理论驱动的模型的基础上，我们将研究一组全面的中介变量，包括假设的“共同过程”因素，如动机，以及特别与自助相关的因素，如互惠学习和12步态度和信念。 5.进行过程评估，重点是DTR小组的实施和持续成长和发展(在研究诊所)，以及DTR小组的气氛。

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.