12-Step Facilitation for the Dually Diagnosed

描述(由申请人提供)：尽管对严重精神疾病患者进行12步治疗的工作相对较少，但现有文献表明，双重诊断的人参加传统的12步计划，如AA、NA和CA的比率与单一诊断的药物滥用者相当，而且参与与药物使用的减少有关。过去10年为双重诊断患者开发的专门12步计划可能会提供额外的好处。为了最大限度地发挥专门的和传统的12步计划对双重诊断患者的有效性，应该开发和测试针对双重诊断患者的特别适应的12步促进(TSF)治疗。应修改标准的TSF，以满足双重诊断患者的特殊需求，与该地区现有的专门12步计划相结合，并解决双重诊断患者在出诊、参与和参与方面遇到的障碍。我们已经开发了一个基于项目匹配TSF手册的修改后的TSF。 对这12周个人治疗的修改包括：强调专门的12步计划参加；主要从专门的12步计划文献中阅读；由社区专门的12步计划成员参加第二次会议；帮助参与者寻找和参加会议的病例管理；省略第四步的工作；以及增加关于药物依从性和谈判12步会议所需的特定社交技能的主题。在一项对10名双重诊断的个人进行的初步研究中，参与者在接受专门的TSF后显示出物质使用的显著减少和12步出勤率的显著增加。在这项初步研究的基础上，拟议的研究是对接受双重诊断治疗的严重精神病患者进行改良的TSF的更大的Ib阶段研究。患有精神病或严重情感障碍的参与者将被随机分为改良TSF组(n=90)和常规治疗组(n=45)。参与者将接受为期48周的跟踪调查。评估将包括对酒精和其他药物使用、后果、精神症状、12步行为、12步具体和非具体改变机制以及社会支持的严格诊断和措施。这项研究的具体目的包括评估计划干预和评估单元的完整性；测试调整后的TSF相对于通常治疗的有效性；确定精神诊断是否缓和治疗反应；以及调查治疗反应的因果机制。

DESCRIPTION (provided by applicant): Although there has been relatively little work on 12-step treatment for seriously mentally ill patients, extant literature indicates that dually diagnosed individuals attend traditional 12-step programs such as AA, NA, and CA at rates comparable to singly diagnosed substance abusers, and that participation is associated with decreases in substance use. Specialized 12-step programs for the dually diagnosed, developed over the past 10 years, may offer additional benefits. In order to maximize the effectiveness of specialized and traditional 12-step programs for dually diagnosed individuals, specially adapted 12-step facilitation (TSF) treatment for the dually diagnosed should be developed and tested. Standard TSF should be modified to address the special needs of dually diagnosed individuals, mesh with specialized 12-step programs available in the area, and address barriers to attendance, participation, and engagement experienced by the dually diagnosed. We have developed a modified TSF based on the Project MATCH TSF manual. Modifications to this 12 week individual therapy include: emphasis on specialized 12-step program attendance; readings primarily from specialized 12-step program literature; participation in the second session by a community specialized 12-step program member; case management to assist participants in finding and attending meetings; omission of work on the fourth step; and the addition of topics covering medication compliance and specific social skills needed to negotiate 12-step meetings. In a pilot study with 10 dually diagnosed individuals, participants showed significant decreases in substance use and significant increases in 12-step attendance after receiving the specialized TSF. Building on this pilot study, the proposed study is a larger Stage Ib study of the modified TSF for seriously mentally ill patients engaged in dual diagnosis treatment. Participants with a psychotic or major affective disorder will be randomized to modified TSF (n=90) vs. treatment as usual (n=45). Participants will be followed for a total of 48 weeks. Assessments will include rigorous diagnosis and measures of alcohol and other drug use, consequences, psychiatric symptoms, 12-step behaviors, 12-step specific and non-specific change mechanisms, and social support. Specific Aims of the study include assessment of the integrity of the planned intervention and assessment battery; tests of the effectiveness of the adapted TSF relative to treatment as usual; determination of whether psychiatric diagnosis moderates treatment response; and investigation of causal mechanisms of response to treatment.