12-Step Facilitation for the Dually Diagnosed

描述（由申请人提供）：虽然对严重精神病患者进行12步治疗的工作相对较少，但现有文献表明，双重诊断的个人参加传统的12步计划，如AA，NA和CA，其比率与单一诊断的物质滥用者相当，并且参与与物质使用减少有关。在过去10年中开发的针对双重诊断的专门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和传统的12步程序的双重诊断的个人，特别是适应12步促进（TSF）治疗双重诊断应开发和测试。 应修改标准TSF，以满足双重诊断个体的特殊需求，与该地区提供的专业12步计划相结合，并解决双重诊断患者在出勤，参与和参与方面遇到的障碍。我们在Project MATCH TSF手册的基础上开发了一个修改后的TSF。 对这12周的个人治疗的修改包括：强调专门的12步程序出席;主要从专门的12步程序文献中阅读;由社区专门的12步程序成员参加第二次会议;个案管理，以帮助参与者寻找和参加会议;省略第四步的工作;并增加了包括药物依从性和谈判12步会议所需的特定社交技能的主题。在一项针对10名双重诊断个体的试点研究中，参与者在接受专门的TSF后，物质使用显着减少，12步出勤显着增加。在这项试验性研究的基础上，拟议的研究是一项更大规模的Ib期研究，旨在对接受双重诊断治疗的严重精神病患者进行改良TSF。患有精神病或严重情感障碍的受试者将随机接受改良TSF（n=90）与常规治疗（n=45）。参与者将被跟踪总共48周。评估将包括酒精和其他药物使用的严格诊断和措施，后果，精神症状，12步行为，12步特定和非特定变化机制以及社会支持。研究的具体目的包括评估计划的干预和评估组合的完整性;测试调整后的TSF相对于常规治疗的有效性;确定精神病诊断是否会减轻治疗反应;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.