论文标题：Factors influencing early withdrawal from a drug and alcohol treatment program and client perceptions of successful recovery and employment: a qualitative study

期刊：BMC Psychiatry

作者：Tarran Prangley, Sabrina Winona Pit, Trent Rees and Jessica Nealon

发表时间：2018/09/18

数字识别码：10.1186/s12888-018-1864-y

原文链接：https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1864-y?utm_source=other&utm_

medium=other&utm_content=null&utm_campaign=BSCN_2_DD_BMCpsychiatry_Arti_Scinet

微信链接：https://mp.weixin.qq.com/s/WyJv5DbYUJn4YOyaB6cHVg

毒品/酒精的滥用会给社会带来巨大的经济和医疗负担，而加入治疗性社群群组会有助于毒品/酒精滥用者的康复。最近在BMC Psychiatry上发表的一项研究进一步表明，成瘾戒除的康复之路并不仅仅只需要禁欲而已。

我们的研究团队希望弄清楚有哪些因素会影响人们成功戒掉毒品和酒精，甚至使其提前推出治疗性社群项目。这个问题的产生也部分来源于我们最近进行的另一项研究，该研究发表在了Substance Abuse Treatment, Prevention, and Policy 上。这项研究发现，在加入治疗性社群项目时，如果成员对自身的情感状况感到满意，那么他们会更可能提前中止项目。

虽然我们认为这可能是因为他们不想因参加项目而与亲人分离，但是我们还是需要进行定性研究才能更好地解释这个现象。为此，我们采访了一位曾在澳大利亚地区参与一项长期治疗性社群项目的成员（该项目由一个社区康复组织主持）。此外，我们还试图研究成功戒毒/酒对这些前成员的实际意义以及他们的工作状况对提早退出和戒断成功的影响。

所谓成功的康复并不仅仅意味着达到并保持禁欲状态。 这些前成员们认为减少滥用和持续的治疗对康复有积极作用。康复是一条漫长之路，了解这一点对于评估康复状态非常重要。

前成员们表示，社群性的康复计划帮助他们加深了对成瘾的早期迹象的了解，因而能够在完全失控前悬崖勒马。总的来说，他们通过在社群性康复计划中学到的技能缩短了滥用发作和复发的持续时间。更重要地，对全社会，而不仅仅是成瘾的人来说，应当认识到发作持续时间的缩短以及更早地识别成瘾迹象都意味着已经患者离成功康复不远了。

保持工作状态的作用

我们的研究表明，在参与社群性康复之前、之时、以及之后，工作都能影响药物成瘾。

在参与康复项目前，许多成瘾者难以找到或保住工作。对一部分人来说，工作甚至会使得他们出于各种原因而使用毒品，比如在偏远地区工作时感到孤独，工作环境节奏过快比如酒吧、俱乐部等，又或者薪酬较高从而足够的钱来购买毒品。

“我过去在工作方面能力很强，当我失去工作的时候我非常茫然无助。工作对我来说很重要。从我失去工作开始，我便失去了寄托。”

有些人提前中止项目是因为他们觉得必须重新开始工作并且也已经做好了离开的准备。我们的研究发现，能够开始工作、学习或者做志愿者是成功康复的非常重要的因素，因为它增强了自我价值感并强化了能够以积极的方式回馈社会的成就感。英国的另一项研究也有类似的发现。

“我真的觉得他们可能重获了一个更好的员工，你能够理解我的意思吗？我可能离开了6个月，但现在他们重获的是一个更好的我。”

维持情感关系的作用

和工作一样，情感关系也是成功康复并提前中止计划的有力影响因素。譬如，有的人无法适应项目的强度，而其他人则非常想念他们的家人和朋友。与家人、朋友、同事和社会关系的改善是成功康复的标志之一。前成员在中止计划后所取得的成功的人际关系包括与新认识的人建立密切关系、重建已有的关系以及在康复之路上为其他成瘾者提供帮助。

“……能够倾听并诚实地面对自己……能够分享他人的故事，做一个倾听者，并向他们提供支持。”

康复成功还包括过上更健康的生活，具有更健康的心理和生理状态。这些前成员中有许多人在中止项目后继续练习瑜伽、冥想，进行体育锻炼等，而这些技能都是他们在康复项目中学会的。

从政策和治疗的角度来看，这项研究表明，应当鼓励康复项目成员不要仅仅将目光锁定在保持禁欲状态上，而是更多地通过学习、志愿服务或者找到一份工作来为社会做出积极贡献。

有些康复计划的前成员以志愿者的身份回到了康复项目中，这为项目成员注入了一针强心剂，让他们坚信能够成功戒毒/戒酒。成功的康复需要充分的支持和安全的环境。

摘要：

Background

Substance use disorders are a major contributor to the economic and healthcare burden in Australia. Therapeutic communities (TCs) are utilised treatment methods globally, though low program completion rates continue to represent a major obstacle in effective and sustainable drug and alcohol treatment. The aim of this study was to explore reasons for early withdrawal from TC programs and perceptions of successful recovery. This study also aimed to explore how employment and volunteering related to early exit and perceptions of successful recovery.

Methods

Semi-structured qualitative interviews were conducted with 13 ex-residents from a long-term TC program at a community-based rehab organisation in regional Australia.

Results

Thematic analysis revealed a complex interplay of factors contributing to early TC withdrawal, and perceptions of successful recovery from a lived experience perspective and how this was shaped by employment and volunteering. Eleven themes were identified. Three relating to reasons for joining the program, which connected with ultimate withdrawal from the program: Pre-program existing relationships, pre-program employment situation and needing a ‘circuit breaker’ in their life. Three relating to reasons for early withdrawal: TC program characteristics, relationships during the program and planning future employment. Five relating to perceptions of successful recovery: Improved understanding of their addiction, reduced substance use, improved physical and psychological health, relationship success and employment success.

Conclusions

Reasons for leaving treatment early are multi-faceted and revolve around relationships, planning future employment and program characteristics. The influence that each plays on their decision to leave early is varied and determined by the value they assign it. Perceived success extends far beyond achieving and maintaining abstinence to encompass improved relationships, psychological and physical wellbeing, understanding of addiction and employment, studying or volunteering. Self-worth and feeling able to contribute to society through employment, study and volunteering were perceived to be essential elements of successful recovery. Clinicians, policy makers and program developers should use the extended definition of successful recovery from the ex-clients perspective when determining the clinical and economic effectiveness of TC programs.

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https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1864-y?utm_source=other&utm_

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期刊介绍:

BMC Psychiatry (https://bmcpsychiatry.biomedcentral.com/,2.419 - 2-year Impact Factor,3.148 - 5-year Impact Factor) is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of psychiatric disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

（来源：科学网）