精神分析治疗与嗜酒者互诫协会对降低酒依赖患者复饮率的效果

Effectiveness of psychoanalysis and alcoholics anonymous on reducing re - drinking rate among patients with alcohol dependence

目的：比较精神分析治疗与嗜酒者互诫协会（AA）对降低酒依赖患者复饮率的有效性。方法将108例酒依赖患者随机分为精神分析治疗组（n ＝54）与 AA 治疗组（n ＝54），治疗时间为16周。两组患者在给予常规治疗的基础上，精神分析治疗组进行每周两次的精神分析治疗，AA 组进行每周三下午的 AA 活动，在治疗前、治疗4周末、8周末、12周末、16周末，分别给予汉密尔顿抑郁量表（HAMD）评估，在治疗前与治疗16周末分别使用症状自评量表（SCL －90）对两组患者进行评定，出院后6个月内保持每月一到两次的电话随访或门诊复查，以了解患者复饮的情况。结果两组治疗前HAMD 、SCL －90评分比较差异无统计学意义（P ＞0．05）。治疗后两组 HAMD 评分均明显下降，且治疗后8，12，16周末精神分析治疗组评分低于 AA 治疗组，差异有统计学意义（P ＜0．01）。治疗后SCL －90评分中除精神病性障碍因子外，两组评分均较治疗前明显改善，差异有统计学意义（P ＜0.05），且精神分析治疗组躯体化、焦虑、抑郁、敌对、人际关系敏感和睡眠饮食不良评分优于 AA 治疗组，差异亦有统计学意义（P ＜0．05）。出院后6个月两组复饮率比较，精神分析治疗组30．4％（14／54）低于 AA 组39．1％（18／54），但差异无统计学意义（χ2＝0．431，P ＝0．511）；多因素 Cox 回归分析表明：精神分析治疗或 AA 治疗、对酒的依赖程度是影响酒依赖患者复饮率的因素。结论精神分析治疗与AA 对于酒依赖患者复饮率的降低均有明显效果，两组总体比较精神分析治疗组优于 AA 组，在治疗过程中精神分析治疗对于患者疾病的缓解明显优于 AA ，在出院后复饮率的比较上，两者差异不明显。

Objective To compare the effectiveness of psychoanalysis and alcoholics anonymous （AA） on reducing re - drinking rate among patients with alcohol dependence .Methods Totals of 108 pa-tients with alcohol dependence were randomly divided into psychoanalytic treatment group （n = 54） and AA treatment group （n = 54） .Treatment time was 16 weeks .On the basis of given routine therapy to patients in both groups ,patients with psychoanalytic treatment were given psychoanalytic therapy twice a week , and holding alcoholics anonymous activity for patients with AA treatment group on every Wednesday afternoon ,assessing each group of patients by Hamilton Depression Scale（HAMD） before treatment ,after 4 ,8 ,12 ,16 weeks of treatment ,evaluating each group of patients by Symptom Self -assessment Scale（SCL - 90） before treatment and after 16 weeks of treatment ,keeping 1 or 2 times a month of telephone follow - up or outpatient care within 6 months after the patients discharged ,in order to understand the patients＇re - drinking situation .Results The scores of HAMD and SCL - 90 showed no significant difference before treatment （P 〉 0 .05） .HAMD scores were significantly decreased in two groups after treatment ,and the score in psychoanalytic treatment group were lower than AA treatment group after 8 ,12 ,16 weeks of treatment ,the difference were statistically significant （P 〈 0.01） .After treatment ,SCL - 90 score except the psychiatric disorder factor ,the score in two groups were improved obviously before treatment ,the difference were statistically significant （P 〈 0 .05） ,and the score of so-matization ,anxiety ,depression ,hostility ,interpersonal sensitivity and poor sleep and diet in psychoana-lytic treatment group were better than those in AA treatment group ,the difference were also statistically significant （P 〈 0 .05） .Compared re - drinking rate 6 months after hospital discharge ,the psychoanalytic treatment group was 30 .4% （14/54） was lower than the AA treatment group 39 .1% （18/54） ,but there was no statistically significant difference （χ2 = 0 .431 ,P = 0 .511） .Cox regression analysis showed that psychoanalytic treatment or AA treatment ,the degree of dependence on alcohol were factors influencing the re - drinking rate of alcohol - dependent patients .Conclusions Both psychoanalysis and AA treatment have obvious influence on reducing re - drinking rate among patients with alcohol dependence , compared with the two groups ,psychoanalytic treatment group was better than the AA group ,for dis-ease remission ,psychoanalytic treatment is better than the AA ,in the comparison of re - drinking rate after hospital discharge ,the difference is not significant .