反复线索暴露治疗联合生物反馈训练治疗急性脱瘾后酒依赖患者的随访对照研究

A follow-up controlled study of repeated cue exposure therapy combined with biofeedback training for patients with alcohol dependence after the acute withdrawal

目的:探讨反复线索暴露治疗联合生物反馈训练治疗急性脱瘾后酒依赖患者的疗效。方法:纳入2016年11月至2018年6月北京回龙观医院住院的男性酒依赖患者130例,采用随机数字表区组随机化法将患者分为试验组和对照组。在控制急性期酒精戒断症状后,试验组给予线索暴露治疗及生物反馈训练12次,对照组给予常规的康复治疗和一般性的心理支持,分别在治疗前后采用可视渴求量表(Visual Analog Scale,VAS)和饮酒迫促性量表(Alcohol Urge Questionnaire,AUQ)评估患者对酒的心理渴求。2组患者治疗4周后出院,并于出院后4周末、8周末、12周末、24周末、52周末进行随访,分析2组复饮率、累计戒酒持续时间、首次复饮间隔天数、复饮后饮酒频率及日均饮酒量,并采用独立样本t检验或卡方检验进行组间比较。结果:试验组治疗前后VAS减分值[2.10(0.33,2.78)分与0.60(-0.30,1.70)分]、AUQ减分值[3.00(1.00,6.00)分与1.00(-2.00,4.00)分]均较对照组高,差异均有统计学意义(Z=-3.50,P=0.001;Z=-3.02,P=0.003)。治疗后4周末随访结果显示,试验组较对照组复饮率低(30.0%与54.2%,χ^(2)=7.17,P=0.007),首次复饮间隔天数长[52.5(26.0,208.5)d与21.0(5.0,183.0)d,Z=-2.50,P=0.013]。随访52周末总的日均饮酒量(标准杯)试验组较对照组少(11.0±8.5与15.2±8.6,t=-2.69,P=0.008)。结论:反复线索暴露治疗联合生物反馈训练可以降低急性脱瘾后酒依赖患者的心理渴求,进一步降低治疗后4周的复饮率,远期(治疗后1年)的复饮率没有明显降低,但是可以延长首次复饮间隔天数及降低日均饮酒量。

Objective This study aims to investigate the effect of repeated cue exposure therapy combined with biofeedback training on patients with alcohol dependence after acute withdrawal.Methods A total of 130 male alcohol dependent patients(PADs)who were hospitalized in Beijing Huilongguan Hospital from November 2016 to June 2018 were enrolled,and after the alcohol withdrawal syndrome eliminated,the PADs were divided into two groups by randomized controlled research methods as follows:repeated cue exposure combined biofeedback therapy group(study group,SG)and routine treatment group(control group,CG).After controlling the symptoms of acute alcohol withdrawal,the SG patients were given cue exposure therapy and biofeedback training 12 times,and the CG patients were given routine rehabilitation treatment and general psychological support over a four-week session.The psychological craving for alcohol of two groups were evaluated with Visual Analog Scale(VAS)and Alcohol Urge Questionnaire(AUQ)before and afer treatment.Both groups were discharged after four-week treatment and received follow-ups at the end of the 4th,8th,12th,24th and 52th week,respectively.The alcohol consumption questionnaire was used to evaluated with the recurrence rate,cumulative abstinence duration(CAD),time to first re-drinking,and average daily alcohol consumption after relapse for each follow-up assessment.Independent sample t test or chi-square test was used for comparison between groups.Results The decrement of VAS before and after cue exposure treatments in the SG was significantly higher than that in the CG(2.10(0.33,2.78)vs.0.60(-0.30,1.70),Z=-3.50,P=0.001).The decrement of AUQ score was also significantly higher than the CG(3.00(1.00,6.00)vs.1.00(-2.00,4.00),Z=-3.02,P=0.003).There was a significant difference in the rate of recurrence at the end of week-4 between the SG and CG(30.0%vs.54.2%,χ^(²)=7.17,P=0.007).The time before the first re-drinking in the experimental group was longer than that in the control group(52.5(26.0,208.5)d vs.21.0(5.0,183.0)d,Z=-2.5,P=0.013).The total average daily alcohol consumption of the experimental group was lower than that of the Control Group(11.0±8.5 vs.15.2±8.6,t=-2.69,P=0.008).Conclusions The results suggest that repeated cue exposure combined with biofeedback therapy can reduce the psychological craving for alcohol and recurrence rate after a short term of treatment.Meanwhile,the long-term(follow-up 1 year after treatment)recurrence rate may not change significantly,however the first re-drinking can be postponed,and they tend to drink less even if they re-drink again.