减低危害心理疗法和培训联盟.ppt

Times are changing cont.与时俱进（续） Increased interest in harm reduction psychotherapy around the world as adjunct to public health interventions 在世界范围内，人们对减低危害心理疗法产生了更浓厚的兴趣，把其作为公共卫生干预的辅助措施 Evidence-based practice riding the HR wave 在减低危害的浪潮中，始终以基于证据的实践作为基础 Increased recognition of need to treat substance use issues in context of co-occurring issues 认识到物质滥用的治疗要放在多种问题同时发生的背景中考虑 Limitations and Clinical Challenges In the USA cont.在美国的局限性和临床挑战(续) 75-93% of drug and alcohol treatment only offers abstinence goal 75%至93%的毒品和酒精治疗仅提供彻底戒断的目标 Very low rates of retention and abstinence in treatment as usual通常，治疗中的维持率和戒断率非常低 Kellogg, 2007, reviewed outcome studies showing 15%-35% retention at 12 weeks and 8% abstinent at 12 weeks 2007年，凯洛格回顾了结果研究的文献，发现12周内只有15%-35%的维持率，而12周内的戒断率只有8% Treatment Limitations and Clinical Challenges In Russia cont.俄罗斯的治疗局限和临床挑战(续) Distrust of treatment services 对治疗的不信任(Mendolevich, 2004) Users (68%) have negative attitudes toward drug tx in Russia due to poor tx outcomes, no counseling, uncaring stigmatizing attitudes and short tx. 在俄罗斯， 68% 的滥用者对脱毒有负面看法，这是由于脱毒治疗效果非常差，没有咨询服务，医生持不负责的歧视态度，治疗时间很短。(Bobrova, 2007) Recommend “a more holistic approach incorporating a range of services that address the diversity of treatment needs” 给俄罗斯的建议是：“结合一系列服务，建立一套更加全面的工作方法，以满足多样化的治疗需求。” Clinical Rationale cont. 临床原理(续) Multiple meanings and adaptive value of substances 物质的多重意义和适应值 Many issues may need to be addressed before motivation to modify substance use grows 在动员物质滥用者作出改变前，需要解决很多问题 An understanding of the role of substances has positive impact on treatment 理解物质的作用对治疗效果可产生正性影响 Need for individualized, matched treatment without predetermined goals 不能预先设定目的，应按照个人情况制定适合的治疗（个性化） Harm Reduction Psychotherapy cont.减低危害心理治疗(续) Embraces core principles of harm reduction 减低危害的核心原则 Seeks to reduce harmful consequences without requiring abstinence 旨在不要求彻底戒断的情况下，减少有害结果。 Starts where the patient is 从病人的情况出发 Embraces small incremental change 接受小的、循序渐进的改变 Addresses drug