Taia le Sini: Manatu mo le Eseʻese Suʻesuʻega Pe a Taulimaina Tagata Taʻitoʻatasi mo Faʻafitauli Faʻaaogaina o Ponokalafi (2018). (Suʻesuʻega o le Grubbs amio le talafeagai faʻataʻitaʻiga)

Faʻamatalaga o amioga tau feusuaiga

, Volume 48, Mataupu 2, pp 431-435 |

https://link.springer.com/article/10.1007%2Fs10508-018-1301-9

Shane W.Kraus, Patricia J. Sweeney

Grubbs, Perry, Wilt, ma Reid (2018a) fuafuaina se faʻataʻitaʻiga mo le malamalama i tagata taʻitoʻatasi faʻafitauli ma ponokalafi ona o amioga le talafeagai (PPMI). Faʻapitoa lava, latou mautinoa o nisi ponokalafi tagata faʻaoga e feagai ma mafatiaga o le mafaufau ma isi faʻafitauli aua o latou amioga e le ogatasi ma a latou lava taua (ie, amio le talafeagai), ma sa faia muamua suʻesuʻega fesoasoani mo lenei fuafuaina faʻataʻitaʻiga (Grubbs, Exline, Pargament, Volk, & Lindberg, 2017; Grubbs, Wilt, Exline, Pargament, & Kraus, 2018b; Volk, Thomas, Sosin, Jacob, & Moen, 2016).

I la latou tusiga, Grubbs et al. (2018a) faʻatulaga ni auala se lua mo faafitauli faʻaaogaina ponokalafi. Auala 1 o loʻo faʻamalamalama ai o faafitauli e fesoʻotaʻi ma ponokalafi e mafua mai i le dysregulation (ie, faʻaaogaina), ma le auala 2 o loʻo faʻamatalaina faafitauli tau ponokalafi ona o le amio le mama. O nei auala uma e mafaufau i le mataupu autu o mafatiaga tatou te malilie i ai o se mataupu taua e talanoaina i tagata taitoatasi o sailia togafitiga mo faafitauli faʻaaogaina ponokalafi. I totonu o le matou falemaʻi, ua matou iloa ai o le mea na tupu i le faʻalavelave, e mafua mai i se tuufaatasiga o popolega, faʻalumaina, ma / poʻo le faʻamausalaina, e masani lava o se mea e faʻaaoga mo tagata sailiili o loʻo sailia se fesoasoani. Ae ui i lea, ina ia mafai ona tuʻuina atu fautuaga talafeagai mo togafitiga mo tagata taʻitoʻatasi, e aofia ai i latou e faʻalauiloaina i latou lava e pei o "mea tau faʻatau," e tatau ona tatou fuafuaina le tikeri e mafai ai ona latou pulea a latou amioga feusuaʻi. Ua matou iloa o le toatele o tagata sailiili e sailia togafitiga mo le faʻaaogaina o le ponokalafi lipoti taua tele mafatiaga faatasi ai ma le tele o taumafaiga ua le mafai ona faʻataʻitaʻi pe aloese mai le amio, o aʻafiaga o le leaga poʻo le leaga o taunuuga mai le faʻaaogaina, ma faʻaauau pea ona faʻaaogaina e ui lava e le fiafia i ai.

O le faʻataʻitaʻiga faʻataʻitaʻi e uiga i amioga mataga faʻamalosi (CSB) sa finauina tele i tausaga ua tuanaʻi (Kraus, Voon, & Potenza, 2016b). O le CSB ua faʻatalanoaina e pei o le tagofia o feusuaiga (Carnes, 2001), feusuaʻiga (Kafka, 2010), faʻamalosi feusuaiga (Bancroft & Vukadinovic, 2004) poʻo amioga ua fai ma vaisu (Kor, Fogel, Reid, & Potenza, 2013). A o faagasolo felafolafoaiga, ua matou talisapaia popolega na tulai mai e nisi o tagata suʻesuʻe (Moser, 2013; Manumalo, 2010) faʻatatau i le ono mafai ona soʻona faʻataʻitaʻia le faia o amioga faʻafeusuaiga masani, o le mafuaʻaga lea matou te talitonu ai e taua le vaʻai mo le i ai o amioga poʻo faʻaopopo faʻailoga faʻailoaina o le tele o gaioiga faʻafeusuaiga e faʻafitauli ma le taofiofia (Kraus, Martino, & Potenza, 2016a).

E pei ona talanoaina e Kraus et al. (2018), nisi suʻesuʻega ma faʻamalosia faʻamatalaga e manaʻomia e lagolago ai le atinaʻeina o se faʻamaoniga lelei faʻavaʻa mo le CSB, e aofia ai le soʻona faʻaoga o ponokalafi (Gola & Potenza, 2018; Walton & Bhullar, 2018). E le gata i lea, matou te malilie faatasi ma Grubbs et al. (2018a) o le malamalamaaga lata mai o mea ua fai ma vaisu i ponokalafi ei ai tu ma aga faaleaganuu talu mai suʻesuʻega muamua na faia i totonu o Sisifo, o atunuʻu faʻapisinisi e iai mea faʻapitoa Kerisiano. O se faʻafitauli tele lenei e mafaufau ai pe faʻafefea ona faʻaalia ma faʻafefeina ponokalafi le faʻaaogaina o fuakalame, ma faʻalauiloaina o tagata mai isi aganuʻu eseese e ese mai i suʻesuʻega a Iutaia i le itu i sisifo o Kerisiano ma Kerisiano e uiga ile faʻaaogaina o ponokalafi ma isi amioga tau feusuaʻiga . O isi suʻesuʻega e uiga i le faʻaaogaina faʻafitauli o ponokalafi e manaʻomia e faʻamautinoa ai e le gata o faʻataʻitaʻiga o faʻataʻitaʻiga ae mafai foi ona mafai ona faʻaaogaina ile aganuu.

Faʻalavelave Faʻaleagaina o Faʻafitauli Feusuai (CSBD): Iloiloga mo Suʻega Eseese

Talu ai nei, o le Faalapotopotoga o le Soifua Maloloina a le Lalolagi (2018) fautuaina e aofia ai le CSBD ile lomiga ole 11th o le Faʻavasegaga Faʻavaomalo o faʻamaʻi (6C72). Na faʻataunuʻuina se faʻasalaga, ma na vaʻaia le CSBD o se faʻafitauli le pulea o le manava ona o suʻesuʻega suʻesuʻe e le lava le malosi e faʻatino ai o se amioga faʻafefete. O se taunuuga, o tuʻutuʻuga a le CSBD e aofia ai mea nei:

O le CSBD e faʻaalia e se faiga faifai pea o le le mafai ona faʻatonutonu, faʻaosofia lagona feusuaʻi faʻamalosi poʻo ni unaʻi e mafua ai le toe faia amioga feusuaʻi. Faʻailoga e ono aofia ai le toe faia gaioiga gaioiga avea ma totonugalemu o le olaga o le tagata i le tulaga o le faʻatamala i le soifua maloloina ma ia lava tausiga poʻo isi mea e fiafia i ai, gaioiga ma matafaioi; tele taumafaiga le faʻamanuiaina e faʻaititia ai le toe faia amioga feusuaʻi; ma faʻaauau amioga fai feusuaʻi e ui lava i le leaga aʻafiaga poʻo le mauaina itiiti pe leai se faʻamalieina mai ai. O le faʻataʻitaʻiga o le le faʻatonutonuina o le malosi, faʻamalosi feusuaiga poʻo unaʻiga ma mafua ai amioga feusuaʻi faifai pea ua faʻaalia i luga o se taimi umi o taimi (eg, 6 masina pe sili atu), ma mafua ai faʻailoga tigaina poʻo le matua faʻaletonuina o oe lava, aiga, lautele, aʻoaʻoga, galuega, poʻo isi vaega taua o le faʻagaioiga. O le faʻanoanoa e fesoʻotaʻi lava ma faʻataʻitaʻiga tau amio ma le le taliaina e uiga i lagona feusuaʻi, uunaiiga, poʻo amioga e le lava e faʻafetaui ai lenei manaʻoga (World Health Organization, 2018).

O le uiga sili ona taua o le CSBD o loʻo faʻaaogaina le taumafai e pulea pe taofia le amio a le tagata i amioga tau feusuaiga lea e mafua ai le le mautonu ma le faaletonu i le galue, ma "mafatiaga faalemafaufau ona o amioga tau feusuaiga na o ia lava e le maua ai se faʻamaoniga o le CSBD" (Kraus et al., 2018, i. 109). O vaega tāua ia e mafaufau ai i togafitiga faʻasolosolo pe o fea mea autu mo soʻo se faʻataʻitaʻiga o faʻamatalaga ma togafitiga togafitiga e amata i se iloiloga maeʻaeʻa ma faʻataʻitaʻiga eseese. Ua tatou atiae le algorithm i le Fig. 1 e fesoasoani ai i fomaʻi e mafaufau i faʻamaʻi ma togafitiga mo tagata faʻatau o loʻo faʻaaogaina faʻafitauli faʻaaogaina ponokalafi.

Ina ia fesoasoani i le malamalamaaga, o le a tatou talanoaina nei faataitaiga e tolu o tagata moni na sailia le togafitiga mo le faʻaaogaina o ponokalafi i totonu o le Vasega Faʻataʻitaʻi o le Veterans Affairs (VA). O faʻataʻitaʻiga uma ua faʻataʻatiaina ina ia mafai ai ona puipuia le le faalauaiteleina o tagata o loʻo faʻatauina.

Ata 1

O ponokalafi faigata e faʻaaoga togafitiga algorithm

Tagata taitoatasi ma le PPMI ma le CSBD

Mr. S o se biracial, heterosexual, nofofua aliʻi veteran i lona 20s o le faigaluega faavaitaimi ao auai i le kolisi. O loʻo togafitia o ia ile falemaʻi falemaʻi VA mo le faʻamaʻi o le mafaufau i tua atu o le faʻalavelave ma le faʻanoanoaga e fesoʻotaʻi ma taua a le militeri. Na sailia foi e Mr.S.S togafiti ona sa ia faailoaina ia lava o se "fai ma vaisu porn ma feusuaiga" ma lipotia le faaaogaina o ponokalafi talu mai lona talavou. Na ia taʻua foi, na te faaaogaina ponokalafi i aso uma. Na ia faamatala le tele o taumafaiga e tuu le faaaogaina o ponokalafi faapea foi ma le faia o feusuaiga le masani ai ma e masani ma totogi totogi tagata faigaluega. Na faamatala e Mr. S o ia lava o se kerisiano faaevagelia toe fuataina ma fai mai o ana ponokalafi faaaoga ma isi amioga tau feusuaiga sa "maasiasi" ma "agasala" ia te ia na mafua ai le taua mafaufau loloto mafatiaga. Na teena e Mr. S ni togafitiga ua tuanaʻi mo le CSBD ae na lipotia le alu i se kulupu a tamaloloa mo se lagolago ona o ana ponokalafi na faaaoga.

I le taimi o le falemai, o tali a le Susuga a S S i le faagasologa o iloiloga na mulimuli mai i le auala o le auala ogatotonu i le Fig. 1. Na ia faamaonia le PPMI talu ai ona o ana amioga feusuai e le ogatasi ma ona talitonuga faalelotu. E ala i lona talaaga ma lipoti o faafitauli o loʻo i ai nei, na ia fetaui ai foi ma tuʻutuʻuga atoatoa mo le CSBD. O le mea e leaga ai, e leʻi auai le Susuga S i togafitiga mulimuli ane ma le matou falemai ona o lona fiafia i le sailia o le fesoasoani naʻo lana ekalesia. Aʻo le i faʻamaeaina le taimi muamua, o fautuaga togafitiga mo le Susuga a S aofia ai le faʻamaonia o vailaʻau (naltrexone) e faʻatautaia ai lona manaʻoga ma tuʻuina atu togafitiga faʻamalosi e faʻatautaia ai talitonuga ma amioga faʻavae na mafua ai lona faʻaaogaina o ponokalafi.

Tagata taitoatasi ma le CSBD Naʻo

Mr. D o se Caucasian, tamaʻitaʻi faʻaipoipo, faʻaipoipo aliʻi fitafita i le amataga o lona 30 ma se talaʻaga o le faʻanoanoaga o ia lava na faʻailoa mai o se "vaisu i porn." Na amata ona ia masani ona faʻaaoga ponokalafi i lona amataga o tausaga talavou ma aʻafia i le faʻaalu soo i ponokalafi mo le 10 tausaga ua tuanaʻi, ae maise le maimoaina o ponokalafi mo taimi uumi taimi na malaga ai lona toʻalua mo galuega. Na ia lipotia le faamalieina o feusuaiga ma lona faletua e ui lava na ia lagona o lana ponokalafi faaaogaina na faalavelave i lona vavalalata vavalalata ma sootaga ma ia. Na faamatala e Mr. D o ana ponokalafi faaaogaaga o se faamalosia ma lipotia laitiiti e leai se faamalieina mai ai. Na lipotia e ia le unaʻi malosi e maimoa i ponokalafi ina ua mavae ni nai aso o le leai o se mea na mafua ai lona faʻaaogaina.

I le taimi o le falemaʻi, e leʻi faamaonia e le Susuga Danny le mafatia ona o le PPMI ae sa feagai ma faigata i le pulea o ana ponokalafi. Na suʻesuʻeina o ia ma maua ai tulaga uma mo le ICD-11 mo le CSBD e pei ona faʻaalia i le Fig. 1. Mr. D na faatonuina vailaʻau (naltrexone, 50 mg / aso), ma na ia auai foi i sauniga taʻitasi o le mafaufau faʻapitoa amioga togafitiga mo vailaʻau faʻaoga vailaʻau na fetuʻunaʻi e faʻatalanoa ai ona faʻafitauli faʻaaogaina ponokalafi. I le gasologa o togafitiga, sa faʻaititia ai e Mr.D ana ponokalafi ma faʻafetaui lelei ma ona manaʻoga. Na ia lipotia foi le faateleina o le auai i gaoioiga fiafia ma lona faletua ma uo e pei o savaliga sopo ma femalagaaiga.

Tagata taitoatasi ma PPMI Na o

Mr. Z o se Caucasian, tamaʻitaʻi tamaʻitaʻi tama taua i le amataga o le 40 o ona tausaga talu ona faʻaipoipo. O ia e faigaluega ma e toatasi lona alo. Na lipotia e Mr. Z se talaaga o le faanoanoa ma le faaaogaina o ponokalafi i luga ma fafo mo le 20 tausaga talu ai lea na mafua ai feteenaiga ma paaga alofa, e aofia ai lona toalua i le taimi nei. Na ia faafitia le faaaogaina o ponokalafi i vaitaimi na ia faia ai feusuaiga ma lona toalua, ae na ia taʻua e faapea, e tele tausaga e le o mafuta vavalalata ma ia. I le taimi nei, na ia matamata i ponokalafi faʻatasi tasi pe faʻalua i le vaiaso e faʻaalu ae na teʻena se faigata taofi pe tipi i tua. Na ia lipotia le faʻaaogaina o ponokalafi ona o le leai o se isi faiga faʻafeusuaiga, ae o lana ponokalafi faʻaaogaina na lagona ai o ia "mataʻutia" ma "inosia" aua o ana amioga na le ogatasi ma ona talitonuga e uiga i le auala "tatau ona amio ai" aliʻi i le tulaga o le faʻaipoipoga. Na feagai o ia ma le loloto o mafatiaga, aemaise lava le atuatuvale, fesoʻotaʻi ma le tulaga o le le mautonu i le va o ana tulaga faatauaina ma ana amioga feusuaiga.

I le taimi o le falemaʻi, na fai mai Mr. Z e le i sailia e ia se togafitiga mo lenei mataupu muamua. Na ia faʻamaonia aafiaga faʻapitoa o le mafatia ona o le PPMI ma ausia tuʻutuʻuga faʻamaonia mo le faʻavaivai ma le atuatuvale ma le popole ae le o le CSBD o loʻo faʻatusalia i le Fig. 1. O le togafitiga a le tagata lava ia na taulai atu i le faʻaitiitia o le popolega o le alii o Z Z e uiga i le amataina o feusuaiga ma lana ava. Na auai foi le Susuga a Z ma lona faletua i ulugalii o le togafitiga lea na tofia ai e le fomaʻi togafitiga ia gaoioiga e le fiafia i feusuaiga mo le ulugalii e fai ao faateleina foi a latou fesootaiga. Na lipotia mai e le Susuga a Z se faaitiitia o ponokalafi ina ua toe faaauau e ia ma lona faletua le vavalalata faaletino. Na ia lipotia foi le tele o fesoʻotaʻiga ma lona faletua faʻapea ai ma le faʻaititia o le atuatuvale ma le atuatuvale lea na mulimuli ane taʻitaʻiina ai o ia e faamuta le togafitiga.

Faaiuga Mulimuli

O lo matou faamoemoe i lenei Faʻamatalaga o le faʻaauauina lea o le faʻatalanoaga e manaʻomia e uiga i iloiloga faʻamaonia mo tagata o loʻo sailia le togafitiga mo le faʻaaoga sese o ponokalafi. E pei ona talanoaina e Grubbs et al. (2018a), o le autu o amioga le talafeagai e talafeagai pe a fuafuaina pe o se tagata maʻi ma faʻafitauli tau ponokalafi faʻaaogaina feiloaʻi ICD-11 taʻiala mo CSBD. Faʻamaoniga fai mai o nisi tagata lipotia taua tele faʻataʻitaʻiga ma / pe faʻatonutonuina a latou faʻaaogaina o ponokalafi e oʻo atu ai i le ogaoga o mafatiaga ma faʻaletonu i le tele o vaega o psychosocial functioning (Kraus, Potenza, Martino, & Grant, 2015b). Faatasi ai ma le mafai ona aofia ai le CSBD i le ICD-11 ma le maualuga o le faʻaaogaina o ponokalafi e faʻaaoga i le tele o atunuʻu i Sisifo, tatou te faʻamoemoe o le a tele tagata o le a sailia togafitiga mo faʻafitauli faʻafefiloi e faʻaaoga i le lumanai. Ae ui i lea, e le oi latou uma e sailia togafitiga mo faʻafitauli faʻafefiloi o ponokalafi e faʻaogaina ponokalafi o le a fetaui ma taiala mo le CSBD. E pei ona talanoaina i luga, o le malamalama i mafuaʻaga i tua o filifiliga a tagata faatau mo le sailia o le fesoasoani mo le faʻaaogaina o ponokalafi o le a taua tele ina ia mafai ai ona fuafua tonu le suʻesuʻega saʻo ma togafitiga togafitiga mo tagata faʻatau.

E pei ona faʻamamafaina e a matou tagata fai pisinisi faʻataʻitaʻiga, e manaʻomia le faʻataʻamilo ese o le natura o faʻafitauli tau faʻafitauli tau ponokalafi mo faʻamalamalamaga faʻapitoa ma talafeagai togafitiga faʻutuaina e ofoina. E tele togafitiga ua uma ona atiaʻe ma faʻataʻitaʻiina mo le CSB, e aofia ai le faʻaaogaina faʻafitauli o ponokalafi. Faʻamaoniga muamua lagolagoina le faʻaaogaina o le mafaufau faʻapitoa amioga togafitiga (Hallberg, Kaldo, Arver, Dhejne, & Öberg, 2017), taliaina tautinoga togafitiga (Crosby & Twohig, 2016) poʻo auala faʻavae mafaufau (Brem, Shorey, Anderson, & Stuart, 2017; Reid, Bramen, Anderson, & Cohen, 2014). I se faʻaopopoga, e i ai ni faʻamaoniga e lagolago ai vailaʻau faʻasoifua maloloina (Gola & Potenza, 2016; Klein, Rettenberger, & Briken, 2014; Kraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015a; Raymond, Grant, & Coleman, 2010). E pei ona faʻaalia i faʻataʻitaʻiga ma tagata faʻataʻitaʻiga ma le Fig. 1, o tagata e iai faafitauli faʻapitoa o ponokalafi faʻaaogaina e eseese faʻamatalaga ile falemaʻi ma mafuaaga mo le sailia o fesoasoani. O le mea lea, o le suʻesuʻega i le lumanaʻi e manaʻomia e atiina ae ai togafitiga e fetaui tonu ma le faʻalavelave ma faʻalauiloaina o mataupu e faʻaaogaina ai le faʻafitauli o ponokalafi.

Faamatalaga

faatupeina

O lenei galuega na lagolagoina e le Vaega o Veterans Affairs, Veterans Health Administration, VISN 1 New England Mental Illness Research, Education, and Clinical Center.

Tausisia o Tulaga Faatauaina

Feeseeseaiga o tului

E leai ni feteenaʻiga a tusitala e faailoa atu mo mea o loʻo i ai i le taimi nei. O manatu faaalia o mea ia a tusitala ma e le o se mea e atagia ai le tulaga poo le faigamalo a le Vaega o Veterans Affairs, ISA.

Talosaga Tino

Na mulimulitaʻia taʻiala uma e pei ona manaʻomia e le Vaega o Veteran Affairs. O lenei tusiga e le aofia ai ni suʻesuʻega faʻatasi ai ma tagata poʻo meaola manu na faia e soʻo se tusitala. O le faʻaaogaina o vailaau faʻataʻitaʻiga na faʻamaonia na aofia ai mo naʻo aʻoaʻoga faʻaaoaoga.

mau faasino

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