Expanding the science on recovery mutual aid for alcohol use disorder: An investigation of SMART Recovery

扩大酒精使用障碍康复互助的科学：SMART Recovery 的调查

• 批准号: 10155379
• 负责人: JOHN F. KELLY
• 金额: $ 36.34万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10155379
• 关键词: Abstinence; Accounting; Alcoholics Anonymous; Alcohols; Behavioral; Behavioral Mechanisms; Caring; Chronic; Clinical; Clinical Practice Guideline; Cognitive; Communities; Data; Disease remission; Distress; Drug Metabolic Detoxication; Drug usage; Economics; Effectiveness; Enrollment; Gender; Geographic state; Goals; Health Care Costs; Impulsivity; Individual; Investigation; Knowledge; Link; Modeling; Monitor; Motivation; Outcome; Participant; Pathway interactions; Patients; Pattern; Persons; Play; Practice Guidelines; Public Health; Quasi-experiment; Recovery; Relapse; Religion; Research; Research Design; Resources; Role; Science; Self Efficacy; Self Management; Services; Severities; Social Network; Societies; Spirituality; Stratification; Testing; Time; Training; United States; addiction; alcohol abuse therapy; alcohol use disorder; base; behavior change; comparative; comparative effectiveness; cost; cost effectiveness; court; demographics; design; evidence base; experience; experimental study; flexibility; indigenous community; inpatient service; meetings; migration; outpatient programs; peer support; preference; prospective; relapse risk; social; standard of care; stem; virtual

Project Summary Professional treatment plays a vital role in helping individuals with alcohol use disorder (AUD) stabilize and begin recovery. Typically, however, some form of ongoing support is needed to increase the chances of stable remission. Consequently, a common clinical strategy is to link patients with freely available mutual-help organizations (MHOs), which can provide flexible ongoing community-based support. MHO effectiveness and cost-effectiveness have been supported empirically and, consequently, referral to MHOs is recommended in most practice guidelines. A limitation of the current standard of care, however, stemming from a lack of data, is the fact that referrals are typically made almost exclusively to spiritually-oriented 12-step organizations, such as Alcoholics Anonymous (AA). One important consequence of this virtual predominance of studies on 12-step MHOs is that they are the only empirically-supported MHO continuing care referral option. Given the spiritual orientation of 12-step organizations, however, and rulings by some US states’ supreme courts that 12-step MHOs are technically religions and thus cannot be the sole referral option, it is important to offer secular alternatives. One prime candidate is SMART Recovery, a secular cognitive-behavioral MHO providing peer support in 1,200 face-to-face meetings in the US. Little is known, however, regarding its real-world benefit. A rigorous study showing SMART Recovery can help reduce relapse risk would provide valuable information that could boost clinical confidence in SMART as a low-cost recovery resource and thus be a secular empirically- supported clinical referral option. As a next step in evaluating the real-world clinical and public health utility of SMART Recovery, the current study will: 1. Characterize and describe professional and non-professional recovery support service participation choices, migrations, and pathways using group trajectory analyses over a two-year period for individuals (N=348) starting a new AUD recovery attempt. 2. Investigate the comparative effectiveness of SMART Recovery by comparing outcomes of AUD individuals making the new recovery attempt (N=348) pursuing either a SMART Recovery (n=174), or a non-SMART recovery (n=174), pathway. Because roughly half of SMART participants also choose to attend AA, we will use a stratified design to enroll persons with AUD making naturally occurring continuing care choices vis-à-vis participation in MHOs in a balanced fashion, and follow them prospectively across a 2-year period (i.e., SMART + AA vs. SMART-Only vs. AA-Only vs. Neither). Because prior data shows SMART participants may be less severe than AA participants, we will stratify groups by AUD severity (mild, moderate, and severe). In addition to using propensity score matching, this stratification will allow us to compare with greater scientific rigor the outcomes of persons choosing to participate in SMART Recovery vs. not, while accounting for simultaneous choices regarding AA or no MHO participation. 3. Explore mechanisms of behavior change (e.g., self-efficacy, impulsivity), as well as moderators of the degree of benefit (e.g., gender, psychiatric distress) to help determine how SMART Recovery may help its affiliates.

项目摘要 专业治疗在帮助酒精使用障碍（AUD）患者稳定和 开始恢复。然而，通常需要某种形式的持续支持来增加稳定的机会 缓解。因此，一种常见的临床策略是将患者与免费提供的互助联系起来 组织（MHO），可以提供灵活的持续社区支持。MHO有效性和 成本效益已得到经验支持，因此，建议转诊到MHO， 大多数实践指南。然而，由于缺乏数据，目前的护理标准存在局限性， 事实上，转介通常几乎完全是以精神为导向的12步组织， 匿名戒酒会（AA）这种对12步的研究占主导地位的一个重要结果是， MHO是他们唯一的医疗支持MHO持续护理转介选择。鉴于精神上的 然而，12步组织的定位，以及美国一些州最高法院的裁决， MHO在技术上是宗教，因此不能成为唯一的推荐选择，重要的是提供世俗的 替代品.一个主要的候选人是SMART Recovery，这是一个世俗的认知行为MHO， 在美国举行的1,200次面对面会议上获得支持。然而，关于它在现实世界中的好处却知之甚少。一 严格的研究表明，SMART恢复可以帮助降低复发风险，这将提供有价值的信息， 可以提高SMART作为低成本恢复资源的临床信心，从而成为一种长期的经验- 支持临床转诊选项。作为评估的现实世界的临床和公共卫生效用的下一步 SMART恢复，目前的研究将：1。描述和描述专业和非专业 恢复支持服务参与选择、迁移和路径，使用组轨迹分析， 开始新的AUD恢复尝试的个人（N=348）为期两年。2.调查比较 通过比较进行新恢复的AUD个体的结果来评估SMART恢复的有效性 尝试（N=348）寻求SMART恢复（n=174）或非SMART恢复（n=174）途径。 由于大约一半的SMART参与者也选择参加AA，我们将使用分层设计来招募 AUD患者自然选择继续护理与参加MHO维斯， 平衡的方式，并在2年内前瞻性地跟踪它们（即，SMART + AA与仅SMART vs. AA-仅vs.均不）。因为之前的数据显示SMART参与者可能没有AA严重 在参与者中，我们将按AUD严重程度（轻度、中度和重度）对各组进行分层。除了使用 倾向评分匹配，这种分层将使我们能够比较更科学的严谨性的结果， 选择参加SMART恢复与不参加SMART恢复的人的比例，同时考虑到同时的选择 关于AA或没有MHO参与。3.探索行为改变的机制（例如，自我效能， 冲动性），以及利益程度的调节者（例如，性别，精神痛苦），以帮助确定 SMART Recovery如何帮助其子公司。