Cost Effectiveness of Combined Contingency Management and Cognitive Behavioral Therapy for Alcohol Use Disorder

联合应急管理和认知行为疗法治疗酒精使用障碍的成本效益

• 批准号: 10294373
• 负责人: PATRICK S. CALHOUN
• 金额: $ 12.85万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10294373
• 关键词: Abstinence; Accounting; Acute; Address; Affect; Aftercare; Alcohol consumption; Alcohols; Ambulatory Care; Chronic; Clinical Trials; Clinical effectiveness; Cognitive Therapy; Data; Data Analyses; Data Set; Development; Diagnosis; Diagnostic; Distress; Dose; Dropout; Ecological momentary assessment; Effectiveness of Interventions; Feeling hopeless; Feeling suicidal; Future; Gender; Goals; Heavy Drinking; High Prevalence; Hospitalization; Hour; Impulsivity; Individual; Intervention; Lead; Life; Link; Literature; Mediating; Mental Depression; Mental Health; Modification; Motivation; Nature; Outcome; Outpatients; Pathway interactions; Persons; Population; Post-Traumatic Stress Disorders; Recording of previous events; Relapse; Reporting; Research; Risk; Self Efficacy; Severities; Socioeconomic Status; Stressful Event; Suicide; Suicide attempt; Surveys; Symptoms; Testing; Thinking; Time; Treatment Failure; Treatment outcome; Veterans; alcohol abuse therapy; alcohol relapse; alcohol response; alcohol risk; alcohol use disorder; behavior influence; chronic alcohol ingestion; contingency management; cost; cost effectiveness; drinking; economic cost; effectiveness testing; emotion dysregulation; experience; high risk; improved; insight; mHealth; negative affect; outcome prediction; parent grant; reduced alcohol use; response; secondary analysis; societal costs; standard of care; statistics; stressor; suicidal; suicidal behavior; suicidal risk; trait impulsivity

The parent grant plans to examine the clinical and cost-effectiveness of cognitive-behavioral therapy (CBT) combined with contingency management (CM) in reducing problematic drinking in veterans who meet diagnostic criteria for alcohol use disorder (AUD). Research suggests that those with AUD and co-occurring suicidal thoughts and behaviors are more likely to respond poorly to AUD treatment and relapse on alcohol use. This is important, given that nearly half of those with AUD who present for AUD treatment report a history of suicidal behavior, and numerous studies indicate that those with co-occurring AUD and suicidal thoughts and behaviors tend to demonstrate more severe and chronic AUD symptoms. Despite the robust association between alcohol and suicide, and the extent that co-occurring suicidal thoughts and behaviors influences the presentation and treatment of AUD, little research has examined mechanisms underlying these associations. The proposed supplement would extend the parent grant study by testing the extent that ongoing suicidal thoughts and behaviors impact the progression of and response to CBT/CM for AUD, and examine if CBT/CM leads to reduction in suicide risk in veterans over time, thereby providing a further test of the clinical and cost effectiveness of CBT/CM for AUD (Aim 1). The proposed supplement would also involve secondary analyses of data from a recently conducted ecological momentary assessment (EMA) study on veterans at high-risk for suicide. This study, which was conducted over a 4-week period, involved veterans completing multiple brief surveys per day on a number of momentary variables, including daily alcohol use, momentary suicidal ideation, and other internal (e.g., affect) and contextual (e.g., daily stressors, interpersonal problems) variables. With these variables, the proposed supplement would use advanced longitudinal statistics to examine the extent that daily alcohol use leads to subsequent increase in suicidal thoughts, as well as if suicidal thoughts lead to increase in alcohol consumption, and explore moderators of these associations (Aim 2). While there have been several studies suggesting a dose response relationship between alcohol use and subsequent suicidal desires, the proposed supplement would be the first use EMA to examine the likely bidirectional and dynamic relationship between AUA and suicidal thoughts and behaviors. This will allow us to better understand how the co-occurring mental health problem of suicidal thoughts and behaviors perpetuates and worsens AUD symptoms in real life. Overall, improved understanding of longitudinal relationships between alcohol consumption and acute fluctuations in suicidal thoughts and behaviors in daily life and in the context of treatment significantly enhances the parent grant, and could be highly informative for the future modification and development of mobile health interventions with CBT/CM.

家长补助金计划检查认知行为疗法（CBT）的临床和成本效益 结合应急管理（CM），以减少退伍军人的问题饮酒， 酒精使用障碍（AUD）的诊断标准。研究表明，那些与AUD和共同发生 自杀想法和行为更可能对AUD治疗反应不佳，并在酒精中复发 使用.这一点很重要，因为近一半接受AUD治疗的AUD患者报告了病史 许多研究表明，那些同时发生AUD和自杀想法的人， 和行为倾向于表现出更严重和慢性的AUD症状。尽管有强大的关联 酒精和自杀之间的关系，以及同时发生的自杀想法和行为对自杀的影响程度。 然而，由于AUD的临床表现和治疗，很少有研究探讨这些相关性的机制。 拟议的补充将通过测试持续自杀的程度来扩展父母补助金研究。 想法和行为影响AUD的CBT/CM的进展和反应，并检查CBT/CM是否 随着时间的推移，导致退伍军人自杀风险降低，从而提供了临床和成本的进一步测试 CBT/CM对AUD的有效性（目标1）。拟议补编还将涉及二次分析 最近进行的一项关于退伍军人高风险的生态瞬时评估（EMA）研究的数据， 自杀这项为期4周的研究涉及退伍军人，他们完成了多项简短的研究。 每天对一些瞬时变量进行调查，包括每日饮酒，瞬时自杀意念， 以及其它内部（例如，影响）和上下文（例如，日常压力、人际关系问题）变量。与 在这些变量中，拟议补编将使用先进的纵向统计数据， 每天饮酒会导致自杀念头的增加，如果自杀念头导致 增加酒精消费，并探索这些协会的主持人（目标2）。尽管已经 有几项研究表明，饮酒与随后的自杀之间存在剂量反应关系， 希望，拟议的补充将是第一次使用EMA检查可能的双向和动态 AUA与自杀想法和行为之间的关系。这将使我们能够更好地了解 同时发生的自杀想法和行为的心理健康问题使AUD持续存在并恶化 真实的生活中的症状。总的来说，对酒精与健康之间的纵向关系的理解得到了提高。 在日常生活中以及在 治疗显着提高了父母补助金，并可能是高度信息化的未来修改 和发展移动的健康干预与CBT/CM。