Therapeutic Interactive Voice Response to Augment CBT in Alcohol Dependence

描述(申请人提供)：交互式语音应答(IVR)是一种基于计算机的电话系统，使用户能够通过电话键盘对询问脚本问题的录音语音进行回复。我们一直在探索IVR作为一种有效数据收集和干预工具的潜力。我们之前研究的证据表明，只需致电IVR报告长期每天饮酒，就可以减少酗酒者的酒精消耗量。在一项正在进行的研究中，我们发现有证据表明，每天的IVR报告放大并扩大了初级保健提供者向危险饮酒者提供的短暂干预的治疗效果。我们现在已经开发和测试了一种更复杂的“治疗性”IVR(TIVR)，作为认知行为疗法(CBT)的补充。除了做日常报告外，患者还可以使用TIVR来回顾和/或排练他们在CBT中学到的应对技能，并获得关于他们临床进展的个性化反馈。由先前的评价者推荐的一项试点研究的结果证明了TIVR用于酒精依赖患者戒酒导向组CBT的治疗增强的可行性、患者接受性和潜在的好处。在本申请中，我们提出了一项TIVR的随机对照试验，作为CBT组的补充，用于 酒精依赖。方法：将完成12个疗程的团体认知行为应对技能训练(CBT)的酒依赖患者200例随机分为两组：1)单纯CBT组，或2)CBT+6个月TIVR组。我们将在不同的时间间隔测量饮酒和与酒精相关的症状、改变的准备、自我效能、情景自信、应对技能的使用和应对行为的有效性，包括：CBT前和治疗后6个月、TIVR期间和之后6个月(即CBT后12个月)。这项应用的主要目标是测试TIVR是否增强了CBT对酒精依赖的治疗效果。我们的长期目标是开发专门设计的干预措施，以利用IVR的独特优势。可以远程访问的有效、低成本的酒精依赖干预措施对公共健康的影响是巨大的。

DESCRIPTION (provided by applicant): Interactive Voice Response (IVR) is a computer-based telephone system that enables users to respond with the telephone keypad to a recorded voice asking scripted questions. We have been exploring the potential of IVR as a tool for efficient data collection and for intervention. Evidence from our previous research suggests that simply calling an IVR to report drinking each day for extended period results in a reduction of alcohol consumption among heavy drinkers. In an ongoing study, we are finding evidence that daily IVR reports amplify and extend the therapeutic effect of brief intervention delivered by primary care providers to hazardous drinkers. We have now developed and tested a more elaborate "Therapeutic" IVR (TIVR) as a supplement to cognitive behavioral therapy (CBT). In addition to making daily reports, patients can use the TIVR to review and/or rehearse coping skills they learned in CBT and get personalized feedback about their clinical progress. Results from a pilot study recommended by the prior reviewers demonstrate feasibility, patient acceptance, and the potential benefits of the TIVR when used for the therapeutic enhancement of abstinence-oriented group CBT in patients with alcohol dependence. In this application we propose a randomized controlled trial of the TIVR as a supplement to group CBT for alcohol dependence. Method: Patients (N= 200) who have completed 12 sessions of group cognitive behavioral coping skills training (CBT) for alcohol dependence will be randomly assigned to one of two treatment groups: 1) CBT only, or 2) CBT plus 6 months of TIVR. We will measure alcohol consumption and alcohol-related symptoms, readiness to change, self-efficacy, situational confidence, use of coping skills, and coping behavior effectiveness at various intervals including: immediately before and after CBT, during and immediately after 6 months of TIVR, and 6 months later (i.e. 12 months post-CBT). The primary goal of this application is to test whether the TIVR enhances the therapeutic effect of CBT for alcohol dependence. Our long-term objective is to develop interventions specifically designed to capitalize on the unique advantages of IVR. The public health implications of effective, low cost interventions for alcohol dependence that can be accessed remotely are considerable.