Therapeutic Interactive Voice Response to Augment CBT in Alcohol Dependence

描述（由申请人提供）：交互式语音应答（IVR）是一种基于计算机的电话系统，用户可以通过电话键盘对录制的语音进行应答，询问脚本问题。我们一直在探索IVR作为有效数据收集和干预工具的潜力。我们之前的研究证据表明，只要每天拨打IVR报告长时间饮酒情况，就能减少重度饮酒者的饮酒量。在一项正在进行的研究中，我们发现每日IVR报告放大并扩展了初级保健提供者对危险饮酒者的短暂干预的治疗效果。我们现在已经开发并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，患者还可以使用TIVR来回顾和/或演练他们在CBT中学到的应对技巧，并获得关于他们临床进展的个性化反馈。先前审稿人推荐的一项试点研究结果表明，在酒精依赖患者中，使用TIVR增强戒酒导向的群体CBT治疗的可行性、患者接受度和潜在益处。在本应用中，我们提出一项随机对照试验，将TIVR作为组CBT的补充

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.