INDIVIDUALIZED ASSESSMENT AND TREATMENT FOR ALCOHOL

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。尽管认知行为治疗（CBT）在物质使用障碍中很受欢迎，但最近的研究结果表明，CBT可能并不比其他理论驱动较少的治疗更有效，并且CBT治疗往往无法获得应对技能。为了探讨目前手动驱动的CBT交付模式可能不足以成功地教应对技能的可能性，我们提出了一个试点项目，为酒精依赖者制定个性化的评估和认知行为治疗计划（IATP），其中通过随机呼叫手机进行的经验抽样被用来提供数据，以创建个性化的治疗计划。在经验采样期间收集的数据将包括对患者饮酒认知、影响和应对行为的瞬时评估。 参与者将是112名符合酒精依赖或酒精滥用标准的男性和女性，他们将被随机分配到一个标准的包装手动驱动的认知行为治疗计划（PCBT），如项目匹配中使用的，或IATP。两种治疗的患者将被要求在治疗前两周进行经验采样，并在治疗结束后再进行两周，以比较两组之间治疗前和治疗后应对技能利用的体内测量。在两种治疗中，治疗将进行12次以上。 在IATP中，从经验采样中收集的信息将形成对监测期间患者饮酒和饮酒冲动的功能分析的基础。认知评价、情绪和应对反应将作为饮酒行为的前因和后果进行评估。治疗师将使用这些信息来解决适应性和适应不良的特定认知、情感和行为，并与患者合作以替代适应性应对策略。 在PCBT中，经验采样数据将不会专门用于治疗，但仍将提供饮酒和应对技能的体内测量。据推测，IATP将产生显着更好的应对技能收购比PCBT，应对技能的变化将预测更好的IATP治疗后的结果。这些结果将对我们提供治疗，以及应对技能培训的有效性酒精成瘾。 具体目标如下：1.确定个体化评估和治疗计划（IATP）是否比标准的成套认知行为治疗（PCBT）更能获得应对技能。H1：据推测，IATP将导致显着更大的增加，报告使用的应对技能，从治疗前到治疗后相对于PCBT。 2.为了确定IATP中的应对技能获得对治疗结果的影响是否超过治疗前个体差异（即，动机和自我效能）。H2：据推测，在IATP条件下，治疗前到治疗后应对技能的增加将比治疗前个体差异变量更能解释治疗后饮酒结果的差异。 3.根据体内患者监测的功能分析，确定IATP在治疗后是否会产生比PCBT H3更好的结局：假设IATP在治疗后会产生比标准包装CB方法更好的饮酒结局。饮酒结果将包括治疗期间戒酒天数比例和重度饮酒天数比例。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Despite the popularity of Cognitive-Behavioral Treatment (CBT) in substance use disorders, recent findings have indicated that CBT may be no more effective than other, less theoretically driven, treatments, and that CBT treatments often fail to result in coping skills acquisition. In order to explore the possibility that current manual-driven modes of CBT delivery may not be adequate to successfully teach coping skills, we are proposing a pilot project for the development of an individualized assessment and cognitive-behavioral treatment program (IATP) for alcohol-dependent persons, in which experience sampling conducted via random calls to cell-phones is used to provide data to create individualized treatment plans. Data collected during experience sampling will include momentary assessments of patients cognitions, affects, and coping behaviors with respect to drinking. Participants will be 112 men and women meeting criteria for alcohol dependence or alcohol abuse, who will be randomly assigned to either a standard packaged manual-driven cognitive-behavioral treatment program (PCBT) like that used in Project MATCH, or to IATP. Patients in both treatments will be asked to engage in experience sampling for two weeks prior to treatment, and for another two weeks after treatment has ended, in order to compare in-vivo measures of coping skills utilization, pre- and posttreatment, between the two groups. Therapy will be conducted over 12 sessions in both treatments. In IATP, the information gathered from experience sampling will form the basis of a functional analysis of patients' drinking and drinking urges during the monitoring period. Cognitive appraisals, moods and coping responses will be evaluated as antecedents and consequences of drinking behavior. Therapists will use the information to address specific cognitions, affects, and behaviors that are adaptive and maladaptive, and will work with the patient to substitute adaptive coping tactics instead. In PCBT the experience sampling data will not be specifically used in therapy, but will still provide in-vivo measures of drinking and coping skills. It is hypothesized that IATP will yield significantly better coping skills acquisition than will PCBT, and that change in coping skills will predict better posttreatment outcomes for IATP. These results would have implications for our delivery of treatment, and for the validity of coping skills training for alcohol addiction. Specific Aims are as follows: 1. To determine whether an Individualized Assessment and Treatment Program (IATP) results in greater acquisition of coping skills than does a standard Packaged Cognitive-Behavioral Treatment (PCBT). H1: It is hypothesized that IATP will result in significantly greater increases in reported use of coping skills from pre- to posttreatment relative to PCBT. 2. To determine if coping skills acquisition in IATP accounts for treatment outcome over and above the contribution made by pretreatment individual differences (i.e., motivation and self-efficacy). H2: It is hypothesized that pre- to posttreatment increases in coping skills in the IATP condition will account for more variance in drinking outcomes at posttreatment than will pretreatment individual difference variables. 3. To determine whether IATP, based on functional analysis of in-vivo patient monitoring, will yield better outcomes at posttreatment than will PCBT H3: It is hypothesized that IATP will yield better drinking outcomes at posttreatment than will the standard packaged CB approach. Drinking outcomes will include proportion days abstinent, and proportion heavy drinking days during the treatment period.