Drinking Trajectories and Mechanisms of Behavior change During and One Year Follo

描述(由申请人提供)：拟议的研究将使用联合研究的现有数据来评估酒精依赖的联合行为干预(CBI)后行为改变的机制。联合(联合药物和行为干预)是一项多点临床试验，旨在评估两种药物(纳曲酮和氨基己酸酯)与两种行为干预(联合行为干预(CBI)和医疗管理(MM))之一联合使用治疗酒精依赖的疗效。拟议的研究将特别关注被随机分配到CBI条件下的个人，这些参与者(n=776)在16周内接受了最多20次50分钟的治疗。在每个治疗过程中，对情绪状态、感觉到的压力、渴望和饮酒进行评估。在8周、16周、26周、52周和68周进行随机化后的心理、饮酒相关和行为结果评估。CBI干预结合了动机增强、认知行为和十二步促进疗法的组成部分，旨在最大限度地发挥对预期的变化有效成分的影响。利用多方法分析框架，将就饮酒结果(包括饮酒数量、频率和与饮酒有关的后果)审查背景变量、风险和保护因素以及治疗过程措施之间的关系。初步分析将纳入一系列潜在变量模型，以量化治疗后饮酒的个体异质性，以及饮酒行为、治疗因素和心理过程之间的动态关系。此外，这项研究将结合动态系统的方法来考察两个特定的CBI模块--情绪管理和应对渴望和冲动--的影响，这两个模块的目的分别是改变情绪和渴望。众所周知，缺乏有效的应对措施会增加复发风险；渴望、情绪和感觉到的压力已被确定为治疗后重回酗酒状态的重要中介因素。然而，复发过程中这些变量之间的关系还没有明确确立。这项拟议的研究将重点放在复发的过程上，而不是将复发评估为两种事件，将检查治疗期间和治疗后第一年饮酒行为的轨迹和相关后果。具体地说，拟议研究的第一个目标是对治疗后饮酒行为模式的间断性和复杂性进行建模。第二个目标是量化治疗期间的改变过程、旨在影响改变机制的具体治疗模块和治疗后饮酒模式之间的关系。丰富的酒精治疗数据使拟议的研究成为研究酒精治疗有效和无效的重要且具有成本效益的贡献；也就是说，酒精治疗后积极行为改变的机制是什么？在美国，大约有1,760万人符合酗酒或依赖的标准，符合标准的人中有12.5%接受了酒精问题的治疗。在接受治疗的人中，大约65%-90%的人会在治疗后的第一年至少喝一杯酒，绝大多数人会回来接受多次治疗。了解治疗后大量饮酒的诱因以及有助于防止治疗后大量饮酒的具体治疗技术，对于改进现有治疗方法并帮助防止个人进入昂贵的酒精治疗计划的旋转门至关重要。

DESCRIPTION (provided by applicant): The proposed research will use existing data from the COMBINE study to evaluate mechanisms of behavior change following a combined behavioral intervention (CBI) for alcohol dependence. COMBINE (Combining Medications and Behavioral Interventions) was a multisite clinical trial conducted to evaluate the efficacy of two medications for alcohol dependence (naltrexone and acamprosate), when used in conjunction with one of two behavioral interventions (combined behavioral intervention (CBI) and medical management (MM)). The proposed research will focus specifically on individuals who were randomly assigned to the CBI conditions, these participants (n=776) received a maximum of 20 50-minute sessions delivered over 16 weeks. Within treatment assessment measures of mood state, perceived stress, craving, and drinking were administered at each treatment session. Post-randomization assessments of psychological, drinking-related, and behavioral outcomes were conducted at 8, 16, 26, 52, and 68 weeks. The CBI intervention incorporated components of motivation enhancement, cognitive behavioral and twelve-step facilitation therapies and was designed to maximize effects on the intended active ingredients of change. Using a multi-method analysis framework, the relationship between background variables, risk and protective factors, and treatment process measures, will be examined with respect to drinking outcomes (including quantity, frequency and drinking-related consequences). The primary analyses will incorporate a series of latent variable models to quantify individual heterogeneity in post-treatment drinking and the dynamic relationship between drinking behavior, treatment factors, and psychological processes. In addition, this study will incorporate a dynamical systems approach to examining the impact of two specific CBI modules, Mood Management and Coping with Craving and Urges, which are intended to change mood and craving, respectively. It is well-documented that a lack of effective coping responses increases relapse risk; and craving, mood and perceived stress have been identified as important mediators in the return to heavy drinking following treatment. However, the relationship between these variables in the relapse process has not been clearly established. Focusing on the process of relapse, rather than evaluating relapse as a dichotomous event, the proposed research will examine trajectories of drinking behavior and related consequences during treatment and in the first year following treatment for alcohol dependence. Specifically, the first goal of the proposed research is to model the discontinuity and complexity of drinking behavior patterns following treatment. The second goal is to quantify the relationship between processes of change during treatment, specific treatment modules intended to impact change mechanisms, and post-treatment drinking patterns. The abundance of alcohol treatment data makes the proposed research an important and cost-effective contribution to the study of what works and does not work in treatment; that is, what are the mechanisms of positive behavior change following alcohol treatment? In the United States, roughly 17.6 million people meet criteria for alcohol abuse or dependence and 12.5% of those individuals who meet criteria receive treatment for an alcohol problem. Of those who receive treatment, roughly 65-90% will have at least one drink in the first year following treatment and a large majority of individuals return for multiple treatments. Understanding the precipitants of heavy drinking following treatment as well as specific treatment techniques that help prevent heavy drinking following treatment is critical to improving existing treatments and helping prevent individuals from entering the revolving door of costly alcohol treatment programs.