Recovery: Varieties and Dimensions

描述（由申请人提供）：酒精研究人员越来越认识到了解恢复过程的重要性。这种从精神病理学的范式转变将注意力集中在个人如何摆脱酒精问题上，包括什么启动和支持康复，从而提供个人如何改善和如何恶化的信息。研究和临床经验表明，康复是一个过程，而不是终点，在关键的生活领域，如精神、身体、社会关系、精神/存在幸福感、亲社会行为和生产力，以及饮酒和吸毒的减少（如果不是消除的话），在改善的速度和时间上存在显著的个体差异。更清楚地了解恢复过程，包括启动和帮助维持恢复的因素，以及不饮酒特征的时间变化，对更有针对性的连续护理具有重要意义。它还可以为药物使用者及其家属以及服务提供者和其他利益攸关方提供切合实际的期望。拟议的研究利用现有的美国国立卫生研究院资助的前瞻性数据集，通过对该样本恢复经验的定量和定性数据的二次分析来检查这些问题。参与者是酗酒者，每6个月调查一次，持续30-36个月，作为先前拨款的一部分（R01AA014442）。他们将根据两套康复/缓解标准——贝蒂福特研究所共识小组（2007年，2009年）和DSM-IV——来描述他们在研究期间的饮酒模式。对于每一组，我们将调查：(1)这些标准所定义的不同群体的特征，他们之间在群体分配上的一致性，以及从基线到最终访谈的康复维度（即心理、身体、社会、存在和亲社会健康）的变化程度；(2)康复关键维度（如心理、身体、社会和职业健康）的预期变化（积极或消极）的程度和时间；精神/存在幸福)通过确定每个群体的这些维度的轨迹；(3)启动和维持恢复的环境和行为，包括确定触发戒断努力的具体事件（例如，后果，量子变化）。研究结果将有助于发展和评估以康复为导向的服务和支持，因为它为连续护理模式提供了信息，该模式与将物质使用障碍视为慢性疾病的流行概念相一致。调查结果还将为政策、服务发展和资金筹措提供信息，满足现役和曾经依赖药物者的需要。最后，该研究将有助于填补有关促进恢复开始和维持的因素的知识空白。

DESCRIPTION (provided by applicant): Alcohol researchers are increasingly recognizing the importance of understanding the process of recovery. This paradigm shift away from psychopathology focuses attention on how individuals move away from alcohol problems, including what initiates and supports recovery, thereby providing information on how individuals improve versus how they deteriorate. Research and clinical experience indicates that recovery is a process, not an endpoint, and that there are significant individual differences in the rate and timing of improvement in key life domains such as mental, physical, social relationships, spiritual/existential well-being, pro-social behaviors, and productivity, as well as reduction, if not elimination, of drinking and drug use. A clearer understanding of the recovery process including factors that initiate and help sustain it, as well as temporal changes in non-drinking characteristics, has significant implications for a more targeted continuum of care. It can also provide realistic expectations to substance users and their families, as well as service providers and other stakeholders. The proposed study capitalizes on an existing NIH-funded prospective dataset to examine these issues through secondary analyses of both quantitative and qualitative data on the recovery experiences of this sample. Participants were alcoholics surveyed every 6 months for 30-36 months as part of a previous grant (R01AA014442). They will be characterized by their drinking patterns over the years of the study according to two sets of criteria for recovery/remission - the Betty Ford Institute Consensus Panel (2007, 2009) and DSM-IV. For each of these groups, we will investigate: (1) the characteristics of the different groups defined by these criteria, the agreement among them in group assignment, and the degree of change in dimensions of recovery (i.e., mental, physical, social, existential, and prosocial health) from baseline to final interview, (2) the degree and timing of prospective changes (positive or negative) in key dimensions of recovery (e.g., mental, physical, social and occupational health, spiritual/existential well-being) by determining for each group the trajectory across time of these dimensions; and (3) the circumstances and behaviors that initiate and sustain recovery, including identifying specific events (e.g., consequences, quantum change) that trigger abstinence efforts. Findings will be useful in the development and evaluation of recovery-oriented services and supports, as it informs a continuum of care model that is consistent with prevalent conceptualizations of substance use disorders as chronic disorders. Findings will also inform policy, service development and funding by speaking to the needs of active and former substance dependent persons. Finally, the study will contribute to filling knowledge gaps about factors that promote the initiation and maintenance of recovery. PUBLIC HEALTH RELEVANCE: Although the field of substance abuse treatment is shifting toward a recovery paradigm (see recent SAMHSA guidelines, CSAT, 2007), our understanding is incomplete on the nature and timing of changes in the dimensions of recovery that accompany increased episodes of abstinence. Deeper knowledge of changes in mental and physical health, social relationships, spiritual/existential health, pro-social behaviors, and productivity, can inform the development of interventions that support recovery. The proposed research intends to investigate the nature and timing of change in dimensions of recovery through a secondary analysis of an R01 dataset, which provides 2 1/2 to 3 years of prospective quantitative and qualitative data on 285 alcoholics.