Longitudinal Study of Mechanisms of Drug Abuse Recovery-Pilot

描述（由申请方提供）：我们的目的是确定影响非临床人群中药物使用障碍病程的主要因素。大多数吸毒者没有进入正规的治疗系统;尽管如此，一些人实现了“自然康复”。互助小组如NA/CA可能很重要，但社会支持、社会资源、共病精神病理学和压力事件也可能有影响。虽然关于自然恢复的研究越来越多，但大多数研究都是横向或纵向的，评估之间的间隔很长。这样的设计告诉我们很少动态因素如何影响药物使用障碍的过程。对于其他精神疾病，随着时间的推移，对受试者进行深入跟踪的自然主义纵向研究提供了对这些疾病缓解或恶化的预测因素的见解，以及人们如何与医疗保健提供者互动（或通常无法互动）的丰富数据。以类似方式研究药物使用障碍的时机已经成熟。该试点项目的目的是为设计更大和更长期的自然研究提供必要的关键数据。我们将从社区而不是诊所招募60名客户，并将对这些病例进行为期一年的密集跟踪。我们将使用从轴I障碍的成功纵向研究中改编的工具来动态跟踪精神状态，生活事件和治疗。我们将使用标准的时间轴措施，动态记录药物的结果;其他潜在的预测因子/介质进行测量的行为和态度相关的互助出勤和隶属关系，社会支持和资源，自我效能和动机。然而，高强度纵向研究的成功设计取决于诸如共病疾病的频率、缓解率、复发率和应激事件以及治疗率等因素。这项试点研究的具体目的是测试招募和评估程序，并估计关键事件的比率，如恢复使用可卡因，以支持未来研究的力量估计。因为纵向数据给我们提供了一个研究事件随时间变化的序列的机会，它们提供了检验关于变量作用机制的理论预测的机会，例如互助和社会支持，这些信息可以帮助我们设计更好的治疗方法。此外，更好地了解导致社区中有毒品问题的人选择或不选择正式治疗支持和/或非正式支持系统的因素，可能会使我们建立更好的系统，以识别和帮助高风险人员。因此，更好地了解生物，心理和社会力量在社区中发挥作用将有助于我们设计未来的干预系统，可以更好地针对高危人群进行预防性干预，并更好地利用个体患者的积极资源。 公共卫生相关性：大多数有资格被诊断为药物滥用或依赖的人并不使用专业治疗;尽管如此，许多人能够克服这种障碍并过上正常的生活。我们对人们如何在不求助于专业治疗的情况下实现缓解知之甚少;这类信息对于为吸毒疾患患者设计干预措施，利用吸毒疾患患者带来的优势，以及应对可能导致病情恶化的风险因素，将是非常有价值的。这项研究代表了社区药物使用障碍恢复和复发研究计划的开始。

DESCRIPTION (provided by applicant): Our objective is to determine the major factors that influence the course of drug use disorders in non- clinical populations. The majority of people who have drug disorders do not enter the formal treatment system; nonetheless, a number achieve "natural recoveries." Mutual-help groups such as NA/CA may be important, but social support, social resources, comorbid psychopathology, and stressful events may also be influential. While there is an increasing body of research on natural recovery, most studies have been cross- sectional or longitudinal with long intervals between assessments. Such designs tell us little about how dynamic factors influence the course of drug use disorders. For other psychiatric disorders, naturalistic longitudinal studies in which subjects are followed intensively over time have provided insights into predictors of remission or exacerbation of these disorders, as well as a wealth of data on how people interact (or, often, fail to interact) with health care providers. The time is ripe for drug use disorders to be studied in a similar manner. The purpose of this pilot project is to provide key data necessary for the design of a larger and longer-term naturalistic study. We will recruit 60 clients from the community rather than from clinics, and will follow these cases intensively for one year. We will use instruments adapted from successful longitudinal studies of Axis I disorders to track psychiatric status, life events, and treatment dynamically. We will use standard timeline measures to record drug outcome dynamically; other potential predictors/mediators to be measured are behaviors and attitudes related to mutual-help attendance and affiliation, social support and resources, self-efficacy, and motivation. Successful design of a high-intensity longitudinal study, however, depends on factors such as frequency of comorbid disorders, rates of remission, relapse, and stressful events, and rates of treatment. The specific aims of this pilot study are to test recruitment and assessment procedures, and to estimate rates of key events such as return to use of cocaine to support power estimates for the study to come. Because longitudinal data give us an opportunity to study sequences of events over time, they provide opportunities to test theoretical predictions about the mechanisms of action of variables such as mutual help and social support, information that could help us design better treatments. Furthermore, a better understanding of the factors that lead people with drug problems in the community to choose, or not choose, formal treatment support and/or informal support systems, may lead us toward better systems for identifying and aiding persons at high risk. Thus, an improved understanding of the biological, psychological, and social forces operating in the community will help us design future intervention systems that can better target persons at high risk for preventive interventions, and be better tailored to take advantage of positive resources available to individual patients. PUBLIC HEALTH RELEVANCE: Most people who qualify for a drug abuse or dependence diagnosis do not use professional treatment for this condition; nonetheless, many are able to overcome the disorder and lead normal lives. We know very little about how people achieve remission without resorting to professional treatment; such information will be valuable in devising interventions for persons with drug use disorders that can take advantage of the strengths that people bring with them, and in coping with the risk factors that can lead to deterioration. This study represents the beginning of a research program on recovery and relapse in drug use disorders in the community.