Center on Adaptive Treatments for Alcoholism

描述（由申请人提供）：尽管许多酒精中毒的行为和药物治疗方法已被证明是有效的，但我们目前的治疗模式在社区环境中的实施和有效性存在几个主要挑战，包括对传统专科护理模式缺乏兴趣，进入传统社区项目的个人早期辍学率高，以及参与治疗的患者反应的相当大的可变性。我们小组和其他人最近所做的工作表明，适应性治疗模式可以为许多妨碍成功提供有效酒精中毒治疗的问题提供解决方案。这些模型也被称为“阶梯式护理”和“治疗算法”，旨在根据患者对治疗的反应，通过提供灵活的护理来提高治疗的参与度。适应性方法还通过尽可能指定低强度治疗，并结合患者偏好等因素，寻求最大程度的参与。本修订版P20的目标是进一步发展以患者为中心的酒精使用障碍患者适应性护理模式。研究方法核心将解决适应性治疗中的一些方法学问题，包括确定触发治疗修改的最佳剪裁变量，调解的统计模型，开发实现复杂自适应算法的计算机系统，以及确定促进依从性的治疗过程。主要研究核心由发展项目组成，这些项目涉及我们概念模型的几个组成部分，包括在初级保健环境中为酒精依赖患者开发适应性护理模型；进入社区专科护理的患者的自适应治疗算法一个创新的，基于网络的适应性持续护理协议。患者选择对治疗选择的影响将在两个项目中进行检验。多学科P20将促进在行为和药理学干预、适应性设计、统计学、经济学和传播方面具有专业知识的科学家与社区项目主管、咨询师和患者之间的合作。总体而言，P20的工作有望提高适应性处理设计的可行性、可接受性和有效性。

DESCRIPTION (provided by applicant): Although a number of behavioral and pharmacological treatments for alcoholism have proven efficacy, there are several major challenges to the implementation and effectiveness of our current treatment models in community settings, including lack of interest in traditional specialty care models, high rates of early dropout in individuals who do enter traditional community programs, and considerable variability of response in patients who do become engage in treatment. Recent work done by our group and others suggests that adaptive treatment models can provide a solution to many of the problems that interfere with the successful delivery of effective alcoholism treatment. These models, which have also been referred to as "stepped care" and "treatment algorithms," are designed to increase participation in treatment by providing flexible care that is tailored over time on the basis of patient response to treatment. Adaptive approaches also seek to maximize participation by specifying lower intensity treatment whenever possible, and incorporating factors such as patient preference. The goal of this revised P20 is the further development of patient centered adaptive models of care for individuals with alcohol use disorders. The Research Methods Core will address a number of methodological issues in adaptive treatment, including identification of optimal tailoring variables that trigger modifications in treatment, statistical models for mediation, development of computer systems to implement complex adaptive algorithms, and identification of within-session therapeutic processes that facilitate adherence. The Principal Research Core consists of Developmental Projects that address several components of our conceptual model, including the development of adaptive models of care for patients identified with alcohol dependence in primary care settings; adaptive treatment algorithms for patients who enter community-based specialty care; and an innovative, web-based adaptive continuing care protocol. The impact of patient choice in treatment selection will be examined in two projects. The multidisciplinary P20 will facilitate collaborations between scientists with expertise in behavioral and pharmacological interventions, adaptive designs, statistics, economics, and dissemination, and directors of community-based programs, counselors and patients. Overall, the work of the P20 is expected to improve the feasibility, acceptability, and effectiveness of adaptive treatment designs.