RCT OF WEB VS. IN-PERSON SUD AND COMORBIDITY TREATMENT

网络与网络的 RCT

• 批准号: 8424320
• 负责人: MARY E. LARIMER
• 金额: $ 40.12万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-02-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8424320
• 关键词: Adult; Affect; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; American Psychiatric Association; Anorexia; Anxiety; Behavior; Behavioral; Bipolar Disorder; Borderline Personality Disorder; Bulimia; Comorbidity; Development; Disease; Drug usage; Early Intervention; Event; Feedback; Feeling suicidal; Gambling; Health Benefit; High Prevalence; Illusions; Individual; Internet; Intervention; Lead; Legal; Marijuana Smoking; Measures; Mediating; Mediator of activation protein; Mental Depression; Neurobiology; Online Systems; Outcome; Participant; Pathological Gambling; Persons; Population; Prevalence; Prevention approach; Process; Public Health; Randomized; Readiness; Relative (related person); Reporting; Research; Risk; Schizophrenia; Social Conformity; Societies; Students; Substance Use Disorder; Symptoms; Techniques; Treatment Efficacy; Vulnerable Populations; Work; addiction; aged; alcohol behavior; base; college; comparison group; coping; cost effective; experience; follow-up; indicated prevention; information processing; post intervention; programs; public health relevance; secondary outcome; social; suicidal behavior; university student; young adult

DESCRIPTION (provided by applicant): The broad, long-term objective of the current research is to reduce the prevalence of disordered gambling and co-morbid substance use disorders and related harm in the population, through development of efficacious and cost-effective indicated prevention/early intervention techniques. While many individuals gamble as an occasional form of entertainment, a significant subset of the population experiences substantive harm related to their gambling. Gambling has been described as a behavioral addiction, with considerable neurobiological and symptom similarity to substance use disorders (SUD). Further, disordered gambling is associated with very high rates of alcohol and drug (AOD) use and SUD co-morbidity. Gambling has been conceptualized as a continuum, from no gambling and non-problem gambling, to at-risk gambling, to diagnosable pathological gambling. Disordered gambling (at-risk and pathological) is estimated to affect 3-5% of the U. S. adult population, with higher rates often reported in young adult (college aged) populations. Disordered gambling has been associated with a host of serious consequences for the gambler and society, including financial, legal, social, familial, and work/educational difficulties as well as elevated rates of anxiety, depression, and suicidal ideation and behavior. These findings have lead to an increasing recognition of disordered gambling as a significant public health problem. The current research builds on our prior work on development of indicated prevention approaches for disordered gambling (R21 MH067026). Our findings indicate a brief, personalized feedback intervention (PFI) utilizing graphic feedback and motivational enhancement strategies is efficacious in reducing gambling and related consequences in a vulnerable population (college students) at risk for or already evidencing pathological gambling. Based on these encouraging findings, we propose to evaluate the longer-term efficacy of this approach, and determine relative efficacy of web- and in-person implementation of PFI interventions, for at-risk gamblers with co-morbid SUDs. Specific aims are: 1) Evaluate relative efficacy of in-person vs. web-based PFIs in comparison to assessment only, in reducing gambling behavior, AOD use, and related consequences of at-risk college student gamblers with SUDs. Participants (N=375) screened as at- risk gamblers with SUD will be randomly assigned to one of 3 conditions: a) in-person motivational PFI; b) web-based PFI; or c) repeated assessment comparison group, assessed at post-intervention, 3-, 6-, 12-, and 24-month follow-up. 2) Evaluate choice of intervention, gambling motives, and substance use as moderators of efficacy. 3) Evaluate mediators of intervention efficacy, including perceived descriptive gambling norms, readiness to change, illusions of control, and depth of processing of information.

描述（由申请人提供）：当前研究的广泛、长期目标是通过开发有效且具有成本效益的指示预防/早期干预技术，减少人群中赌博障碍和共病物质使用障碍的患病率以及相关危害。虽然许多人将赌博作为一种偶尔的娱乐方式，但仍有相当一部分人遭受了与赌博相关的实质性伤害。赌博被描述为一种行为成瘾，与物质使用障碍 (SUD) 具有相当大的神经生物学和症状相似性。此外，赌博失调与酒精和毒品 (AOD) 使用率以及 SUD 合并症的发病率极高有关。赌博被概念化为一个连续体，从不赌博和无问题赌博，到有风险的赌博，再到可诊断的病态赌博。据估计，赌博失调（高风险和病态）影响着 3-5% 的美国成年人，其中年轻人（大学生）的发病率更高。赌博失调会给赌徒和社会带来一系列严重后果，包括财务、法律、社会、家庭和工作/教育困难，以及焦虑、抑郁和自杀意念和行为的增加。这些发现使人们越来越认识到赌博失调是一个重大的公共卫生问题。目前的研究建立在我们之前开发针对赌博失调的指示性预防方法的工作（R21 MH067026）的基础上。我们的研究结果表明，利用图形反馈和动机增强策略进行简短的个性化反馈干预（PFI）可以有效减少有病态赌博风险或已经出现病态赌博的弱势群体（大学生）的赌博和相关后果。基于这些令人鼓舞的发现，我们建议评估这种方法的长期疗效，并确定网络和面对面实施 PFI 干预措施对于患有共病 SUD 的高危赌徒的相对疗效。具体目标是： 1) 与仅评估相比，评估面对面 PFI 与基于网络的 PFI 在减少赌博行为、AOD 使用以及使用 SUD 的高危大学生赌徒的相关后果方面的相对功效。被筛选为 SUD 风险赌徒的参与者 (N=375) 将被随机分配到以下 3 个条件之一： a) 面对面的动机 PFI； b) 基于网络的 PFI； c) 重复评估对照组，在干预后、3、6、12 和 24 个月随访时进行评估。 2) 评估干预措施的选择、赌博动机和药物使用作为功效的调节因素。 3) 评估干预效果的中介因素，包括感知的描述性赌博规范、改变的准备程度、控制幻觉和信息处理的深度。