Improving brief alcohol interventions with a behavioral economic supplement

通过行为经济补充改善短暂的酒精干预

• 批准号: 8491970
• 负责人: JAMES G. MURPHY
• 金额: $ 40.38万
• 依托单位: UNIVERSITY OF MEMPHIS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8491970
• 关键词: Administrator; Adopted; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Behavior; Behavioral; Caring; Control Groups; Controlled Study; Cost-Benefit Analysis; Costs and Benefits; Development; Drug Controls; Economics; Evaluation; Feedback; Female; Goals; Heavy Drinking; Individual; Intervention; Intervention Trial; Measures; Mediating; Mediation; Mediator of activation protein; Methods; Minority; Modality; National Institute on Alcohol Abuse and Alcoholism; Neurobiology; Outcome; Participant; Pattern; Persons; Preventive; Preventive Intervention; Psychological reinforcement; Randomized; Randomized Clinical Trials; Recruitment Activity; Relative (related person); Relaxation; Relaxation Therapy; Reporting; Research; Research Proposals; Rewards; Risk Factors; Students; Substance abuse problem; Testing; Time; Translational Research; Universities; active control; alcohol demand; alcohol intervention; alcohol related problem; base; brief alcohol intervention; brief motivational intervention; career; college; cost; cost effective; cost effectiveness; discounting; drinking; follow-up; heavy drinking college student; improved; innovation; pilot trial; post intervention; public health priorities; reduced alcohol use; response; success; theories; treatment response; university student; young adult

DESCRIPTION (provided by applicant): Brief motivational interventions (BMIs) for young adult alcohol abuse are among the most cost-effective preventive care measures, yet there has been relatively little theory-based research aimed at improving their efficacy and identifying mechanisms of change. Based on research indicating that low-levels of substance-free reinforcement is a risk factor for poor BMI response, this research team developed and pilot tested a supplemental session to traditional feedback and MI-based alcohol interventions. This session directly targets the behavioral economic mechanisms of substance-free reinforcement and delayed reward discounting by encouraging the development of and commitment to academic and career goals, and by and highlighting the impact of day-to-day patterns of heavy drinking and academic engagement on these goals. A pilot trial (R21AA016304) found that a two session (alcohol BMI + Substance-Free Activity Session; SFAS) intervention resulted in significantly greater reductions in alcohol problems (p = .01, db= .52) relative to a two session (alcohol BMI + Relaxation) active control condition. The BMI + SFAS was also associated with significantly greater reductions in heavy drinking for participants with lower levels of substance-free reinforcement at baseline. This was the first controlled study to demonstrate that a supplement to traditional BMIs can improve outcomes. The current proposal would improve and more extensively evaluate the efficacy of the SFAS in a randomized 3-group (BMI + SFAS vs. BMI + Relaxation Training vs. Assessment only) trial with 425 first and second year college students (projected 50% female and 20% minority) who report recent heavy drinking recruited from two large public universities. The results will determine whether the SFAS enhances the efficacy of a standard BMI while controlling for total contact time. Drinking and substance-free activity outcomes will be assessed 1, 4, 12 and 16 months post-intervention. It is hypothesized that at follow-up BMI + SFAS participants will report significantly lower levels of drinking and alcohol-related problems, and higher levels of constructive substance-free activities, than BMI + Relaxation and assessment only participants, and that the predicted advantage for BMI + SFAS will be mediated by increased participation in substance-free activities and reduced delay discounting. It is further hypothesized that the BMI + SFAS intervention will be more effective for participants who report high baseline alcohol reinforcing efficacy (measured using demand curve and proportional substance-related reinforcement measures) and greater delayed reward discounting than those who report low reinforcing efficacy and delayed reward discounting. This study will also evaluate the economic costs and benefits associated with the BMI + SFAS intervention relative to an active control condition. Should this behavioral economic supplement demonstrate efficacy and cost-effectiveness then clinicians would have a more effective modality for attempting to reduce alcohol use in young adult drinkers, and administrators would have an economic rationale for adopting the intervention in their universities.

描述（由申请人提供）：针对年轻成人酒精滥用的简短动机干预（BMI）是最具成本效益的预防性护理措施之一，但旨在提高其疗效和确定变化机制的基于理论的研究相对较少。基于研究表明低水平的无物质强化是BMI反应不良的风险因素，该研究小组开发并试点测试了传统反馈和基于MI的酒精干预的补充会议。本课程直接针对无物质强化和延迟奖励折扣的行为经济机制，鼓励发展和致力于学术和职业目标，并强调酗酒和学术参与的日常模式对这些目标的影响。一项初步试验（R21 AA 016304）发现，与两个阶段（酒精BMI+放松）主动控制条件相比，两个阶段（酒精BMI +无物质活动阶段; SFAS）干预导致酒精问题显著减少（p = .01，db= .52）。BMI + SFAS还与基线时无物质强化水平较低的参与者的大量饮酒显著减少相关。这是第一项对照研究，证明传统BMI的补充可以改善结果。目前的提案将改善和更广泛地评估SFAS在随机3组（BMI + SFAS vs. BMI +放松训练vs.仅评估）试验中的有效性，该试验有425名一年级和二年级的大学生（预计50%为女性，20%为少数民族），他们报告最近从两所大型公立大学招募的大量饮酒。结果将确定SFAS是否在控制总接触时间的同时增强标准BMI的功效。饮酒和无物质活动的结果将在干预后1、4、12和16个月进行评估。假设在随访时，BMI + SFAS参与者报告的饮酒和酒精相关问题水平显著低于BMI +放松和仅评估参与者，而建设性无物质活动水平较高，并且BMI + SFAS的预测优势将通过增加无物质活动的参与和减少延迟折扣来介导。进一步假设BMI + SFAS干预对以下患者更有效： 报告高基线酒精强化功效（使用需求曲线和比例物质相关强化措施测量）和更大延迟奖励折扣的参与者比报告低强化功效和延迟奖励折扣的参与者。本研究还将评估BMI + SFAS干预相对于主动控制条件的经济成本和效益。如果这种行为经济学补充证明有效性和成本效益，那么临床医生将有一个更有效的方式来尝试减少年轻成年饮酒者的酒精使用，管理人员将有一个经济上的理由在他们的大学采取干预措施。