Time Horizons and the Behavioral Economics of Recovery from Drinking Problems

描述（由申请人提供）：成瘾障碍患者倾向于离散的选择，包括不太有价值的，更直接的选择（例如，饮酒），而不是参与具有延迟积极后果的行为模式，这些行为模式总体上更有价值，更有利于康复。行为经济学提供了新的概念和方法来研究问题饮酒者的“时间范围”是如何围绕现在和未来的目标来组织他们的行为的，以及这些选择过程是否作为恢复过程中的一种变化机制。这项为期5年的R01申请将评估时间范围的变化是否与最近自己停止过度饮酒的社区居住问题饮酒者的饮酒变化有暂时关系（N = 265）。使用自然恢复样本将最大限度地提高感兴趣维度的可变性，并将解决有关非戒断决议的未解决问题，这在自然恢复中比治疗辅助恢复中更常见。当最初的变化不稳定且复发风险高时，参与者将在缓解开始后不久入组。将在基线时评估饮酒问题严重程度、求助史、行为经济和其他对延迟结果的时间敏感性指标，然后在3、6、9和12个月时前瞻性地评估时间范围和饮酒变量。本文将提出三个假设：(1)即使在大量饮酒的情况下，对长期突发事件更敏感的问题饮酒者是否更有可能保持稳定的决心？(2)与那些保持戒酒或复吸的饮酒者相比，那些保持稳定的不戒酒决心的饮酒者是否在更长的时间间隔内组织他们的行为分配？(3)对延迟偶发事件敏感性的变化是否预示了随后的饮酒变化，包括达到和维持非戒酒决议的能力？前两个假设重复并扩展了之前关于稳定的禁欲和非禁欲决议的研究。第三个假设涉及时间范围的变化是否先于饮酒的变化，并将评估时间范围结构作为变化的潜在机制。该研究还将确定多重时间敏感性测量如何相互关联并随时间变化，这将为临床和公共卫生环境中的方法选择提供信息。据我们所知，该研究首次提供了纵向多元评估，以确定时间范围的变化是否与最近解决问题的饮酒者的饮酒变化有关。除了阐明变化的机制外，研究结果有可能增加酒精问题服务的吸引力和对人口的影响。公共健康相关性：我们将前瞻性地研究嗜酒者解决酒精相关问题的途径、过程和机制变化，研究对象是最近自行停止过量饮酒的大量不同社区嗜酒者。大多数问题饮酒者不寻求帮助，许多人自己恢复，研究自然恢复有可能增加酒精相关问题服务的吸引力、有效性和人口影响。拟议中的研究将重点关注饮酒者的“时间视野”，或者他们围绕当前和未来目标组织行为的程度，因为成功的恢复可能涉及从短期到长期的未来视角的转变，并相应地组织行为。

DESCRIPTION (provided by applicant): Persons with addictive disorders tend to favor discrete choices involving less valuable, more immediate options (e.g., drinking) over engaging in behavior patterns with delayed positive consequences that are more valuable overall and more conducive to recovery. Behavioral economics provides new concepts and methods to study how the "time horizons" of problem drinkers serve to organize their behavior around present vs. future goals and whether these choice processes serve as a mechanism of change in recovery. This 5-year R01 application will evaluate whether changes in time horizons are temporally related to changes in drinking in community- dwelling problem drinkers who recently stopped excessive drinking on their own (N = 265). Use of a natural recovery sample will maximize variability in dimensions of interest and will address unsettled issues about non- abstinent resolutions, which are more common among natural than treatment-assisted recoveries. Participants will be enrolled soon after resolution onset when initial changes are unstable and relapse risk is high. Drinking problem severity, help-seeking history, and behavioral economic and other measures of time-sensitivity to delayed outcomes will be assessed at baseline, and then time horizon and drinking variables will be assessed prospectively at 3, 6, 9, and 12-months. Three hypotheses will be addressed: (1) Even when drinking heavily, are problem drinkers with greater sensitivity to longer term contingencies more likely to maintain stable resolutions? (2) Do drinkers who maintain stable non-abstinent resolutions organize their behavioral allocation over longer intervals compared to those who remain abstinent or relapse? (3) Do changes in sensitivity to delayed contingencies predict subsequent changes in drinking, including ability to reach and maintain non- abstinent resolutions? The first two hypotheses replicate and extend previous research on stable abstinent and non-abstinent resolutions. The third hypothesis addresses whether changes in time horizons precede changes in drinking and will evaluate the time horizon construct as a potential mechanism of change. The study also will establish how the multiple time sensitivity measures inter-relate and change over time, which will inform method selection in clinical and public health settings. To our knowledge, the study offers the first longitudinal multivariate evaluation of whether changes in time horizons are temporally related to changes in drinking among recently resolved problem drinkers. In addition to elucidating mechanisms of change, the results have potential for increasing the appeal and population impact of services for alcohol problems. PUBLIC HEALTH RELEVANCE: The pathways, processes, and mechanisms of change by which problem drinkers resolve their alcohol-related problems will be investigated prospectively using a large, diverse community sample of problem drinkers who recently stopped excessive drinking on their own. Most problem drinkers do not seek help, many recover on their own, and studying natural recoveries has potential for increasing the appeal, effectiveness, and population impact of services for alcohol-related problems. The proposed research will focus on drinkers' "time horizons," or the extent to which they organize their behavior around present vs. future goals, because successful recoveries likely involve a shift from a shorter to a longer view of the future and organizing behavior accordingly.