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选择价值较低、更直接的选择(例如饮酒)，而不是参与具有延迟的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”如何围绕现在和未来的目标来组织他们的行为，以及这些选择过程是否起到了改变恢复的机制的作用。这个为期5年的R01应用程序将评估时间范围的变化是否与最近自行停止过量饮酒的社区居住问题饮酒者的饮酒变化在时间上相关(N=265)。使用自然恢复样本将最大限度地提高感兴趣方面的可变性，并将解决有关非禁欲解决办法的悬而未决的问题，这些问题在自然恢复中比治疗辅助恢复中更为常见。当最初的变化不稳定且复发风险很高时，参与者将在解决开始后不久进行登记。将在基线上评估饮酒问题的严重性、求助历史、行为经济学和其他对延迟结果的时间敏感性指标，然后在3、6、9和12个月时前瞻性评估时间范围和饮酒变量。我们将提出三个假设：(1)即使在大量饮酒的时候，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解决方案？(2)与保持戒酒或故态复萌的人相比，保持稳定的非禁欲解决方案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)对延迟突发事件的敏感性变化是否可以预测随后饮酒的变化，包括达到并保持非禁欲解决方案的能力？前两个假设重复和扩展了先前关于稳定的禁欲和非禁欲决议的研究。第三种假设解决了时间范围的变化是否先于饮酒的变化，并将时间范围结构作为一种潜在的变化机制进行评估。这项研究还将确定多种时间敏感性测量如何相互关联和随时间变化，这将为临床和公共卫生环境中的方法选择提供参考。据我们所知，这项研究首次提供了关于时间范围的变化是否与最近解决的问题饮酒者的饮酒变化在时间上相关的纵向多变量评估。除了阐明改变的机制外，这些结果还有可能增加酒精问题服务的吸引力和对人口的影响。公共卫生相关性：问题饮酒者解决与酒精相关的问题的途径、过程和机制将使用最近自行停止过量饮酒的大量、多样化的社区样本进行前瞻性调查。大多数问题饮酒者不寻求帮助，许多人自己康复，研究自然康复有可能增加酒精相关问题服务的吸引力、有效性和对人口的影响。这项拟议中的研究将聚焦于饮酒者的“时间视野”，即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对未来的短期观点到长期观点的转变，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.