Moderators of Motivation to Maintain Sobriety over Eighteen Months

描述（由申请人提供）：改变的动机在酒精和药物文献中得到了广泛的关注。然而，大多数研究发现动机和结果之间只有适度的联系。大多数研究的一个局限性是在治疗开始时测量动机（即，基线），并在预测随后的酒精和药物使用方面进行评估。这种方法有一些缺点。首先，当动机更接近于结果评估时，对动机的影响知之甚少（即，在随访时间点测量）。其次，人们对动机如何随着时间的推移而变化以及何时其影响最大知之甚少。第三，治疗开始时的动机被概念化为改变或消除酒精和药物使用的愿望。因此，保持禁欲或减少使用药物的动机被忽视。第四，关于动机何时影响酒精和药物使用结果的情况知之甚少（即，主持人）。最后，动机通常是在正式治疗方案的背景下进行研究的。然而，该领域越来越多地将严重成瘾性疾病概念化为需要持续监测的慢性疾病。因此，随着时间的推移和在正式治疗的背景之外评估动机越来越重要。本申请通过研究保持清醒的动机如何与18个月以上的禁欲和减少物质使用相关联来解决这些缺点。而不是另一个研究的动机在一个正式的治疗计划，本申请建议研究它的人口中的个人进入清醒的生活恢复家园。假设表明：1）动机将与酒精和药物使用的时间点内和跨2）动机对酒精和药物使用的影响的主持人将包括支持性对抗措施和饮酒和药物使用的社会网络。该研究将包括对先前两项赠款的数据进行二次分析，即“清醒生活之家的评估”（R01 AA014030）（N=323）和“恢复期间的对抗测量”（R21 DA023677）。这两项研究都跟踪了清醒生活之家（SLH）居民（N=323）在进入房屋时以及6个月、12个月和18个月随访时的结果。在多个功能领域，包括酒精和药物使用，逮捕，就业和精神病严重程度的纵向改善。在18个月时，超过42%的人已经完全戒除物质至少6个月，尽管几乎所有人都离开了清醒的生活场所。这项研究的结果将大大增加我们对动机如何随着时间的推移影响社区恢复过程的认识。调查结果还将为发展早期阶段的新干预提供信息，该干预旨在帮助维持长期恢复，激励性访谈案例管理。关键的线人访谈将增加SLH供应商和消费者对研究结果的看法，并有助于制定增加和维持SLH居民动机的指导方针。

DESCRIPTION (provided by applicant): Motivation for change has received extensive attention in the alcohol and drug literature. However, most studies have found only modest associations between motivation and outcome. One limitation of most studies is motivation is measured 0nly at treatment entry (i.e., baseline) and assessed in terms of predicting subsequent alcohol and drug use. There are a number of shortcomings to this approach. First, little is known about the impact of motivation when it is more proximal to assessments of outcome (i.e., measured at follow up time points). Second, little is known about how motivation can change over time and when its impact might be strongest. Third, motivation at treatment entry is conceptualized in terms of a desire to change or eliminate alcohol and drug use. Motivation to maintain abstinence or reduced use of substances is therefore ignored. Fourth, little is known about the circumstances of when motivation impacts alcohol and drug use outcome (i.e., moderators). Finally, motivation has typically been studied within the context of formal treatment programs. However, the field is increasingly conceptualizing serious addictive disorders as chronic diseases that require ongoing monitoring. Assessing motivation over time and outside the context of formal treatment is therefore increasingly important. This application addresses these shortcomings by studying how motivation to maintain sobriety is associated with abstinence and reduced substance use over 18 months. Rather than yet another study of motivation within a formal treatment program, this application proposes to study it among a population of individuals entering sober living recovery homes. Hypotheses suggest 1) motivation will be associated with alcohol and drug use within and across time points and 2) moderators of the impact of motivation on alcohol and drug use will include measures of supportive confrontation and drinking and drug use in the social network. The study will consist of a secondary analysis of data from two previous grants, "An Evaluation of Sober Living Houses" (R01 AA014030) (N=323), and "Measuring Confrontation during Recovery" (R21 DA023677). Both studies tracked outcomes of Sober Living House (SLH) residents (N=323) at entry into the house and 6-, 12-, and 18-month follow up. Longitudinal improvements were noted in multiple areas of functioning, including alcohol and drug use, arrests, employment, and psychiatric severity. At 18 months, over 42% had been completely abstinent from substances for at least 6 months even though nearly all had left the sober living houses. Findings from the study will add substantively to our knowledge about how motivation impacts the recovery process over time in the community. Findings will also inform a new intervention in the early stages of development that is designed to help sustain long term recovery, motivational interviewing case management. Key informant interviews will add SLH provider and consumer perspectives on study findings and contribute to the development of guidelines for increasing and sustaining motivation among SLH residents.