Pretreatment Change in Drinking: Relationship to Treatment Outcome

描述(申请人提供)：本申请是对PA-10-100，酒精使用障碍：治疗，服务研究和恢复的回应。正如本计划公告中所述，“由于许多有酒精使用障碍的人在没有成瘾治疗提供者或自助团体帮助的情况下改变他们的饮酒行为，了解人们如何以及为什么在专门的治疗环境之外改变他们的饮酒行为，就像在他们体内一样至关重要。”与这种自我改变的概念一致的是，几项研究，包括根据《美国复苏和再投资法案》(RC1AA018986；Pi-Stasiewicz)资助的挑战赠款，都报告了行为改变发生在开始正式治疗之前。这些数据挑战了这样的假设，即改变过程的主要部分发生在进入治疗后，并表明行为改变必须通过更广泛的视角来检查(威伦布林，2007)。因此，这项研究将评估酒精使用前的变化，以努力确定不同的增长轨迹(即潜在类别)，并检查前增长轨迹与酒精治疗结果的关系(例如，每天饮酒)。为了检验治疗前轨迹组的潜在预测因素，将评估来自自我改变的经验研究和健康行为改变的模型--自我决定理论(SDT)的变量(例如，自主性、对改变的承诺、自我效能)。最后，在为期12周的酒精依赖认知行为治疗过程中，将探索治疗前变化轨迹与每周间隔测量的几个治疗过程变量(例如，负面情绪、戒酒自我效能)之间的关系。参与者将是220名酒精依赖男性和女性，他们同意参加为期12周的酒精依赖认知行为疗法(CBT)试验。研究的前期阶段包括最初的电话筛选和全面的基线评估。将在以下时间间隔内对饮酒前的情况进行评估：电话筛查前2周，电话筛查到基线评估，以及第一次治疗前的基线。治疗阶段包括为期12周的酒精依赖门诊认知行为治疗(CBT)(Kadden等人，1992年)。临床研究评估将在基线、治疗结束以及治疗后3个月和6个月进行。总而言之，这将是第一次采用系统的方法来调查饮酒前的变化，并检查这种变化对治疗结果和行为治疗过程的影响。根据个体的预处理变化轨迹确定个体亚组，对于开辟治疗发展的新途径，包括使用基于预处理变化模式的适应性治疗设计，具有巨大的潜力。这些可能包括旨在加强或维持已经作出的改变的治疗方法(例如，预防复发)，以及旨在促进那些以更渐进的治疗前改变轨迹进入治疗的人进一步改变的干预措施。

DESCRIPTION (provided by applicant): This application is in response to PA-10-100, Alcohol Use Disorders: Treatment, Services Research, and Recovery. As stated in this Program Announcement, "because many individuals with alcohol use disorders change their drinking behavior without help from addiction treatment providers or self-help groups, it is as vital to understand how and why people change their drinking outside of specialized treatment settings as it is within them." Consistent with this notion of self-change, several studies, including a challenge grant funded under the American Recovery and Reinvestment Act (RC1 AA018986; PI-Stasiewicz), have reported that behavioral changes occur prior to initiating formal treatment. These data challenge the assumption that the major portion of the change process occurs after treatment entry and suggest that behavior change must be examined through a broader lens (Willenbring, 2007). Therefore, this study will assess pretreatment changes in alcohol use in an effort to identify different trajectories of growth (i.e., latent classes), and examine the relatioship of pretreatment growth trajectories to alcohol treatment outcomes (e.g., drinks per drinking day). To examine potential predictors of pretreatment trajectory groups, variables derived from empirical studies of self-change and a model of health-behavior change, Self-Determination Theory (SDT), will be assessed (e.g., autonomy, commitment to change, self-efficacy). Finally, the relationship between pretreatment change trajectories and several treatment process variables (e.g., negative affect, alcohol abstinence self-efficacy) measured at weekly intervals during a 12-week course of cognitive-behavioral treatment for alcohol dependence will be explored. Participants will be 220 alcohol dependent men and women who agree to participate in a 12-week trial of cognitive-behavioral therapy (CBT) for alcohol dependence. The pretreatment phase of the study includes the initial phone screen and a comprehensive baseline assessment. Pretreatment drinking will be assessed across the following intervals; 2-weeks prior to the phone screen, phone screen to baseline assessment, and baseline to the first treatment session. The treatment phase includes a 12-week course of outpatient Cognitive- Behavioral Treatment (CBT) for alcohol dependence (Kadden et al., 1992). Clinical research assessments will be conducted at baseline, end-of-treatment and at 3- and 6-months post-treatment. In summary, this would be the first study to take a systematic approach to investigating pretreatment changes in drinking and to examine the impact of such changes on treatment outcomes and behavioral treatment processes. Identifying subgroups of individuals based on their trajectory of pretreatment change has great potential for opening up new avenues of treatment development including the use of adaptive treatment designs based on pretreatment change patterns. These could include treatment approaches designed to reinforce or maintain changes already made (e.g., relapse prevention) as well as interventions that take aim at facilitating further change for those entering treatment with a more gradual trajectory of pretreatment change.