Pretreatment Change in Drinking: Relationship to Treatment Outcome

治疗前饮酒变化：与治疗结果的关系

• 批准号: 8627789
• 负责人: PAUL R STASIEWICZ
• 金额: $ 54.23万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8627789
• 关键词: Abstinence; Affect; Affective; Aftercare; Alcohol consumption; Alcohol dependence; Alcohols; American; Behavior Therapy; Behavioral; Clinical Research; Cognitive; Cognitive Therapy; Data; Funding; Grant; Growth; Health Personnel; Health Services Research; Health behavior change; Individual; Intervention; Investigation; Lead; Measures; Mental Depression; Mental Health; Methods; Modeling; NIH Program Announcements; Obesity; Outpatients; Participant; Pattern; Persons; Phase; Process; Recovery; Reporting; Research; Sampling; Self Determination; Self Efficacy; Subgroup; Support Groups; Telephone; Therapeutic; Treatment outcome; Woman; addiction; alcohol abstinence; alcohol abuse therapy; alcohol behavior; alcohol use disorder; base; behavior change; design; disorder later incidence prevention; drinking; drinking behavior; improved; insight; lens; men; physical conditioning; public health relevance; response; theories; therapy design; therapy development; treatment planning; week trial

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.

描述（由申请人提供）：本申请是为了响应 PA-10-100，酒精使用障碍：治疗、服务研究和康复。正如该计划公告中所述，“由于许多患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了饮酒行为，因此了解人们如何以及为何在专门治疗环境之外改变饮酒行为与在专门治疗环境中改变饮酒行为同样重要。”与这种自我改变的概念相一致，一些研究，包括根据《美国复苏和再投资法案》（RC1 AA018986；PI-Stasiewicz）资助的一项挑战拨款，报告称行为改变发生在开始正式治疗之前。这些数据挑战了“改变过程的主要部分发生在治疗进入之后”的假设，并表明必须通过更广泛的视角来检查行为改变（Willenbring，2007）。因此，本研究将评估治疗前饮酒的变化，以确定不同的增长轨迹（即潜在类别），并检查治疗前的增长轨迹与酒精治疗结果（例如每天饮酒量）的关系。为了检查治疗前轨迹组的潜在预测因素，将评估源自自我改变实证研究和健康行为改变模型、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，将探讨在为期 12 周的酒精依赖认知行为治疗过程中，治疗前变化轨迹与每周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。研究的预处理阶段包括初始电话筛查和全面的基线评估。将在以下时间间隔内评估治疗前饮酒情况；电话筛查前 2 周、电话筛查至基线评估、基线至第一次治疗疗程。治疗阶段包括针对酒精依赖的为期 12 周的门诊认知行为治疗 (CBT) 疗程（Kadden 等，1992）。临床研究评估将在基线、治疗结束以及治疗后 3 个月和 6 个月时进行。总之，这将是第一项采用系统方法来调查饮酒治疗前变化并检查这些变化对治疗结果和行为治疗过程的影响的研究。根据治疗前变化轨迹识别个体亚组具有开辟治疗开发新途径的巨大潜力，包括使用基于治疗前变化模式的适应性治疗设计。这些可能包括旨在加强或维持已经做出的改变（例如预防复发）的治疗方法，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。