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: 9210591
• 负责人: PAUL R STASIEWICZ
• 金额: $ 56.23万
• 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/9210591
• 关键词: Abstinence; 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; Phonation; Process; Recovery; Reporting; Research; Sampling; Self Determination; Self Efficacy; Statistical Data Interpretation; Subgroup; Support Groups; Telephone; Therapeutic; Treatment outcome; Woman; addiction; alcohol abstinence; alcohol abuse therapy; alcohol behavior; alcohol use disorder; alcoholism therapy; base; behavior change; design; disorder later incidence prevention; drinking; drinking behavior; improved; insight; lens; men; negative affect; physical conditioning; public health relevance; rate of change; 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）：此申请响应PA-10-100，酒精使用障碍：治疗，服务研究和恢复。正如本计划公告中所述：“由于许多饮酒障碍的人在没有成瘾治疗提供者或自助群体的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将饮酒在特殊治疗环境之外改变以外的方式至关重要。”与这种自我改变概念一致，几项研究，包括根据《美国回收和再投资法》（RC1 AA018986; pi-stasiewicz）资助的挑战赠款，已报告说，行为改变发生在开始正式治疗之前发生。这些数据挑战了变化过程的主要部分发生在治疗后发生的假设，并建议必须通过更广泛的镜头检查行为变化（Willenbring，2007年）。因此，这项研究将评估酒精使用的预处理变化，以确定不同的生长轨迹（即潜在类别），并检查预处理生长轨迹与酒精治疗结果的关系（例如，每天喝酒日）。为了检查预处理轨迹组的潜在预测指标，将评估自我改变的经验研究和健康行为变化模型，自决理论（SDT）的变量（例如，自治，对变化的承诺，自我效能，自我效能）。最后，将在12周的认知行为行为治疗中，以每周的间隔测量了预处理变化轨迹与几种治疗过程变量（例如，负面影响，戒酒自我效能感）之间的关系。参与者将是220名依赖酒精的男女，他们同意参加为期12周的认知行为疗法（CBT）的酒精依赖试验。研究的预处理阶段包括初始电话屏幕和全面的基线评估。预处理饮酒将在以下时间间隔进行评估；在手机屏幕之前，电话屏幕到基线评估以及第一个治疗课程的基准。治疗阶段包括为期12周的酒精依赖的门诊认知行为治疗（CBT）（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个月进行。总而言之，这将是第一个采用系统的方法来研究饮酒的预处理变化，并检查此类变化对治疗结果和行为治疗过程的影响。根据他们的预处理变化的轨迹来识别个人的亚组，在开放新的治疗开发途径方面具有巨大的潜力，包括基于预处理变化模式使用自适应治疗设计。这些可能包括旨在加强或维持已经进行的变化（例如，预防复发）的治疗方法，以及旨在促进人们进一步变化的干预措施，以进一步改变治疗的人，并具有更逐步的预处理变化轨迹。