Mechanisms of Behavior Change in Alcohol Use Disorder Treatment

酒精使用障碍治疗中行为改变的机制

• 批准号: 9900689
• 负责人: Davood Tofighi
• 金额: $ 42.87万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9900689
• 关键词: Address; Adopted; Aftercare; Alcohol consumption; Alcohols; Behavioral Mechanisms; Client; Clinical Trials; Communities; Data; Data Analytics; Data Set; Decision Making; Development; Distal; Etiology; Failure; Future; Genotype; Goals; Health Personnel; Heavy Drinking; Heterogeneity; Horns; Individual; Intervention; Knowledge; Language; Literature; Mediating; Mediation; Mediator of activation protein; Methodology; Methods; Modeling; Outcome; Participant; Performance; Persons; Phase; Precision Medicine Initiative; Prediction of Response to Therapy; Process; Randomized Clinical Trials; Recommendation; Relapse; Reproducibility; Research; Research Personnel; Risk Factors; Sampling; Self Efficacy; Severities; Social support; Specificity; Techniques; Testing; Theoretical model; Therapeutic; Treatment Factor; Treatment outcome; Work; alcohol abuse therapy; alcohol use disorder; analytical tool; base; behavior change; behavioral pharmacology; clinical decision-making; coping; craving; design; evidence base; experience; improved; individual variation; knowledge base; negative mood; personalized approach; precision medicine; randomized trial; regression trees; research study; response; simulation; therapy development; tool; treatment effect; treatment program; treatment research; treatment response

Project Summary/Abstract Numerous evidence-based behavioral and pharmacological interventions have been developed and some have been adopted by alcohol treatment providers, however very little is known why specific treatments are effective (i.e., what are the mechanisms of behavior change in treatment) and which treatments are most effective for specific individuals. Despite an increased focus on mechanisms of behavior change among alcohol researchers over the past 15 years, many findings have not been replicated and an evidence-based understanding of why and for whom individual treatments for alcohol use disorder (AUD) are effective remains elusive. First, it is clear that AUD is heterogeneous in both etiology and outcomes following treatment, yet heterogeneity in mediators of AUD treatment has not been considered, mostly because of methodological limitations. In general, the mechanisms of behavior change following alcohol treatment are not well understood. Second, AUD treatment studies investigate multiple mechanisms of behavior change. One issue is a lack of understanding and methodological techniques to test which mechanism of behavior change is robust if it were to be replicated under a different set of conditions (e.g., different participants with different mechanisms of behavior change). To address these gaps in understanding, this study will build an empirical knowledge base by identifying robust mechanisms of behavior change (i.e., do mechanisms replicate across different participants?) and by modeling heterogeneity in alcohol treatment (i.e., for whom it works/fails to work) through development and application of the state-of-the-art methodological techniques, extensive analyses of eleven existing randomized clinical trials for AUD, as well as simulation studies based on AUD clinical trial data. Candidate mechanisms of behavior change, based on prior studies and the dynamic model of relapse as a guiding theoretical model, will include self-efficacy, craving or urges to drink, mutual help involvement, social support, therapeutic alliance, client language, and coping responses. Results from the proposed study will inform an individualized approach to formulating treatment recommendations, clarify which treatment mechanisms (mediators) are most robust across studies, and directly inform clinical decision making. In addition, the proposed study will provide an extensive suite of data analytic tools that will be designed specifically to answer questions regarding (a) testing robustness of candidate mediators, and (b) testing mediation in the presence of heterogeneity. The analytic tools will accommodate features of data commonly observed in AUD clinical trials and will be accessible to substantive researchers with knowledge of regression and mediation. The ultimate goal of this study is to yield a better understanding of mechanisms of AUD treatment outcomes in order to inform precision medicine initiatives.

项目总结/摘要 已经开发了许多基于证据的行为和药理干预措施， 已经被酒精治疗提供者采用，但是很少有人知道为什么特定的治疗方法 有效（即，治疗中行为改变的机制是什么）以及哪些治疗最重要 对特定个人有效。尽管越来越多的关注行为改变的机制， 在过去的15年里，酒精研究人员，许多发现没有被复制和证据为基础的 对于酒精使用障碍（AUD）的个体治疗为什么有效以及对谁有效的理解仍然存在 难以捉摸。首先，很明显，AUD在病因和治疗后的结局方面都是异质性的， 尚未考虑AUD治疗介质的异质性，主要是由于方法学原因 局限性。一般来说，酒精治疗后行为改变的机制尚不清楚 明白其次，AUD治疗研究调查了行为改变的多种机制。一个问题是 缺乏理解和方法技术来测试哪种行为改变机制是稳健的 如果它在不同的条件组下被复制（例如，不同的参与者， 行为改变机制）。为了解决这些理解上的差距，本研究将建立一个经验性的 通过识别行为改变的鲁棒机制（即，机制是否可以复制 不同的参与者？）并通过模拟酒精治疗中的异质性（即，为谁工作/不工作） 通过发展和应用最先进的方法技术， 现有的11项AUD随机临床试验，以及基于AUD临床试验的模拟研究 数据行为改变的候选机制，基于先前的研究和复发的动态模型， 一个指导性的理论模型，将包括自我效能，渴望或冲动喝酒，互助参与，社会 支持，治疗联盟，客户语言和应对反应。拟议研究的结果将 告知制定治疗建议的个性化方法，澄清哪些治疗 机制（介质）是最强大的跨研究，并直接告知临床决策。在 此外，拟议的研究将提供一套广泛的数据分析工具，这些工具将被设计 特别是回答关于（a）测试候选调解人的鲁棒性，以及（B）测试 在存在异质性的情况下进行调解。分析工具将适应数据的特征， 在AUD临床试验中观察到，并将由具有回归知识的实质性研究人员访问 调解。本研究的最终目的是更好地了解AUD的机制 治疗结果，以便为精准医疗举措提供信息。