Expanding the science on recovery mutual aid for alcohol use disorder: An investigation of SMART Recovery

扩大酒精使用障碍康复互助的科学：SMART Recovery 的调查

• 批准号: 10392411
• 负责人: JOHN F. KELLY
• 金额: $ 36.34万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392411
• 关键词: Abstinence; Accounting; Alcoholics Anonymous; Alcohols; Behavioral; Behavioral Mechanisms; Caring; Chronic; Clinical; Clinical Practice Guideline; Cognitive; Communities; Data; Disease remission; Distress; Drug Metabolic Detoxication; Drug usage; Economics; Effectiveness; Enrollment; Gender; Geographic state; Goals; Health Care Costs; Impulsivity; Individual; Investigation; Knowledge; Link; Modeling; Monitor; Motivation; Outcome; Participant; Pathway interactions; Patients; Pattern; Persons; Play; Practice Guidelines; Public Health; Quasi-experiment; Recovery; Recovery Support; Relapse; Religion; Research; Research Design; Resources; Role; Science; Self Efficacy; Self Management; Services; Severities; Social Network; Societies; Spirituality; Stratification; Testing; Time; Training; United States; addiction; alcohol abuse therapy; alcohol use disorder; base; behavior change; comparative; comparative effectiveness; cost; cost effectiveness; court; demographics; design; evidence base; experience; experimental study; flexibility; indigenous community; inpatient service; meetings; migration; outpatient programs; peer support; preference; prospective; relapse risk; social; standard of care; stem; virtual

Project Summary Professional treatment plays a vital role in helping individuals with alcohol use disorder (AUD) stabilize and begin recovery. Typically, however, some form of ongoing support is needed to increase the chances of stable remission. Consequently, a common clinical strategy is to link patients with freely available mutual-help organizations (MHOs), which can provide flexible ongoing community-based support. MHO effectiveness and cost-effectiveness have been supported empirically and, consequently, referral to MHOs is recommended in most practice guidelines. A limitation of the current standard of care, however, stemming from a lack of data, is the fact that referrals are typically made almost exclusively to spiritually-oriented 12-step organizations, such as Alcoholics Anonymous (AA). One important consequence of this virtual predominance of studies on 12-step MHOs is that they are the only empirically-supported MHO continuing care referral option. Given the spiritual orientation of 12-step organizations, however, and rulings by some US states’ supreme courts that 12-step MHOs are technically religions and thus cannot be the sole referral option, it is important to offer secular alternatives. One prime candidate is SMART Recovery, a secular cognitive-behavioral MHO providing peer support in 1,200 face-to-face meetings in the US. Little is known, however, regarding its real-world benefit. A rigorous study showing SMART Recovery can help reduce relapse risk would provide valuable information that could boost clinical confidence in SMART as a low-cost recovery resource and thus be a secular empirically- supported clinical referral option. As a next step in evaluating the real-world clinical and public health utility of SMART Recovery, the current study will: 1. Characterize and describe professional and non-professional recovery support service participation choices, migrations, and pathways using group trajectory analyses over a two-year period for individuals (N=348) starting a new AUD recovery attempt. 2. Investigate the comparative effectiveness of SMART Recovery by comparing outcomes of AUD individuals making the new recovery attempt (N=348) pursuing either a SMART Recovery (n=174), or a non-SMART recovery (n=174), pathway. Because roughly half of SMART participants also choose to attend AA, we will use a stratified design to enroll persons with AUD making naturally occurring continuing care choices vis-à-vis participation in MHOs in a balanced fashion, and follow them prospectively across a 2-year period (i.e., SMART + AA vs. SMART-Only vs. AA-Only vs. Neither). Because prior data shows SMART participants may be less severe than AA participants, we will stratify groups by AUD severity (mild, moderate, and severe). In addition to using propensity score matching, this stratification will allow us to compare with greater scientific rigor the outcomes of persons choosing to participate in SMART Recovery vs. not, while accounting for simultaneous choices regarding AA or no MHO participation. 3. Explore mechanisms of behavior change (e.g., self-efficacy, impulsivity), as well as moderators of the degree of benefit (e.g., gender, psychiatric distress) to help determine how SMART Recovery may help its affiliates.

项目摘要 专业治疗在帮助患有饮酒障碍的人（AUD）稳定和 开始恢复。但是，通常需要某种形式的持续支持来增加稳定的机会 缓解。因此，一种常见的临床策略是将患者与可用的共同助手联系起来 组织（MHO），可以提供灵活的基于社区的支持。 MHO有效性和 成本效益已得到经验支持，因此，建议在 大多数练习指南。然而，由于缺乏数据而导致的当前护理标准的局限性是 转介通常几乎专门针对以精神为导向的12个步骤组织的事实，例如 作为酗酒者匿名（AA）。这项研究的虚拟占主导地位的一个重要结果 MHO是它们是唯一紧急支持的MHO持续护理推荐选项。鉴于精神 但是，12步组织的方向以及美国某些州最高法院的裁决 MHO在技术上是宗教，因此不能成为唯一的推荐选择，很重要的是要提供世俗的 替代方案。一个主要候选人是智能恢复，这是一个安全的认知行为MHO 在美国的1200次面对面会议中支持。但是，关于其现实世界的利益知之甚少。一个 严格的研究表明，智能恢复可以帮助降低救济风险，将提供有价值的信息 可以提高对SMART作为低成本恢复资源的临床信心，从而成为牢固的经验 - 支持的临床推荐选项。作为评估现实世界中的临床和公共卫生实用程序的下一步 明智的恢复，当前的研究将：1。表征和描述专业和非专业 恢复支持服务参与选择，迁移和途径使用小组轨迹分析 个人为期两年（n = 348）开始了新的AUD恢复尝试。 2。研究比较 通过比较AUD个人的结果，使新恢复的结果通过比较智能恢复的有效性 尝试（n = 348）追求智能恢复（n = 174）或非智能恢复（n = 174），途径。 因为大约有一半的智能参与者也选择参加AA，所以我们将使用分层设计来注册 有声音的人与参与MHO的人自然发生持续的护理选择 平衡时尚，并在2年的时间内前瞻性地关注它们 vs.仅AA vs.都不）。因为先前的数据显示智能参与者可能不如AA严重 参与者，我们将根据AUD严重性（轻度，中度和严重）对组进行分层。除了使用 倾向得分匹配，此分层将使我们能够与更严格的结果进行比较 选择参加智能恢复的人，而不是在考虑简单选择的同时 考虑AA或没有MHO参与。 3。探索行为改变的机制（例如，自我效率， 冲动性）以及利益程度的主持人（例如性别，精神病困扰），以帮助确定 明智的恢复如何有助于其分支机构。