Clinical Course of Alcohol Use Disorder Recovery

项目总结/摘要 酒精使用障碍（AUD）仍然是一个普遍的问题，估计有29%的美国人 12岁及以上的人在其一生中符合DSM-5诊断标准（13.9%在过去12个月内; 格兰特等人，2015）。虽然禁欲仍然是许多治疗方案的主要结果， "复苏"的定义仍然过于狭窄。最近，NIAAA传播了一个恢复的定义， 解决过去研究的局限性，激励新的研究，更好地实施恢复（NIAAA， 2020年）。具体来说，NIAAA将恢复定义为"一个过程，通过这个过程，一个人既追求缓解， 戒金戒酗酒"他们进一步指出，"一个人可能是 如果达到AUD缓解和重度饮酒停止，则认为已恢复， 随着时间的推移”。虽然这一新的操作定义将有助于组织现有的文献， 为今后的研究提供指导，但仍存在一些问题。第一，将追回归为初步追回， 早期、持续和稳定需要进一步研究，以确定这些阈值是否对 临床实践和研究。第二，用酗酒阈值来定义恢复的效用仍然存在 最多也就是有问题最后，新定义没有提供一个概念框架， 需要持续监测可能影响恢复的临床标志物（临床变化点）的"过程" status.本申请的目的是检查该新定义在 澳元复苏的新理论模型。拟议的研究将招募参与者， 社区AUD治疗。参与者将完成一个结构化的临床面试，并提供 了解他们目前的饮酒情况和相关行为。所有参与者将获得12周的澳元 在每次治疗结束时和治疗期间每两周进行一次心理治疗和完成简短评估。 治疗后12个月。此外，参与者将在3个月和6个月时完成面对面访谈， 在研究期间，治疗后1个月间隔（治疗后24 - 54个月，取决于 注册时间）。拟议研究的结果有可能增加对以下问题的理解： 恢复的动态性质，从而改善临床决策，并产生未来的研究。 具体来说，我们的目标是解决这样一个问题："复发、复发缓解或 恢复有用的药理学的临床实践和研究，如果是这样，如何？“确定进程 重要的是，每种类型的变化，在临床过程中可能有助于设计适应性治疗， 根据我们目前对治疗文献的了解例如，人们可能需要使用不同的策略 (e.g.,权衡利弊，替代新的行为）的不同阶段的恢复。据我们所知，这 应用程序是第一个测试NIAAA的新定义和恢复的动态性质，以及认知， 行为和情感过程被假设为是重要的发起与维持变化。

Project Summary/Abstract Alcohol use disorder (AUD) continues to be a widespread problem with an estimated 29% of all Americans ages 12 and up meeting DSM-5 criteria for diagnosis during their lifetime (13.9% within the past 12 months; Grant et al., 2015). Although abstinence remains as the primary outcome for many treatment programs, such definitions of “recovery” remain far too narrow. Recently, NIAAA disseminated a definition of recovery aimed at addressing limitations of past research, stimulating new research, and better operationalizing recovery (NIAAA, 2020). Specifically, NIAAA defines recovery as “a process through which an individual pursues both remission from AUD and cessation from heavy drinking.” They further go on to state that “an individual may be considered recovered if both remission from AUD and cessation from heavy drinking are achieved and maintained over time.” Although this new operational definition will help to organize the existing literature and provide guidance for future research, several questions remain. First, categorization of recovery as initial, early, sustained, and stable requires further research to establish whether such thresholds are meaningful in both clinical practice and research. Second, the utility of heavy drinking thresholds to define recovery remains questionable at best. Finally, the new definition does not provide a conceptual framework for which recovery is a “process” requiring continual monitoring for clinical markers (clinical change points) that may impact recovery status. The aim of the current application is to examine the utility and validity of this new definition within the context of a novel theoretical model of AUD recovery. The proposed study will recruit participants seeking treatment for AUD from the community. Participants will complete a structured clinical interview and provide information on their current alcohol use and related behaviors. All participants will receive 12 weeks of AUD psychotherapy and complete brief assessments at the end of each treatment session and biweekly during the first 12-months post treatment. In addition, participants will complete in-person interviews at 3-month and 6- month intervals post-treatment for the duration of the study (for up to 24-54 months post treatment depending on time of enrollment). Findings from the proposed research have the potential to increase understanding of the dynamic nature of recovery and thereby improve clinical decision-making and generate future research. Specifically, our goal is to address the question of “Are the constructs of relapse, recurrence remission, or recovery useful heuristics for clinical practice and research, and if so, how?” Identification of the processes important for each type of change in clinical course may help in designing adaptive treatments that capitalize on our current knowledge of the treatment literature. For example, people may need to use different strategies (e.g., weighing pros/cons, substituting new behaviors) for different phases of recovery. To our knowledge, this application is the first to test NIAAA’s new definition and the dynamic nature of recovery, as well as cognitive, behavioral, and affective processes hypothesized to be important for initiating versus maintaining change.