Clinical Course of Alcohol Use Disorder Recovery

酒精使用障碍康复的临床过程

• 批准号: 10707414
• 负责人: STEPHEN A MAISTO
• 金额: $ 60.14万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707414
• 关键词: Abstinence; Address; Adult; Affective; Aftercare; Age; Alcohol consumption; American; Area; Behavior; Behavior Therapy; Behavioral; Behavioral Mechanisms; Behavioral inhibition; Categories; Clinical; Clinical Markers; Clinical Research; Cognitive; Communities; DSM-V; Data Analyses; Data Collection; Diagnosis; Dimensions; Disease remission; Enrollment; Frequencies; Goals; Grant; Heavy Drinking; Impulsivity; Individual; Interview; Knowledge; Literature; Measures; Modeling; Monitor; Motivation; National Institute on Alcohol Abuse and Alcoholism; Nature; Outcome; Participant; Patient Recruitments; Pattern; Personal Satisfaction; Persons; Phase; Probability; Process; Psychotherapy; ROC Curve; Recommendation; Recovery; Recurrence; Relapse; Research; Self Efficacy; Severities; Structure; Subgroup; Survival Analysis; Symptoms; Testing; Theoretical model; Therapeutic; Time; Treatment Protocols; Treatment outcome; alcohol abuse therapy; alcohol use disorder; base; behavior change; clinical decision-making; clinical practice; clinically relevant; craving; depression model; design; effective intervention; follow-up; heuristics; improved; insight; interest; meetings; negative affect; novel; partial recovery; person centered; primary outcome; recruit; response; sustained recovery; therapy design; treatment duration; treatment program; treatment response

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.

项目摘要/摘要 酒精使用障碍(AUD)仍然是一个普遍存在的问题，估计有29%的美国人 12岁及以上的儿童一生中符合DSM-5诊断标准(13.9%在过去12个月内； Grant等人，2015年)。尽管禁欲仍然是许多治疗方案的主要结果，如 “复苏”的定义仍然过于狭隘。最近，NIAAA发布了一个复苏定义，目的是 解决过去研究的局限性，刺激新的研究，并更好地实施恢复(NIAAA， 2020)。具体地说，NIAAA将康复定义为“一个人既追求缓解，又追求缓解的过程 远离澳元，戒掉大量饮酒。他们还进一步指出，“一个人可能是 如果AUD的缓解和大量饮酒的戒断都实现了，则被视为康复，并且 随着时间的推移而保持。尽管这一新的操作性定义将有助于组织现有的文献和 为未来的研究提供指导，仍然存在几个问题。首先，将复苏归类为初始， 早期、持续和稳定需要进一步研究，以确定这些阈值是否对 无论是临床实践还是研究。其次，用大量饮酒阈值来定义恢复的效用仍然存在 充其量也是有问题的。最后，新的定义没有提供恢复的概念框架 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” 状态。当前应用程序的目的是检查这一新定义在 一种新的澳元恢复理论模型的背景。拟议的研究将招募参与者寻求 来自社区的AUD治疗。参与者将完成结构化的临床面试，并提供 关于他们目前饮酒和相关行为的信息。所有参与者将获得12周的澳元 心理治疗，并在每次治疗结束时完成简要评估，并在治疗期间每两周进行一次 第一次治疗后12个月。此外，参与者将在3个月和6个月完成面谈。 在研究期间的治疗后间隔一个月(最多24-54个月，取决于治疗后 在注册时)。拟议中的研究结果有可能增加对 恢复的动态性质，从而改善临床决策并产生未来的研究。 具体地说，我们的目标是解决这样一个问题：“复发、复发缓解或 恢复对临床实践和研究有用的启发式方法，如果是这样的话，是如何进行的？过程的识别 对于临床病程中的每一种类型的改变都很重要，这可能有助于设计适合的治疗方法 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 (例如，权衡利弊，替换新的行为)来代替不同的恢复阶段。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， 行为和情感过程被认为对启动和维持变化是重要的。