Clinical Course of Alcohol Use Disorder Recovery

酒精使用障碍康复的临床过程

• 批准号: 10585118
• 负责人: STEPHEN A MAISTO
• 金额: $ 58.82万
• 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/10585118
• 关键词: Abstinence; Address; Adult; Affective; Aftercare; Age; Alcohol consumption; American; Area; Behavior; Behavior Therapy; Behavioral; Behavioral Mechanisms; Behavioral inhibition; 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; 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）仍然是一个广泛的问题，估计有29％的美国人 年龄在12岁及以上的DSM-5诊断标准（在过去12个月内为13.9％）； Grant等，2015）。尽管禁欲仍然是许多治疗计划的主要结果，但是 “恢复”的定义仍然太狭窄了。最近，NIAAA传播了针对恢复的定义 解决过去研究的局限性，刺激新的研究和更好的运营恢复（NIAAA， 2020）。特别是，NIAAA将恢复定义为“个人追求两者缓解的过程 从大量饮酒到戒烟。”他们进一步指出：“一个人可能是 如果在AUD中可以缓解和停止大量饮酒，并且被认为已被恢复 随着时间的流逝，这种新的操作定义将有助于组织现有文献和 为将来的研究提供指导，还有几个问题。首先，恢复类别作为初始， 早期，持续和稳定需要进一步研究，以确定此类阈值是否有意义 临床实践和研究。其次，重饮酒阈值定义恢复的效用仍然存在 充其量是值得怀疑的。最后，新定义不提供恢复的概念框架 需要对临床标记（临床变化点）进行连续监控的“过程”，这可能会影响恢复 地位。当前应用的目的是检查此新定义的效用和有效性 新型理论恢复理论模型的上下文。拟议的研究将招募参与者寻求 从社区的aud进行处理。参与者将完成结构化的临床面试，并提供 有关他们当前的饮酒和相关行为的信息。所有参与者将获得12周的AUD 在每个治疗课程结束时，心理治疗和完整的简短评估，并在每周一次 治疗后的第12个月。此外，参与者将在3个月和6--中完成面对面的访谈 在研究期间进行治疗后的月度间隔（在治疗后长达24-54个月，取决于 在注册时）。拟议研究的发现有可能增加对 恢复的动态性质，从而改善临床决策并产生未来的研究。 具体而言，我们的目标是解决“救济，复发的结构，还是 恢复有用的临床实践和研究的启发式方法，如果是的话，如何识别该过程 对于每种类型的临床课程变化都重要的可能有助于设计资本化的自适应治疗 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 （例如，加权利弊，代替新行为）用于恢复的不同阶段。据我们所知，这个 应用是第一个测试NIAAA的新定义以及恢复的动态性质的应用以及认知的动态性质 行为和情感过程假设对启动与维持变化很重要。