Using Technology To Deliver Brief Interventions in DUI Programs

利用技术对酒驾项目进行简短干预

• 批准号: 7817883
• 负责人: Katherine E Watkins
• 金额: $ 49.47万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-25 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7817883
• 关键词: Accounting; Address; Affect; Alcohol consumption; Alcoholism; Alcohols; American; American Psychological Association; Area; Blood alcohol level measurement; California; Caring; Cessation of life; Client; Collaborations; Communities; Community Practice; Counseling; County; Early treatment; Economics; Education; Effectiveness; Elements; Environment; Ethnic Origin; Evidence Based Medicine; Evidence based intervention; Evidence based treatment; Fill-It; Frequencies; Funding; Future; Goals; Grant; Health Care Costs; Health Personnel; Health Services; Hispanics; Individual; Injury; Internet; Intervention; Knowledge; Letters; Los Angeles; Methods; Motivation; Nature; Occupations; Online Systems; Outcome; Persons; Pharmaceutical Preparations; Population; Population Heterogeneity; Preparation; Prevalence; Prevention; Provider; Public Health; Race; Randomized Controlled Clinical Trials; Recovery; Relative (related person); Research; Resistance; Risk; Self Efficacy; Services; Social Welfare; Societies; Specific qualifier value; Staging; Substance abuse problem; Surveys; Survivors; System; Technology; Testing; Time; Traffic accidents; Training; United States National Institutes of Health; Work; alcohol abuse therapy; alcohol prevention; alcohol related consequences; alcohol use disorder; base; behavior change; behavioral health; brief intervention; community setting; comparative effectiveness; convict; cost; disability; drinking; drinking behavior; driving under influence; effective intervention; effectiveness research; efficacy trial; evidence base; experience; health science research; high risk drinking; improved; innovation; innovative technologies; meetings; motivational enhancement therapy; neighborhood safety; normative feedback; offender; opportunity cost; premature; prevent; programs; psychoeducational; recidivism; repeat offender; response; theories; treatment as usual; trial comparing; use alcohol to cope; vehicular accident

Description (provided by applicant): This proposal is in response to the Recovery Act Limited Competition: NIH Challenge Grants in Health and Science Research (RC1). The broad challenge area is Comparative Effectiveness Research (05). The specific topic is Use of Innovative Technologies in Alcohol Treatment Research (05-AA-103), a topic assigned highest priority. Alcohol-related motor vehicle accidents (AR-MVA) are a significant public health concern. AR-MVA fatalities account for the largest proportion of MVA fatalities. In 2006, 41% of vehicle-related fatalities were alcoholrelated (17,000 deaths) and 86% of these fatalities involved a driver with a blood alcohol content of 0.08 or greater. Traffic accidents are among the top 10 leading causes of disability in the US. Together, alcoholrelated crashes cost society about 51 billion dollars every year. Evidence-based interventions to reduce the frequency of AR-MVA are urgently needed because the consequences are costly, and often lethal. Need and Challenge Addressed. The prevalence of AR-MVAs and the disturbing cost and health outcomes pose a dual challenge. The scientific challenge is how to increase access to effective care for 1st time DUI offenders and keep them from becoming repeat offenders. We address this challenge by asking whether providing brief interventions in alcohol education programs (AEP), the traditional method for preventing future alcohol-related incidents among 1st-time DUI offenders, is feasible and acceptable to offenders and providers, and whether adding a BI decreases alcohol consumption and risky drinking behaviors. We know that BIs are effective at reducing risky alcohol use and alcohol-related consequences with at-risk drinkers in diverse populations and settings, and there are good reasons to believe BIs might be efficacious in the AEP setting. We also ask whether the mode of BI delivery differentially affects outcomes. The public health challenge is to improve outcomes for AEPs, which have only modest effects on reducing alcoholism and AR-MVAs. In California, as in other areas, more than a third of all DUI convictions are repeat offenders, and a disproportionate number of DUI fatalities are caused by drivers previously convicted of an ARMVA. These rates of recidivism suggest that AEP programs are a missed opportunity for alcohol prevention and treatment. The opportunity could be especially valuable for Hispanic offenders, who are disproportionately more likely to be arrested for a DUI compared to other race/ethnicities in California, have higher rates of recidivism, and are more likely to die in alcohol-related crashes than their White counterparts. AEP programs may have only modest effects because the programs are primarily psychoeducational, and program content is not driven by an underlying theory of behavior change. By its nature, the mandated AEP program cannot provide individualized normative feedback, an essential element of BIs. In contrast, BIs are theory-based. They address intrinsic motivation and self-efficacy, which are key to changing behavior. Since clients convicted of a DUI are frequently upset about their mandatory sentence and resistant to change, the motivational interviewing style used to deliver the BI may help clients become more willing to change, which may affect outcomes. However we lack scientific evidence for the efficacy of BIs in the AEP context and the use of BIs is limited by the availability of trained therapists, the cost of their time, and the difficulty of implementing the BI uniformly and reliably. Using web-based technology to deliver the brief intervention (WBBIs) is an efficient and innovative way to address these limitations. Aim 1. To develop an individualized, interactive, web-based brief intervention for English- and Spanishspeaking DUI offenders in AEPs and evaluate its feasibility and acceptability to English- and Spanishspeaking offenders, clinicians, and AEP programs. Aim 2. To conduct a pilot randomized trial comparing usual AEP care to two methods of delivering a brief intervention (IP-BI and WB-BI) to 1st-time DUI offenders in reducing alcohol consumption and at-risk drinking. Innovation. The proposed work is innovative because it evaluates a proven intervention (BIs) with a new population (1st time DUI offenders) and compares the differential effectiveness of alternative delivery systems (WB and IP). Evaluating the effectiveness of BIs for the Spanish speaking DUI population is also innovative. By evaluating the use of the web to deliver the intervention we directly address the need to develop innovative treatment technologies specified in the Challenge topic. This research area is one that would benefit substantially from two-year jump-start funds. With these funds, we can develop a WB-BI and pilot test the differential efficacy of WB-BI and IP-BI relative to usual care, in preparation for a larger efficacy trial. This study meets the goals of the American Recovery & Reinvestment Act. It fills a significant knowledge gap in the research field and may help a population likely to be highly affected by the recession, as research suggests that individuals are using alcohol to cope with the stressful economic environment.

描述（由申请人提供）：本提案是对恢复法案有限竞争：NIH健康和科学研究挑战赠款（RC 1）的回应。广泛的挑战领域是比较有效性研究（05）。具体的主题是使用创新技术在酒精治疗研究（05-AA-103），一个主题指定的最高优先级。与酒精有关的机动车事故（AR-MVA）是一个重大的公共卫生问题。AR-MVA死亡人数占MVA死亡人数的最大比例。2006年，41%的车辆相关死亡与酒精有关（17，000人死亡），其中86%的死亡涉及血液酒精含量为0.08或更高的司机。交通事故是美国十大主要残疾原因之一。与酒精有关的车祸每年给社会造成约510亿美元的损失。迫切需要减少AR-MVA频率的循证干预措施，因为其后果是昂贵的，而且往往是致命的。需求和挑战得到解决。抗逆转录病毒/艾滋病疫苗的流行以及令人不安的费用和健康结果构成了双重挑战。科学上的挑战是如何增加首次酒后驾车罪犯获得有效护理的机会，并防止他们成为累犯。我们通过询问在酒精教育计划（AEP）中提供简短的干预措施来解决这一挑战，这是预防第一次DUI罪犯未来酒精相关事件的传统方法，对罪犯和提供者来说是可行和可接受的，以及添加BI是否会减少酒精消费和危险饮酒行为。我们知道，在不同的人群和环境中，BI可以有效地减少危险酒精使用和酒精相关后果，并且有充分的理由相信BI在AEP环境中可能有效。我们还询问BI交付模式是否会对结果产生差异性影响。公共卫生挑战是改善AEP的结果，AEP对减少酗酒和AR-MVA的影响有限。在加州，与其他地区一样，超过三分之一的DUI定罪是累犯，而不成比例的DUI死亡是由以前被判犯有ARMVA的司机造成的。这些再犯率表明，AEP计划是一个错过的机会，酒精预防和治疗。对于西班牙裔罪犯来说，这个机会可能特别有价值，与加州的其他种族/民族相比，他们更有可能因酒后驾车而被捕，累犯率更高，并且比白色同行更有可能死于与酒精有关的撞车事故。AEP项目可能只有适度的效果，因为这些项目主要是心理教育，项目内容不是由行为改变的基本理论驱动的。就其性质而言，强制性AEP计划不能提供个性化的规范反馈，而这是BI的一个基本要素。相反，BI是基于理论的。他们解决内在动机和自我效能，这是改变行为的关键。由于被判酒后驾车的客户经常对他们的强制性判决感到不安，并抵制改变，用于提供BI的动机性访谈风格可能会帮助客户变得更愿意改变，这可能会影响结果。然而，我们缺乏BI在AEP背景下有效性的科学证据，BI的使用受到训练有素的治疗师的可用性、他们的时间成本以及统一可靠地实施BI的困难的限制。使用基于网络的技术来提供简短干预（WBBI）是解决这些限制的有效和创新的方法。目标1.开发一个个性化的，互动的，基于网络的简短干预英语和西班牙语的DUI罪犯在AEP和评估其可行性和可接受性英语和西班牙语的罪犯，临床医生，和AEP程序。目标2.进行一项试点随机试验，比较常规AEP护理与两种向首次DUI罪犯提供简短干预（IP-BI和WB-BI）的方法，以减少饮酒和危险饮酒。创新拟议的工作是创新的，因为它评估了一个行之有效的干预措施（BI）与新的人口（第一次酒后驾车罪犯），并比较了替代交付系统（WB和IP）的差异有效性。对使用西班牙语的酒后驾车者进行的BI效果评估也是一种创新。通过评估网络的使用来提供干预，我们直接解决了开发挑战主题中指定的创新治疗技术的需求。这一研究领域将从两年期启动资金中获益匪浅。有了这些资金，我们可以开发一种WB-BI，并对WB-BI和IP-BI相对于常规治疗的差异疗效进行初步测试，为更大规模的疗效试验做准备。该研究符合《美国复苏与再投资法案》的目标。它填补了研究领域的一个重大知识空白，并可能帮助可能受到经济衰退严重影响的人群，因为研究表明，人们正在使用酒精来科普紧张的经济环境。