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(由申请者提供)：本提案是对《恢复法》《有限竞争：美国国立卫生研究院健康与科学研究挑战补助金》(RC1)的回应。广泛的挑战领域是比较有效性研究(05)。具体主题是酒精治疗研究中创新技术的使用(05-AA-103)，这是一个被赋予最高优先的主题。与酒精相关的机动车事故(AR-MVA)是一个重大的公共卫生问题。AR-MVA死亡在MVA死亡中所占比例最大。2006年，41%的与车辆有关的死亡与酒精有关(17000人死亡)，其中86%的死亡涉及血液酒精含量在0.08或更高的司机。在美国，交通事故是导致残疾的十大原因之一。每年，与酗酒有关的撞车事故总共给社会造成了约510亿美元的损失。迫切需要以证据为基础的干预措施，以减少AR-MVA的频率，因为其后果代价高昂，而且往往是致命的。已解决需求和挑战。AR-MVA的流行以及令人不安的成本和健康后果构成了双重挑战。科学上的挑战是如何增加第一次酒后驾车罪犯获得有效护理的机会，并防止他们成为惯犯。我们通过在酒精教育计划(AEP)中提供短暂干预来应对这一挑战，AEP是防止第一次酒后驾车犯罪者未来发生与酒精相关的事件的传统方法，是否可行，是否为犯罪者和提供者所接受，以及增加BI是否减少了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，BIS在减少高风险饮酒和与酒精相关的后果方面是有效的，而且有充分的理由相信BIS在AEP设置中可能是有效的。我们还询问BI的交付模式是否会对结果产生不同的影响。公共卫生面临的挑战是改善AEP的结果，AEP在减少酒精中毒和AR-MVA方面只有轻微的影响。在加利福尼亚州，就像在其他地区一样，超过三分之一的酒后驾车定罪是屡教不改的，而酒后驾车死亡的人数不成比例地是由以前被判有ARMVA罪的司机造成的。这些再犯罪率表明，AEP计划错过了预防和治疗酒精的机会。这一机会对拉美裔罪犯来说可能特别宝贵，与加州其他种族/民族相比，他们因酒后驾车被捕的可能性更大，累犯率更高，而且比白人更有可能死于与酒精有关的车祸。AEP计划可能只有轻微的影响，因为这些计划主要是心理教育，而计划内容并不是由行为改变的基本理论驱动的。就其性质而言，强制的AEP计划不能提供个性化的规范反馈，而这是国际清算银行的一个基本要素。相比之下，国际清算银行是以理论为基础的。它们解决了内在动机和自我效能感，这是改变行为的关键。由于被判酒后驾车的客户经常对自己的强制判决感到不安，并抵制改变，因此用于交付BI的激励性面试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，我们缺乏关于BIS在AEP环境下的有效性的科学证据，BIS的使用受到以下因素的限制：可获得训练有素的治疗师、他们的时间成本以及统一和可靠地实施BI的困难。使用基于网络的技术提供简短干预(WBBIS)是解决这些限制的一种有效和创新的方式。目的1.开发针对英语和西班牙语酒后驾车罪犯的个性化、互动式、基于网络的短期干预，并评估其对英语和西班牙语罪犯、临床医生和AEP项目的可行性和可接受性。目的2.进行一项先导性随机试验，比较普通AEP护理和两种对首次酒后驾车犯罪者进行短暂干预的方法(IP-BI和WB-BI)在减少饮酒和高风险饮酒方面的作用。创新。这项拟议的工作是创新的，因为它评估了新人群(第一次酒后驾车犯罪者)的已证实干预(BIS)，并比较了替代交付系统(WB和IP)的不同有效性。评估国际清算银行对讲西班牙语的酒后驾车人群的有效性也是创新的。通过评估使用网络来提供干预，我们直接解决了在挑战主题中指定的开发创新治疗技术的需要。这一研究领域将从两年期启动基金中受益匪浅。有了这些资金，我们可以开发WB-BI，并初步测试WB-BI和IP-BI相对于常规护理的不同疗效，为更大规模的疗效试验做准备。这项研究符合《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，可能会帮助可能受到经济衰退高度影响的人群，因为研究表明，个人正在使用酒精来应对紧张的经济环境。