Using Technology To Deliver Brief Interventions in DUI Programs

描述（由申请人提供）：本提案是对恢复法案有限竞争的回应：NIH健康与科学研究挑战拨款（RC1）。广泛的挑战领域是比较有效性研究（05）。具体主题是创新技术在酒精治疗研究中的应用（05-AA-103），这是一个被赋予最高优先级的主题。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%的与车辆有关的死亡与酒精有关（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致残原因之一。与酒精有关的交通事故每年总共给社会造成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。需求和挑战已得到解决。AR-MVAs的流行以及令人不安的成本和健康结果构成了双重挑战。科学上的挑战是如何增加第一次酒后驾车违法者获得有效护理的机会，并防止他们成为惯犯。为了应对这一挑战，我们提出了以下问题：在酒精教育项目（AEP）中提供简短的干预措施（AEP是预防首次酒后驾车违法者未来酒精相关事件的传统方法）对违法者和提供者是否可行和可接受，以及增加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，BIs在减少高风险饮酒和酒精相关后果方面是有效的，有充分的理由相信BIs在AEP环境中可能是有效的。我们还询问BI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对减少酒精中毒和ar - mva只有适度的影响。在加州，和其他地区一样，超过三分之一的酒后驾车被定罪者是惯犯，而酒后驾车死亡人数的不成比例是由以前被判犯有ARMVA罪的司机造成的。这些再犯率表明，AEP项目错失了预防和治疗酒精的机会。这个机会对西班牙裔罪犯来说尤其有价值，与加州其他种族/民族相比，他们更有可能因酒后驾车被捕，他们的累犯率更高，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潜在理论驱动的。就其本质而言，强制性的AEP计划无法提供个性化的规范性反馈，而这是BIs的基本要素。相反，BIs是基于理论的。它们解决了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，并且拒绝改变，因此用于提供BI的动机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，我们缺乏关于脑电刺激在AEP环境下的有效性的科学证据，而且脑电刺激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脑电刺激的难度的限制。利用基于网络的技术提供短期干预（WBBIs）是解决这些限制的一种有效和创新的方法。目的1。为AEP中讲英语和西班牙语的酒驾违法者开发一个个性化的、交互式的、基于网络的简短干预，并评估其对讲英语和西班牙语的违法者、临床医生和AEP项目的可行性和可接受性。目标2。进行一项随机试验，比较常规的AEP护理与两种提供简短干预的方法（IP-BI和WB-BI）对初次酒后驾车违法者在减少酒精消耗和高危饮酒方面的效果。创新。这项工作具有创新性，因为它对新人群（首次酒后驾车罪犯）进行了有效干预（BIs）评估，并比较了替代输送系统（WB和IP）的不同效果。评估BIs对西班牙语酒后驾车人群的有效性也是一项创新。通过评估使用网络提供干预措施，我们直接解决了挑战主题中指定的开发创新治疗技术的需求。这一研究领域将从为期两年的启动基金中受益匪浅。有了这些资金，我们可以开发一种WB-BI，并对WB-BI和IP-BI相对于常规护理的不同疗效进行试点测试，为更大规模的疗效试验做准备。本研究符合《美国复苏与再投资法案》的目标。它填补了研究领域的重要知识空白，并可能帮助那些可能受到经济衰退严重影响的人群，因为研究表明，人们正在利用酒精来应对紧张的经济环境。

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.