Location-Based Monitoring and Intervention for Alcohol Use Disorders

描述(由申请人提供)：本提案符合RFA-OD-09-004(RC2)的研究重点，“扩大酒精障碍的治疗选择并使其个人化”。目前，需要接受酒精滥用治疗的人数与实际接受治疗的人数之间存在巨大差距。造成这一差距的因素很多，包括治疗的可获得性和可负担性、希望独立解决酒精问题的个人以及与接受治疗相关的耻辱。由于它们有可能绕过这些治疗障碍，技术创新有望大幅增加接受治疗服务的个人数量。例如，最近的研究表明，容易获得的基于网络的酒精干预措施在减少问题饮酒者的酒精消费方面是有效的。然而，这种基于网络的干预措施在一定程度上是有限的，因为它们对饮酒或复发发生的日常环境不敏感，也不能在其中使用。这种直接性的缺乏是一个特别令人担忧的问题，因为研究一直表明，线索，如个人以前饮酒的地点，是持续饮酒或复发的强烈触发因素，而且这些线索往往压倒了个人的理性决策能力。为了解决这些关切并使干预措施更容易获得和获得，一种方法是利用新兴技术开发一种工具，帮助在实际高危地点进行干预。该项目的主要目的是开发这样一个工具，即基于位置的监测和干预-酒精(LBMI-A)，这是一个利用GPS智能手机的最新进展的系统。LBMI-A将被编程为在用户进入其地理定义的复发高危地区时发出警报，并提供立即的心理社会干预(例如，通过向支持人员发送短信和提供应对策略)。LMBI-A的其他功能包括评估和反馈报告、酒精使用自我监测和反馈功能以及技能模块(例如，应对技能)。在拟议项目的第一和第二阶段，将制定LBMI-A的初步技术和心理社会干预方面的内容。在第三阶段，酒精中毒治疗专家将测试和审查LBMI-A，并将根据他们的建议进行修改。在第四阶段，将对60名表现出轻度至中度酒精依赖的年轻人进行为期6周的随机等待名单对照试点研究。将收集用户界面数据，以检查该人群如何使用LBMI-A，并收集试点数据，以检查其作为干预工具的有效性。在第五阶段，在试点数据的基础上，LBMI-A将最终确定，并准备在未来的研究中进行额外的、严格的疗效测试。 与公共卫生相关：酗酒和酗酒是严重的公共卫生问题，会给个人和社会带来巨大的代价。据估计，由于顽固的治疗障碍，80%以上需要酒精治疗的人无法获得酒精治疗。该项目将导致一种基于技术的酒精治疗系统，该系统可以绕过许多这些治疗障碍，并在最需要的地方，即在现实世界的高风险环境中提供干预措施。这一治疗系统有可能为酒精成瘾治疗带来革命性的变化，并将服务扩展到数以百万计的人，否则他们将无法获得必要的治疗。

DESCRIPTION (provided by applicant): This proposal is consistent with the research priorities of RFA-OD-09-004 (RC2), "Expanding and Personalizing Treatment Options for Alcohol Disorders". At present, a wide gap exists between the number of individuals needing alcohol abuse treatment and the number actually receiving it. Many factors account for this gap, including treatment availability and affordability, individuals wanting to independently solve their problems with alcohol, and stigma associated with receiving treatment. Due to their potential to circumvent these treatment barriers, technological innovations hold promise for increasing dramatically the number of individuals who receive treatment services. For example, recent research has indicated that readily- accessible web-based alcohol interventions are effective in reducing alcohol consumption among problem drinkers. However, such web-based interventions are limited to the extent that they are not sensitive to, or available within, the everyday environment in which drinking or relapse occurs. This lack of immediacy is particularly a concern as research has demonstrated consistently that cues, such as locations where an individual has previously drank, are strong triggers for continued alcohol use or relapse and that these cues often overwhelm an individual's rational decision-making abilities. To address these concerns and to make interventions more readily available and accessible, one approach is to use emerging technologies to develop a tool that helps to intervene in actual high-risk locations. The primary aim of this project is to develop such a tool, the Location-Based Monitoring and Intervention - Alcohol (LBMI-A), a system that utilizes recent advances in GPS-enabled smartphones. The LBMI-A will be programmed to alert users when they are entering their geographically defined high-risk areas for relapse and provide an immediate psychosocial intervention (e.g., by sending a text message to a support person and providing coping strategies). Other LMBI-A features will include assessment and feedback reports, alcohol use self- monitoring and feedback functions, and skills modules (e.g., coping skills). During Phases I and II of the proposed project, the initial technological and psychosocial intervention aspects of the LBMI-A will be developed. In Phase III, alcoholism treatment experts will test and review the LBMI-A and modifications will be made based on their recommendations. In Phase IV, a 6-week, randomized waitlist control pilot study will be performed with 60 young adults who demonstrate mild to moderate alcohol dependence. User- interface data will be gathered to examine how the LBMI-A is used by this population and pilot data will be gathered to examine its efficacy as an intervention tool. In Phase V, based on pilot data, the LBMI-A will be finalized and prepared for additional, rigorous testing for efficacy in future research. PUBLIC HEALTH RELEVANCE: Alcohol abuse and alcoholism are serious public health issues that have significant individual and society costs. It is estimated that over 80% of people who need alcohol treatment are unable to access it due to intractable treatment barriers. This project will lead to a technologically-based alcohol treatment system that can circumvent many of these barriers to treatment as well as provide interventions where they are needed most, namely, in real-world, high-risk environments. This treatment system holds the potential to revolutionize alcohol addiction treatment and to extend services to millions of individuals who otherwise would not obtain needed treatment.