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: 7937082
• 负责人: Katherine E Watkins
• 金额: $ 50.42万
• 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 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7937082
• 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; Recovery; Relative (related person); Research; Resistance; Risk; Self Efficacy; Services; Social Welfare; Societies; Specific qualifier value; Staging; 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; randomized trial; recidivism; repeat offender; response; substance abuse treatment; 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）：该提案响应《恢复法》有限竞争：NIH挑战卫生与科学研究（RC1）。广泛的挑战领域是比较有效性研究（05）。具体的主题是在酒精治疗研究中使用创新技术（05-AA-103），这是一个主题最高的优先级。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死亡的最大比例。在2006年，与车辆相关的死亡人数中有41％是酗酒（17,000人死亡），其中86％的死亡人数涉及血液酒精含量为0.08或更高的驾驶员。交通事故是美国残疾的十大主要原因之一。与酒精相关的崩溃每年损失约510亿美元。迫切需要基于证据的干预措施以减少AR-MVA的频率，因为后果是昂贵的，而且通常是致命的。需要和挑战。 AR-MVA的患病率和令人不安的成本和健康成果构成了双重挑战。科学挑战是如何在第一次DUI犯罪者中提高有效护理的机会，并阻止他们成为反复犯罪者。我们通过询问对酒精教育计划提供简短干预措施（AEP）是防止第一任DUI罪犯之间未来与酒精相关的事件的传统方法，应对罪犯和提供者可以接受的，以及是否降低酒精消费和风险饮酒行为是可行的，并且是否可以接受。我们知道，BIS可以有效地减少饮酒危险和与酒精相关的后果，并在不同的人群和环境中饮酒，并且有充分的理由相信BIS在AEP环境中可能有效。我们还询问BI交付方式是否会差异地影响结果。公共卫生挑战是改善AEP的结果，AEP对减少酒精中毒和AR-MVA的影响只有适度的影响。在加利福尼亚州，与其他地区一样，所有DUI定罪的三分之一以上是反复犯罪者，而数量不成比例的DUI死亡是由以前被定罪的驾驶员造成的。这些累犯率表明，AEP计划是预防酒精和治疗的错失机会。对于西班牙裔罪犯而言，这一机会可能特别有价值，与加利福尼亚州的其他种族/族裔相比，与其他种族/族裔相比，他们的累犯率更高，并且比白人白人同行更有可能在与酒精有关的撞车事故中死亡。 AEP程序可能只有适度的效果，因为这些程序主要是心理教育，并且程序内容并非由行为改变理论驱动。从本质上讲，授权的AEP计划无法提供个性化的规范反馈，这是BI的基本要素。相反，BI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。由于被判犯有DUI的客户经常对他们的强制性刑罚和抵抗变革的抗拒，因此用于交付BI的动机采访方式可能会帮助客户变得更加愿意改变，这可能会影响结果。但是，我们缺乏科学证据表明BI在AEP背景下的功效，而使用BIS受到训练的治疗师的可用性，其时间的成本以及难以统一可靠地实施BI的困难。使用基于Web的技术提供简短干预（WBBI）是解决这些局限性的有效且创新的方法。目标1。为英语和西班牙语的DUI罪犯开发一个个性化的，互动的，基于网络的简短干预，并评估其对英语和西班牙语的罪犯，临床医生和AEP计划的可行性和可接受性。 AIM 2。进行试验随机试验，将通常的AEP护理与两种短暂干预（IP-BI和WB-BI）与第一次DUI罪犯进行比较，以减少酒精消耗和危险饮酒。创新。拟议的工作具有创新性，因为它评估了一项经过验证的干预措施（BIS）（第一次DUI罪犯），并比较了替代输送系统（WB和IP）的差异有效性。评估BIS对西班牙语DUI人群的有效性也是创新的。通过评估网络的使用来提供干预措施，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。该研究领域将从两年的启动基金中受益匪浅。通过这些资金，我们可以开发WB-BI和试点测试WB-BI和IP-BI相对于通常的护理的差异功效，以准备更大的疗效试验。这项研究符合《美国恢复与再投资法》的目标。它填补了研究领域的显着知识差距，可能有助于可能受到经济衰退的高度影响的人口，因为研究表明，个人正在使用酒精来应对压力大的经济环境。