Testing CBT models and change mechanisms for Alcohol Dependent Women

测试酒精依赖女性的 CBT 模型和变革机制

• 批准号: 8137311
• 负责人: Elizabeth Ellen Epstein
• 金额: $ 69.13万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8137311
• 关键词: Abstinence; Address; Advertisements; Affect; Alcohol abuse; Alcohol dependence; Alcoholic beverage heavy drinker; Alcoholism; Ambulatory Care Facilities; Behavioral; Clinical; Clinical Research; Cognitive; Cognitive Therapy; Communities; Community Outreach; Coping Skills; Female; Goals; Group Therapy; Health Services Research; Individual; Literature; Maintenance; Manuals; Mediator of activation protein; Modeling; National Institute of Drug Abuse; National Institute on Alcohol Abuse and Alcoholism; Newspapers; Outcome; Outpatients; Participant; Patients; Persons; Process; Public Health; Randomized; Recovery; Recruitment Activity; Relative (related person); Research; Running; Self Efficacy; Social Network; Social support; Testing; Underserved Population; United States National Institutes of Health; Woman; Work; alcohol abuse therapy; alcohol use disorder; base; cost effective; cost effectiveness; disorder later incidence prevention; drinking; follow up assessment; health care delivery; response; skills; skills training; sobriety

DESCRIPTION (provided by applicant): This is a first revision of application 1 R01 AA017163-01, "Testing CBT Models and Change Mechanisms for Alcohol Dependent Women," originally submitted 02/07. The overall goal of the proposed research is to develop empirically supported and cost-effective models of treatment for women with alcohol use disorders. The proposed research will address three gaps in the scientific literature and clinical options for treatment of alcohol problems, including a. limited research on and understanding of alcohol dependent women, b. limited understanding of what change mechanisms make alcohol treatment work to help patients reduce drinking and maintain sobriety, and c. a dearth of clinical research to develop and test cost-effective group therapy models for alcohol use disorders. The proposal is in response to PA-07-066, "Alcohol Use Disorders: Treatment, Services Research, and Recovery," and is consistent with several recent emphases within NIH, including community-friendly health services research (e.g., NIDA, 2002, 2003), underserved populations (i.e. women) (Longabaugh & Wirtz, 2001), and a focus on the mechanisms that underlie the process of change in therapy (NIAAA, 2006a). The study has 4 specific aims: (1) To modify our existing Individual Female Specific Cognitive Behavioral Therapy (I -FSCBT) approach to treat women with alcohol dependence in a group format (GFSCBT); (2) To test the relative efficacy of Individual and Group FSCBT; and (3) To test hypothesized mechanisms of change in drinking that are common to both treatments, including (a) coping skills and enhanced self-efficacy for abstinence; (b) enhanced sense of autonomy; (c) alleviation of negative affect, and (d) increased social network support for abstinence, and (4) To assess the relative cost-effectiveness of the individual and group treatment. To accomplish these specific aims, 200 alcohol dependent women will be recruited via newspaper advertisement and community outreach to our outpatient clinic. The participants will complete baseline assessments, and then will be randomly assigned to 12 weekly outpatient manual guided sessions of either Individual or Group FSCBT. Recruitment will span 37 months, over which we will run 16 therapy groups each comprised of 6 women, and also treat 100 individual cases. Both treatment conditions will be cognitive-behavioral in focus and adapted specifically for women. Both the group and individual treatments will be abstinence based, and include motivational enhancement, coping skills training, management of negative affect, skills to manage heavy drinkers in the social network, relapse prevention and themes related to autonomy. Participants will be assessed during treatment to track temporal changes in proposed mediator and outcome variables. Participants will complete in-person follow up assessments at 3, 9, and 15 months post-baseline, to assess maintenance of gains. The proposed clinical research is directly relevant to public health. Ultimately, availability of effective and affordable group therapy models to treat alcohol dependent women based on an understanding of how and why the therapy works, will enhance health delivery services and help reduce the personal and societal consequences of alcoholism.

描述（由申请人提供）：这是申请 1 R01 AA017163-01“测试酒精依赖女性的 CBT 模型和改变机制”的第一次修订，最初于 02/07 提交。拟议研究的总体目标是为患有酒精使用障碍的女性开发经经验支持且具有成本效益的治疗模型。拟议的研究将解决酒精问题治疗的科学文献和临床选择中的三个空白，包括：对酒精依赖妇女的研究和了解有限，b．对酒精治疗能够帮助患者减少饮酒和保持清醒的改变机制了解有限，以及 c.缺乏临床研究来开发和测试具有成本效益的酒精使用障碍团体治疗模型。该提案是对 PA-07-066“酒精使用障碍：治疗、服务研究和康复”的回应，并且与 NIH 内最近的几个重点一致，包括社区友好型卫生服务研究（例如 NIDA，2002 年、2003 年）、服务不足的人群（即妇女）（Longabaugh 和 Wirtz，2001 年）以及对该过程背后的机制的关注治疗方法的改变 （NIAAA，2006a）。该研究有 4 个具体目标：(1) 修改我们现有的个体女性特定认知行为疗法 (I -FSCBT) 方法，以小组形式 (GFSCBT) 治疗患有酒精依赖的女性； (2) 测试个人和团体FSCBT的相对功效； (3) 测试两种治疗方法共有的假设的饮酒变化机制，包括 (a) 应对技巧和增强戒酒自我效能； (b) 增强自主意识； (c) 减轻负面影响，以及 (d) 增加对禁欲的社交网络支持，以及 (4) 评估个人和团体治疗的相对成本效益。为了完成 为了实现这些具体目标，我们将通过报纸广告和社区外展招募 200 名酗酒妇女到我们的门诊诊所。参与者将完成基线评估，然后被随机分配到每周 12 次门诊手动指导的个人或团体 FSCBT 课程。招募将持续 37 个月，在此期间我们将运行 16 个治疗组，每个治疗组由 6 名女性组成，并治疗 100 个个体病例。两种治疗条件都将以认知行为为重点，并专门针对女性进行调整。团体和个人治疗都将以戒酒为基础，包括动机增强、应对技能培训、负面情绪管理、社交网络中管理酗酒者的技能、预防旧病复发以及与自主性相关的主题。将在治疗期间对参与者进行评估，以跟踪拟议的中介变量和结果变量的时间变化。参与者将在基线后 3、9 和 15 个月完成面对面的后续评估，以评估收益的维持情况。拟议的临床研究与公共卫生直接相关。最终，在了解治疗如何以及为何发挥作用的基础上，提供有效且负担得起的团体治疗模式来治疗酒精依赖女性，将增强卫生服务，并有助于减少酗酒对个人和社会的影响。