Testing CBT models and change mechanisms for Alcohol Dependent Women

描述（由申请人提供）：这是最初于2007年2月提交的申请1 R 01 AA 017163 -01“酒精依赖女性的CBT模型和变化机制测试”的首次修订。拟议研究的总体目标是为酒精使用障碍的女性开发经验支持和具有成本效益的治疗模式。这项拟议的研究将解决科学文献和治疗酒精问题的临床选择中的三个差距，包括：对酒精依赖妇女的研究和了解有限，B.对什么样的变化机制使酒精治疗有助于患者减少饮酒和保持清醒的理解有限，以及c.缺乏临床研究来开发和测试酒精使用障碍的成本效益团体治疗模式。该提案是对PA-07-066“酒精使用障碍：治疗、服务研究和恢复”的回应，并与NIH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，2002，2003），服务不足的人群（即妇女）（Longabaugh和维尔茨，2001），以及关注治疗变化过程的机制（NIAAA，2006 a）。本研究有四个具体目的：（1）改进我们现有的个别女性特定认知行为疗法（2）检验个体和群体FSCBT的相对疗效;和（3）为了测试两种治疗方法共同的饮酒变化的假设机制，包括（a）应对技巧和增强的自我效能;（B）增强的自主意识;（c）减轻负面影响;（d）增加社会网络对禁欲的支持;（4）评估个人和团体治疗的相对成本效益。完成 为了达到这些具体目标，我们将通过报纸广告和社区外展活动招募200名酒精依赖妇女到我们的门诊诊所。参与者将完成基线评估，然后将被随机分配到12个每周一次的门诊手动指导的个人或团体FSCBT会议。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例个体病例。这两种治疗条件将集中在认知行为上，并专门针对女性进行调整。小组和个人治疗都将以禁欲为基础，包括动机增强、应对技能培训、负面影响管理、在社交网络中管理酗酒者的技能、预防复发和与自主权有关的主题。将在治疗期间对参与者进行评估，以跟踪拟议中介变量和结局变量的时间变化。参与者将在基线后3个月、9个月和15个月完成亲自随访评估，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，有效和负担得起的集体治疗模式，以治疗酒精依赖的妇女的基础上，了解如何和为什么治疗工程，将加强保健服务，并有助于减少酗酒的个人和社会后果。

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.