Testing CBT models and change mechanisms for Alcohol Dependent Women

描述（由申请人提供）：这是申请1 R01 AA017163-01的第一次修订，“测试酒精依赖妇女的CBT模型和改变机制”，最初提交于02/07年。拟议研究的总体目标是为患有酒精使用障碍的妇女制定具有经验支持和成本效益的治疗模式。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空白，包括a.对酒精依赖妇女的研究和理解有限，b.对哪些变化机制使酒精治疗有效以帮助患者减少饮酒和保持清醒的理解有限，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式。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最近的几个重点是一致的，包括社区友好型卫生服务研究（例如，NIDA， 2002年，2003年），服务不足人群（即妇女）（Longabaugh和Wirtz， 2001年），以及关注治疗过程变化背后的机制（NIAAA, 2006a）。本研究有4个具体目的：(1)修改现有的女性个体特定认知行为疗法（I -FSCBT）方法，以群体形式治疗女性酒精依赖（GFSCBT）；(2)检验个体与群体FSCBT的相对效果；(3)测试两种治疗方法共同的饮酒改变的假设机制，包括(a)应对技能和增强的戒酒自我效能；(b)自主意识增强；(c)减轻负面影响，(d)增加社会网络对戒断的支持，(4)评估个人和团体治疗的相对成本效益。来完成

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.