RCT OF WEB VS. IN-PERSON SUD AND COMORBIDITY TREATMENT

描述（由申请人提供）：当前研究的广泛、长期目标是通过开发有效且具有成本效益的预防/早期干预技术，降低人群中赌博障碍和共病药物使用障碍的患病率及相关危害。虽然许多人赌博作为一种偶尔的娱乐形式，但相当一部分人经历了与赌博有关的实质性伤害。赌博被描述为一种行为成瘾，与物质使用障碍（SUD）具有相当大的神经生物学和症状相似性。此外，赌博障碍与酒精和药物（AOD）使用率非常高以及SUD合并症相关。赌博已被概念化为一个连续体，从没有赌博和非问题赌博，到有风险的赌博，再到可诊断的病理性赌博。据估计，赌博紊乱（高危和病态）影响了美国3-5%的人口。S.成年人，年轻人（大学年龄）的发病率往往更高。无序的赌博与赌徒和社会的一系列严重后果有关，包括财务，法律的，社会，家庭和工作/教育困难以及焦虑，抑郁和自杀意念和行为的增加率。这些发现导致越来越多的人认识到赌博紊乱是一个重大的公共卫生问题。目前的研究建立在我们先前关于制定赌博障碍的预防方法的工作基础上（R21 MH 067026）。我们的研究结果表明，一个简短的，个性化的反馈干预（PFI）利用图形反馈和动机增强策略是有效的，在减少赌博和相关后果的弱势群体（大学生）的风险或已经证明病态赌博。基于这些令人鼓舞的研究结果，我们建议评估这种方法的长期疗效，并确定网络和个人实施PFI干预措施的相对疗效，为有共同病态SUD的高危赌徒。具体目标是：1）评估与仅评估相比，面对面与基于网络的PFI在减少赌博行为，AOD使用以及有SUD风险的大学生赌徒的相关后果方面的相对功效。被筛选为SUD高危赌徒的参与者（N=375）将被随机分配到3个条件之一：a）面对面激励PFI; B）基于网络的PFI;或c）重复评估比较组，在干预后、3个月、6个月、12个月和24个月随访时进行评估。2)评估干预措施的选择，赌博的动机，和物质使用作为疗效的调节剂。3)评估干预效果的中介，包括感知描述性赌博规范，准备改变，控制的幻想，和信息处理的深度。

DESCRIPTION (provided by applicant): The broad, long-term objective of the current research is to reduce the prevalence of disordered gambling and co-morbid substance use disorders and related harm in the population, through development of efficacious and cost-effective indicated prevention/early intervention techniques. While many individuals gamble as an occasional form of entertainment, a significant subset of the population experiences substantive harm related to their gambling. Gambling has been described as a behavioral addiction, with considerable neurobiological and symptom similarity to substance use disorders (SUD). Further, disordered gambling is associated with very high rates of alcohol and drug (AOD) use and SUD co-morbidity. Gambling has been conceptualized as a continuum, from no gambling and non-problem gambling, to at-risk gambling, to diagnosable pathological gambling. Disordered gambling (at-risk and pathological) is estimated to affect 3-5% of the U. S. adult population, with higher rates often reported in young adult (college aged) populations. Disordered gambling has been associated with a host of serious consequences for the gambler and society, including financial, legal, social, familial, and work/educational difficulties as well as elevated rates of anxiety, depression, and suicidal ideation and behavior. These findings have lead to an increasing recognition of disordered gambling as a significant public health problem. The current research builds on our prior work on development of indicated prevention approaches for disordered gambling (R21 MH067026). Our findings indicate a brief, personalized feedback intervention (PFI) utilizing graphic feedback and motivational enhancement strategies is efficacious in reducing gambling and related consequences in a vulnerable population (college students) at risk for or already evidencing pathological gambling. Based on these encouraging findings, we propose to evaluate the longer-term efficacy of this approach, and determine relative efficacy of web- and in-person implementation of PFI interventions, for at-risk gamblers with co-morbid SUDs. Specific aims are: 1) Evaluate relative efficacy of in-person vs. web-based PFIs in comparison to assessment only, in reducing gambling behavior, AOD use, and related consequences of at-risk college student gamblers with SUDs. Participants (N=375) screened as at- risk gamblers with SUD will be randomly assigned to one of 3 conditions: a) in-person motivational PFI; b) web-based PFI; or c) repeated assessment comparison group, assessed at post-intervention, 3-, 6-, 12-, and 24-month follow-up. 2) Evaluate choice of intervention, gambling motives, and substance use as moderators of efficacy. 3) Evaluate mediators of intervention efficacy, including perceived descriptive gambling norms, readiness to change, illusions of control, and depth of processing of information.