Improving brief alcohol interventions with a behavioral economic supplement

描述(由申请人提供)：针对青少年酗酒的简短动机干预(BMI)是最具成本效益的预防保健措施之一，但旨在提高其有效性和确定变化机制的基于理论的研究相对较少。根据研究表明，低水平的无物质强化是BMI反应差的风险因素，该研究团队开发并试点测试了传统反馈和基于MI的酒精干预的补充会议。本课程直接针对无物质强化和延迟奖励折扣的行为经济学机制，通过鼓励发展和致力于学业和职业目标，并通过和强调日常酗酒和学术投入模式对这些目标的影响。一项试点试验(R21AA016304)发现，与两次(酒精BMI+放松)主动控制条件相比，两次干预(酒精BMI+无物质活动会话；SFAS)显著减少了酒精问题(p=.01，db=.52)。BMI+SFAS还与基线水平无物质强化水平较低的参与者大量饮酒的显著减少有关。这是第一项证明补充传统BMI可以改善结果的对照研究。目前的建议将改善和更广泛地评估SFAS的有效性，这是一项随机的3组试验(BMI+SFAS与BMI+放松训练与仅限评估)，试验对象为425名一年级和二年级的大学生(预计50%为女性，20%为少数民族)，他们报告最近从两所大型公立大学招募的酗酒者。结果将决定SFAS是否在控制总接触时间的同时增强标准BMI的功效。饮酒和无物质活动的结果将在干预后1、4、12和16个月进行评估。据假设，在后续的研究中，BMI+SFAS参与者的饮酒和酒精相关问题的水平将显著低于BMI+放松和仅进行评估的参与者，而建设性无物质活动的水平将显著高于BMI+放松和评估参与者，并且BMI+SFAS的预期优势将通过更多地参与无物质活动和减少延迟折扣来实现。进一步假设，BMI+SFAS干预将对 那些报告高基线酒精强化效果的参与者(使用需求曲线和比例物质相关的强化措施来衡量)，以及比那些报告低强化效果和延迟奖励折扣的参与者更多的延迟奖励折扣。这项研究还将评估与积极控制条件相关的BMI+SFAS干预的经济成本和收益。如果这种行为经济学补充显示出有效性和成本效益，那么临床医生将拥有一种更有效的方式来尝试减少年轻成年饮酒者的酒精使用，管理人员将有经济理由在他们的大学采用这种干预措施。

DESCRIPTION (provided by applicant): Brief motivational interventions (BMIs) for young adult alcohol abuse are among the most cost-effective preventive care measures, yet there has been relatively little theory-based research aimed at improving their efficacy and identifying mechanisms of change. Based on research indicating that low-levels of substance-free reinforcement is a risk factor for poor BMI response, this research team developed and pilot tested a supplemental session to traditional feedback and MI-based alcohol interventions. This session directly targets the behavioral economic mechanisms of substance-free reinforcement and delayed reward discounting by encouraging the development of and commitment to academic and career goals, and by and highlighting the impact of day-to-day patterns of heavy drinking and academic engagement on these goals. A pilot trial (R21AA016304) found that a two session (alcohol BMI + Substance-Free Activity Session; SFAS) intervention resulted in significantly greater reductions in alcohol problems (p = .01, db= .52) relative to a two session (alcohol BMI + Relaxation) active control condition. The BMI + SFAS was also associated with significantly greater reductions in heavy drinking for participants with lower levels of substance-free reinforcement at baseline. This was the first controlled study to demonstrate that a supplement to traditional BMIs can improve outcomes. The current proposal would improve and more extensively evaluate the efficacy of the SFAS in a randomized 3-group (BMI + SFAS vs. BMI + Relaxation Training vs. Assessment only) trial with 425 first and second year college students (projected 50% female and 20% minority) who report recent heavy drinking recruited from two large public universities. The results will determine whether the SFAS enhances the efficacy of a standard BMI while controlling for total contact time. Drinking and substance-free activity outcomes will be assessed 1, 4, 12 and 16 months post-intervention. It is hypothesized that at follow-up BMI + SFAS participants will report significantly lower levels of drinking and alcohol-related problems, and higher levels of constructive substance-free activities, than BMI + Relaxation and assessment only participants, and that the predicted advantage for BMI + SFAS will be mediated by increased participation in substance-free activities and reduced delay discounting. It is further hypothesized that the BMI + SFAS intervention will be more effective for participants who report high baseline alcohol reinforcing efficacy (measured using demand curve and proportional substance-related reinforcement measures) and greater delayed reward discounting than those who report low reinforcing efficacy and delayed reward discounting. This study will also evaluate the economic costs and benefits associated with the BMI + SFAS intervention relative to an active control condition. Should this behavioral economic supplement demonstrate efficacy and cost-effectiveness then clinicians would have a more effective modality for attempting to reduce alcohol use in young adult drinkers, and administrators would have an economic rationale for adopting the intervention in their universities.