Improving brief alcohol interventions with a behavioral economic supplement

描述（由申请人提供）：针对青少年酒精滥用的简短动机干预（bmi）是最具成本效益的预防保健措施之一，然而，旨在提高其功效和确定变化机制的基于理论的研究相对较少。研究表明，低水平的无物质强化是BMI反应不良的一个危险因素，该研究团队开发并试点测试了传统反馈和基于mi的酒精干预的补充课程。本次会议直接针对无物质强化和延迟奖励折扣的行为经济机制，鼓励对学术和职业目标的发展和承诺，并强调酗酒和学术参与的日常模式对这些目标的影响。一项试点试验（R21AA016304）发现，相对于两次（酒精BMI +放松）主动控制条件，两次（酒精BMI +无物质活动）干预导致酒精问题的显著减少（p = 0.01, db= 0.52）。对于基线无物质强化水平较低的参与者，BMI + SFAS也与大量饮酒的显著减少有关。这是第一个证明补充传统bmi可以改善结果的对照研究。目前的建议将在随机3组（BMI + SFAS vs BMI +放松训练vs仅评估）试验中改进和更广泛地评估SFAS的有效性，试验对象为425名一年级和二年级大学生（预计50%为女性，20%为少数民族），这些学生来自两所大型公立大学，他们报告最近大量饮酒。结果将确定SFAS是否在控制总接触时间的情况下增强了标准BMI的功效。将在干预后1、4、12和16个月评估饮酒和无物质活动的结果。假设在随访中，BMI + SFAS参与者报告的饮酒和酒精相关问题水平明显低于BMI +放松和仅评估的参与者，并且BMI + SFAS的预测优势将通过增加参与无物质活动和减少延迟折扣来调节。进一步假设BMI + SFAS干预将更有效

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.