Recovery Adherence Therapy for Bipolar Alcoholics

描述(由申请人提供)：我们建议对酒精中毒和双相情感障碍的双重障碍的早期康复进行调整、完善和试点测试基于动机的坚持治疗模式。这项建议涉及计划公告中确定的主要感兴趣的领域，即开发和评估专门的行为干预措施，以促进共病患者参与、保留和坚持治疗。酒精中毒和双相情感障碍并存的现象非常普遍。共病的存在对治疗依从性、治疗反应和病程具有显著的负面影响，并增加了自杀和双相情感障碍复发的风险。尽管最近对酒精中毒的精神共病问题给予了更多的关注，但令人惊讶的是，关于这种复杂形式的共病的研究很少，特别是关于有效的治疗方法。目前还没有针对酗酒和共病双相情感障碍患者量身定做的个人心理治疗干预措施。我们建议的干预是基于治疗模式，强调将心理社会和药物治疗干预整合在同理心和动机知情的范式中。我们提出了以下三个具体目标：1)开发和完善一种基于理论和程序上特定的个体依从性治疗干预措施，用于早期康复期间共发生的酒精使用和双相情感障碍。2)制定标准化的程序、方法和技术，以便以高度的保真度和能力提供治疗。3)采用随机、平行分组设计进行先导性疗效研究，将这种新的干预措施与目前的常规临床护理照常治疗(TAU)进行比较。我们建议在所请求的三年支助中分三个阶段实现上述目标。在第一阶段，我们将开发、实施并通过协作、专家评审持续改进治疗方案，将建议的疗法应用于8个病例。在第二阶段，我们将就另外8个病例培训两名新的治疗师，并最终完成治疗手册。在第三阶段，我们将通过对32名受试者(每组16名)进行随机、平行分组试点疗效研究，将我们的方案与常规治疗(TAU)条件进行比较，初步测试我们方案的有效性。

DESCRIPTION (provided by applicant): We propose to adapt, refine, and pilot-test a motivationally based model of adherence therapy for the dual disorders of alcoholism and bipolar disorder in early recovery. This proposal pertains to the major areas of interest identified in the Program Announcement, namely the development and evaluation of specialized behavioral interventions for the engagement, retention, and adherence of comorbid patients in treatment. Comorbid alcoholism and bipolar disorder is highly prevalent. The presence of comorbidity has a significant negative impact on treatment adherence, treatment response, and course of illness with heightened risk for suicide, recurrence of bipolar illness. Despite the substantial recent increased attention to the problem of psychiatric comorbidity with alcoholism, surprisingly little research has been conducted on this complex form of comorbidity, especially in regard to effective treatment approaches. There are no existing individual psychotherapeutic interventions that are tailored to patients with alcoholism and comorbid bipolar disorder. Our proposed intervention is based on treatment models that emphasize integrating psychosocial and pharmacotherapeutic interventions in an empathic and motivationally informed paradigm. We propose the following three specific aims: 1) To develop and refine a theoretically based and procedurally specified individual adherence therapy intervention for co-occurring alcohol use and bipolar disorder in early recovery. 2) To develop standardized procedures, methods, and techniques so that treatment is delivered with a high degree of fidelity and competence. And 3) To conduct a pilot-efficacy study with randomized, parallel-group design comparing this new intervention with current regular clinical care standardized as Treatment as Usual (TAU). We propose to achieve the above aims in three stages over three years of requested support. During Stage 1 we will develop, implement, and continuously refine the treatment protocol by collaborative, expert review by applying the proposed therapy to 8 cases. During Stage 2 we will train two new therapists on 8 additional cases, and finalize the treatment manual. During Stage 3 we will pilot-test the efficacy of our protocol as compared to the Treatment as Usual (TAU) condition by conducting a randomized, parallel group pilot-efficacy study of 32 subjects (16 in each group).