METHODOLOGY FOR DEVELOPING ADAPTIVE INTERVENTIONS

该项目的长期目标是，通过促进以证据为基础的药物滥用有效、适应性预防干预和治疗措施的构建，改善临床实践，从而改善公共卫生。临床医生自然会根据患者的结果调整治疗的水平和类型，如严重程度、对过去治疗的反应、风险、压力源、依从性、偏好和负担。该项目将开发方法来告知和加强这种适应性临床实践。适应性干预由可操作的决策规则组成，这些规则输入患者的结果，输出建议的强度和/或治疗类型的改变。适应性干预措施的构建需要解决以下问题：

The long-term goal of this project is to improve clinical practice and thus public health by facilitating the evidence-based construction of efficacious, adaptive preventive interventions and treatments in drug abuse. Clinicians naturally adapt the level and type of therapy according to patient outcomes such as severity, response to past therapy, risk, stressors, adherence, preference and burden. This project will develop methods for informing and enhancing this adaptive clinical practice. Adaptive interventions are composed of operationalized decision rules that input patient outcomes and output recommended alterations in intensity and/or type of therapy. The construction of adaptive interventions requires addressing questions such as, "How do we best use measures of risk and other outcomes in order to decide when a patient's therapy needs to be intensified or stepped down?". "What sequence of therapies is best for achieving maximal improvement or preventing drug dependence?" and "Should this sequence of therapies vary by patient outcomes?" This project facilitates the construction of adaptive interventions by developing the following methodological innovations. First, practical experimental designs that will yield data most useful in constructing evidence-based adaptive interventions will be developed. Second, this project will improve and evaluate analysis methods that can be used with subject data in which either or both the timing of therapeutic changes and therapy alterations are randomized. These methods can be used to construct the decision rules that comprise an adaptive intervention. Third, this project will provide methods that can be used with subject data in which the timing of therapeutic changes and therapy alterations were made according to decision rules. This third group of methods can be used to assess the utility of the decision rules comprising an implemented adaptive intervention. To ensure applicability and receive feedback this work will include collaborative research with health scientists interested in constructing adaptive interventions. The goal is to accelerate the improvement of both prevention programs and treatments. Because drug abuse and dependence are costly to society, the broader public benefits from improved prevention programs aimed at reducing drug abuse and from improved treatment for drug dependent individuals.