INDIVIDUALIZED ASSESSMENT AND TREATMENT FOR ALCOHOL

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。尽管认知行为治疗（CBT）在物质使用障碍中很受欢迎，但最近的研究结果表明，CBT可能并不比其他理论驱动的治疗更有效，而且CBT治疗通常不能导致应对技能的习得。为了探索当前手工驱动的CBT交付模式是否足以成功地教授应对技能的可能性，我们提出了一个针对酒精依赖者的个性化评估和认知行为治疗项目（IATP）的试点项目，其中通过随机拨打手机进行经验抽样，为创建个性化治疗计划提供数据。在经验抽样期间收集的数据将包括对患者饮酒的认知、影响和应对行为的瞬间评估。参与者将是112名符合酒精依赖或酒精滥用标准的男性和女性，他们将被随机分配到一个标准包装的手册驱动的认知行为治疗项目（PCBT），就像在项目MATCH中使用的那样，或者是itp。接受两种治疗的患者将被要求在治疗前两周和治疗结束后两周进行经验抽样，以比较两组患者在治疗前和治疗后应对技能利用的体内测量值。治疗将在两种治疗中进行12个疗程。在IATP中，从经验抽样中收集的信息将构成监测期间患者饮酒和饮酒冲动功能分析的基础。认知评价、情绪和应对反应将被评估为饮酒行为的前因和后果。治疗师将利用这些信息来处理适应和不适应的特定认知、影响和行为，并将与患者一起采用适应性应对策略。在PCBT中，经验抽样数据不会专门用于治疗，但仍将提供体内饮酒和应对技能的测量。假设与PCBT相比，IATP能显著提高应对技能习得率，并且应对技能的改变能预测IATP治疗后的预后。这些结果将对我们的治疗提供和酒精成瘾应对技能培训的有效性产生影响。具体目的如下：确定个性化评估和治疗方案（IATP）是否比标准的打包认知行为治疗（PCBT）更能获得应对技能。H1：据推测，相对于PCBT， IATP会导致治疗前后应对技能使用的显著增加。2. 确定在IATP中应对技能习得对治疗结果的影响是否超过了预处理个体差异（即动机和自我效能感）的影响。H2：假设治疗前和治疗后应对技能的提高比治疗前的个体差异变量更能解释治疗后饮酒结果的差异。3. 为了确定基于体内患者监测功能分析的IATP是否在治疗后比PCBT H3产生更好的结果：假设IATP在治疗后比标准包装CB方法产生更好的饮酒结果。饮酒结果包括治疗期间戒酒天数的比例和重度饮酒天数的比例。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Despite the popularity of Cognitive-Behavioral Treatment (CBT) in substance use disorders, recent findings have indicated that CBT may be no more effective than other, less theoretically driven, treatments, and that CBT treatments often fail to result in coping skills acquisition. In order to explore the possibility that current manual-driven modes of CBT delivery may not be adequate to successfully teach coping skills, we are proposing a pilot project for the development of an individualized assessment and cognitive-behavioral treatment program (IATP) for alcohol-dependent persons, in which experience sampling conducted via random calls to cell-phones is used to provide data to create individualized treatment plans. Data collected during experience sampling will include momentary assessments of patients cognitions, affects, and coping behaviors with respect to drinking. Participants will be 112 men and women meeting criteria for alcohol dependence or alcohol abuse, who will be randomly assigned to either a standard packaged manual-driven cognitive-behavioral treatment program (PCBT) like that used in Project MATCH, or to IATP. Patients in both treatments will be asked to engage in experience sampling for two weeks prior to treatment, and for another two weeks after treatment has ended, in order to compare in-vivo measures of coping skills utilization, pre- and posttreatment, between the two groups. Therapy will be conducted over 12 sessions in both treatments. In IATP, the information gathered from experience sampling will form the basis of a functional analysis of patients' drinking and drinking urges during the monitoring period. Cognitive appraisals, moods and coping responses will be evaluated as antecedents and consequences of drinking behavior. Therapists will use the information to address specific cognitions, affects, and behaviors that are adaptive and maladaptive, and will work with the patient to substitute adaptive coping tactics instead. In PCBT the experience sampling data will not be specifically used in therapy, but will still provide in-vivo measures of drinking and coping skills. It is hypothesized that IATP will yield significantly better coping skills acquisition than will PCBT, and that change in coping skills will predict better posttreatment outcomes for IATP. These results would have implications for our delivery of treatment, and for the validity of coping skills training for alcohol addiction. Specific Aims are as follows: 1. To determine whether an Individualized Assessment and Treatment Program (IATP) results in greater acquisition of coping skills than does a standard Packaged Cognitive-Behavioral Treatment (PCBT). H1: It is hypothesized that IATP will result in significantly greater increases in reported use of coping skills from pre- to posttreatment relative to PCBT. 2. To determine if coping skills acquisition in IATP accounts for treatment outcome over and above the contribution made by pretreatment individual differences (i.e., motivation and self-efficacy). H2: It is hypothesized that pre- to posttreatment increases in coping skills in the IATP condition will account for more variance in drinking outcomes at posttreatment than will pretreatment individual difference variables. 3. To determine whether IATP, based on functional analysis of in-vivo patient monitoring, will yield better outcomes at posttreatment than will PCBT H3: It is hypothesized that IATP will yield better drinking outcomes at posttreatment than will the standard packaged CB approach. Drinking outcomes will include proportion days abstinent, and proportion heavy drinking days during the treatment period.