Recovery: Varieties and Dimensions

描述（由申请人提供）：酒精研究人员越来越认识到了解恢复过程的重要性。这种远离精神病理学的范式转变将注意力集中在个人如何摆脱酒精问题上，包括什么启动和支持恢复，从而提供有关个人如何改善与如何恶化的信息。研究和临床经验表明，恢复是一个过程，而不是一个终点，并且在关键生活领域（如精神，身体，社会关系，精神/存在幸福感，亲社会行为和生产力）的改善速度和时间方面存在显着的个体差异，以及减少（如果不是消除）饮酒和吸毒。更清楚地了解恢复过程，包括启动和帮助维持它的因素，以及非饮酒特征的时间变化，对更有针对性的连续护理具有重要意义。它还可以为物质使用者及其家庭以及服务提供者和其他利益攸关方提供现实的期望。拟议的研究利用现有的NIH资助的前瞻性数据集，通过对该样本恢复经验的定量和定性数据的二次分析来研究这些问题。参与者是每6个月进行一次调查的酗酒者，为期30-36个月，作为先前赠款的一部分（R 01 AA 014442）。根据两套恢复/缓解标准-贝蒂福特研究所共识小组（2007年，2009年）和DSM-IV，他们将通过研究多年来的饮酒模式来表征。对于这些组中的每一个，我们将调查：（1）由这些标准定义的不同组的特征，它们在组分配中的一致性，以及恢复维度的变化程度（即，心理、身体、社会、存在和亲社会健康），（2）恢复的关键维度（例如，精神、身体、社会和职业健康、精神/存在幸福感），通过确定每个组这些维度的时间轨迹;以及（3）启动和维持恢复的环境和行为，包括识别特定事件（例如，后果，量子变化），引发禁欲的努力。调查结果将是有益的，在开发和评估的恢复为导向的服务和支持，因为它通知一个连续的护理模式，是一致的物质使用障碍作为慢性疾病的流行概念。调查结果还将告知政策，服务发展和资金，通过发言的需要，积极和前物质依赖者。最后，这项研究将有助于填补关于促进启动和维持恢复的因素的知识空白。 公共卫生相关性：虽然药物滥用治疗领域正在向恢复范式转变（见最近的SAMHSA指南，CSAT，2007），但我们对伴随禁欲事件增加的恢复维度变化的性质和时间的理解是不完整的。更深入地了解心理和身体健康，社会关系，精神/存在健康，亲社会行为和生产力的变化，可以为支持恢复的干预措施的制定提供信息。拟议的研究旨在通过对R 01数据集的二次分析来调查恢复维度变化的性质和时间，R 01数据集提供了285名酗酒者为期2年半至3年的前瞻性定量和定性数据。

DESCRIPTION (provided by applicant): Alcohol researchers are increasingly recognizing the importance of understanding the process of recovery. This paradigm shift away from psychopathology focuses attention on how individuals move away from alcohol problems, including what initiates and supports recovery, thereby providing information on how individuals improve versus how they deteriorate. Research and clinical experience indicates that recovery is a process, not an endpoint, and that there are significant individual differences in the rate and timing of improvement in key life domains such as mental, physical, social relationships, spiritual/existential well-being, pro-social behaviors, and productivity, as well as reduction, if not elimination, of drinking and drug use. A clearer understanding of the recovery process including factors that initiate and help sustain it, as well as temporal changes in non-drinking characteristics, has significant implications for a more targeted continuum of care. It can also provide realistic expectations to substance users and their families, as well as service providers and other stakeholders. The proposed study capitalizes on an existing NIH-funded prospective dataset to examine these issues through secondary analyses of both quantitative and qualitative data on the recovery experiences of this sample. Participants were alcoholics surveyed every 6 months for 30-36 months as part of a previous grant (R01AA014442). They will be characterized by their drinking patterns over the years of the study according to two sets of criteria for recovery/remission - the Betty Ford Institute Consensus Panel (2007, 2009) and DSM-IV. For each of these groups, we will investigate: (1) the characteristics of the different groups defined by these criteria, the agreement among them in group assignment, and the degree of change in dimensions of recovery (i.e., mental, physical, social, existential, and prosocial health) from baseline to final interview, (2) the degree and timing of prospective changes (positive or negative) in key dimensions of recovery (e.g., mental, physical, social and occupational health, spiritual/existential well-being) by determining for each group the trajectory across time of these dimensions; and (3) the circumstances and behaviors that initiate and sustain recovery, including identifying specific events (e.g., consequences, quantum change) that trigger abstinence efforts. Findings will be useful in the development and evaluation of recovery-oriented services and supports, as it informs a continuum of care model that is consistent with prevalent conceptualizations of substance use disorders as chronic disorders. Findings will also inform policy, service development and funding by speaking to the needs of active and former substance dependent persons. Finally, the study will contribute to filling knowledge gaps about factors that promote the initiation and maintenance of recovery. PUBLIC HEALTH RELEVANCE: Although the field of substance abuse treatment is shifting toward a recovery paradigm (see recent SAMHSA guidelines, CSAT, 2007), our understanding is incomplete on the nature and timing of changes in the dimensions of recovery that accompany increased episodes of abstinence. Deeper knowledge of changes in mental and physical health, social relationships, spiritual/existential health, pro-social behaviors, and productivity, can inform the development of interventions that support recovery. The proposed research intends to investigate the nature and timing of change in dimensions of recovery through a secondary analysis of an R01 dataset, which provides 2 1/2 to 3 years of prospective quantitative and qualitative data on 285 alcoholics.