Longitudinal Study of Mechanisms of Drug Abuse Recovery-Pilot

描述(由申请人提供)：我们的目标是确定影响非临床人群药物使用障碍过程的主要因素。大多数有药物障碍的人没有进入正式的治疗系统；尽管如此，仍有一些人实现了“自然康复”。像NA/CA这样的互助小组可能很重要，但社会支持、社会资源、共病精神病和应激事件也可能有影响。虽然关于自然恢复的研究越来越多，但大多数研究都是横向或纵向的，两次评估之间的间隔很长。这样的设计很少告诉我们动态因素如何影响药物使用障碍的过程。对于其他精神障碍，随着时间的推移，对受试者进行密集跟踪的自然主义纵向研究提供了对这些障碍缓解或恶化的预测因素的见解，以及关于人们如何与医疗保健提供者互动(或经常无法互动)的大量数据。以类似的方式研究药物使用障碍的时机已经成熟。这一试点项目的目的是为设计一项更大和更长期的自然主义研究提供必要的关键数据。我们将从社区而不是诊所招募60名客户，并将对这些病例进行为期一年的密集跟踪。我们将使用从成功的轴心I障碍纵向研究中改编的工具来动态跟踪精神状态、生活事件和治疗。我们将使用标准的时间线测量来动态记录药物结果；其他需要测量的潜在预测/中介因素包括与互助出勤和隶属关系、社会支持和资源、自我效能和动机相关的行为和态度。然而，高强度纵向研究的成功设计取决于诸如并存疾病的频率、缓解率、复发率和应激性事件以及治疗率等因素。这项试点研究的具体目的是测试招募和评估程序，并估计关键事件的比率，如恢复使用可卡因，以支持即将进行的研究的权力估计。因为纵向数据让我们有机会研究一段时间内的事件序列，它们提供了机会来测试关于互助和社会支持等变量作用机制的理论预测，这些信息可以帮助我们设计更好的治疗方法。此外，更好地了解导致社区中有毒品问题的人选择或不选择正式治疗支持和/或非正式支持系统的因素，可能会引导我们建立更好的系统来识别和帮助高危人群。因此，更好地了解在社区中运作的生物、心理和社会力量将有助于我们设计未来的干预系统，能够更好地针对高危人群进行预防性干预，并更好地量身定做，以利用可供个别患者使用的积极资源。 公共卫生相关性：大多数有资格被诊断为药物滥用或依赖的人并没有对这种情况使用专业治疗；尽管如此，许多人能够克服这种障碍，过上正常的生活。我们对人们如何在不求助于专业治疗的情况下获得缓解知之甚少；这些信息将有助于为药物使用障碍患者设计干预措施，利用他们带来的优势，并应对可能导致病情恶化的风险因素。这项研究代表了一个关于社区药物使用障碍康复和复发的研究计划的开始。

DESCRIPTION (provided by applicant): Our objective is to determine the major factors that influence the course of drug use disorders in non- clinical populations. The majority of people who have drug disorders do not enter the formal treatment system; nonetheless, a number achieve "natural recoveries." Mutual-help groups such as NA/CA may be important, but social support, social resources, comorbid psychopathology, and stressful events may also be influential. While there is an increasing body of research on natural recovery, most studies have been cross- sectional or longitudinal with long intervals between assessments. Such designs tell us little about how dynamic factors influence the course of drug use disorders. For other psychiatric disorders, naturalistic longitudinal studies in which subjects are followed intensively over time have provided insights into predictors of remission or exacerbation of these disorders, as well as a wealth of data on how people interact (or, often, fail to interact) with health care providers. The time is ripe for drug use disorders to be studied in a similar manner. The purpose of this pilot project is to provide key data necessary for the design of a larger and longer-term naturalistic study. We will recruit 60 clients from the community rather than from clinics, and will follow these cases intensively for one year. We will use instruments adapted from successful longitudinal studies of Axis I disorders to track psychiatric status, life events, and treatment dynamically. We will use standard timeline measures to record drug outcome dynamically; other potential predictors/mediators to be measured are behaviors and attitudes related to mutual-help attendance and affiliation, social support and resources, self-efficacy, and motivation. Successful design of a high-intensity longitudinal study, however, depends on factors such as frequency of comorbid disorders, rates of remission, relapse, and stressful events, and rates of treatment. The specific aims of this pilot study are to test recruitment and assessment procedures, and to estimate rates of key events such as return to use of cocaine to support power estimates for the study to come. Because longitudinal data give us an opportunity to study sequences of events over time, they provide opportunities to test theoretical predictions about the mechanisms of action of variables such as mutual help and social support, information that could help us design better treatments. Furthermore, a better understanding of the factors that lead people with drug problems in the community to choose, or not choose, formal treatment support and/or informal support systems, may lead us toward better systems for identifying and aiding persons at high risk. Thus, an improved understanding of the biological, psychological, and social forces operating in the community will help us design future intervention systems that can better target persons at high risk for preventive interventions, and be better tailored to take advantage of positive resources available to individual patients. PUBLIC HEALTH RELEVANCE: Most people who qualify for a drug abuse or dependence diagnosis do not use professional treatment for this condition; nonetheless, many are able to overcome the disorder and lead normal lives. We know very little about how people achieve remission without resorting to professional treatment; such information will be valuable in devising interventions for persons with drug use disorders that can take advantage of the strengths that people bring with them, and in coping with the risk factors that can lead to deterioration. This study represents the beginning of a research program on recovery and relapse in drug use disorders in the community.