Recovery: Varieties and Dimensions

描述(由申请者提供)：酒精研究人员越来越认识到了解康复过程的重要性。这种从精神病理学的范式转变关注个人如何摆脱酒精问题，包括什么启动和支持康复，从而提供关于个人如何改善和如何恶化的信息。研究和临床经验表明，康复是一个过程，而不是终点，在精神、身体、社会关系、精神/生存福祉、亲社会行为和生产力等关键生活领域的改善速度和时间上存在显著的个体差异，以及减少(如果不是消除)饮酒和吸毒。更清楚地了解康复过程，包括启动和帮助维持康复过程的因素，以及不饮酒特征的临时变化，对于更有针对性的连续护理具有重要意义。它还可以向物质使用者及其家人以及服务提供者和其他利益攸关方提供现实的期望。这项拟议的研究利用了现有的由美国国立卫生研究院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检查这些问题。参与者是每6个月接受一次调查的酗酒者，持续30-36个月，作为先前资助(R01AA014442)的一部分。他们将根据两套康复/缓解标准--贝蒂福特研究所共识小组(2007、2009)和DSM-IV--在研究期间的饮酒模式来表征他们的特征。对于这些群体中的每一个，我们将调查：(1)这些标准定义的不同群体的特征，他们在小组分配中的一致性，以及从基线到最终访谈在恢复维度(即，心理、身体、社会、生存和亲社会健康)方面的变化程度，(2)通过确定每个群体这些维度的时间轨迹，在恢复的关键维度(例如，心理、身体、社会和职业健康、精神/生存幸福)方面的预期变化(积极或消极)的程度和时间；以及(3)启动和维持康复的环境和行为，包括确定触发禁欲努力的特定事件(例如，后果、量的变化)。调查结果将有助于制定和评价以康复为导向的服务和支助，因为它提供了一种与普遍将物质使用障碍视为慢性病的概念相一致的连续护理模式。调查结果还将为政策、服务发展和筹资提供信息，以满足在职和曾经的药物依赖者的需求。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。 与公共卫生相关：尽管药物滥用治疗领域正在向康复范式转变(见最近的SAMHSA指南，CSAT，2007年)，但我们对随着戒毒事件增加而发生的康复方面变化的性质和时机的理解是不完整的。更深入地了解心理和身体健康、社会关系、精神/生存健康、亲社会行为和生产力方面的变化，可以为支持康复的干预措施的发展提供信息。这项拟议的研究旨在通过对R01数据集的二次分析来调查康复维度变化的性质和时间，R01数据集提供了285名酗酒者两年半至三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.