RCT OF WEB VS. IN-PERSON SUD AND COMORBIDITY TREATMENT

描述（由申请人提供）：当前研究的广泛，长期目标是通过开发有效且具有成本效益的指示预防/早期干预技术，减少人群中无序赌博和共病物质使用障碍的患病率和相关危害。虽然许多人把赌博作为一种偶尔的娱乐形式，但仍有相当一部分人因赌博而受到实质性伤害。赌博被描述为一种行为成瘾，与物质使用障碍（SUD）具有相当大的神经生物学和症状相似性。此外，无序赌博与非常高的酒精和药物（AOD）使用率和SUD合并症有关。赌博已经被概念化为一个连续体，从无赌博和无问题赌博，到有风险的赌博，再到可诊断的病态赌博。据估计，美国成年人中有3-5%患有赌博紊乱（高危和病态），其中年轻人（大学年龄）的比例更高。赌博紊乱会给赌徒和社会带来一系列严重后果，包括经济、法律、社会、家庭和工作/教育困难，以及焦虑、抑郁和自杀意念和行为的发生率升高。这些发现使人们越来越认识到，无序赌博是一个重大的公共卫生问题。目前的研究建立在我们之前的工作基础上，开发了针对无序赌博的指示性预防方法（R21 MH067026）。我们的研究结果表明，一个简短的，个性化的反馈干预（PFI）利用图形反馈和动机增强策略是有效的减少赌博和相关后果的弱势群体（大学生）有风险或已经证明病态赌博。基于这些令人鼓舞的发现，我们建议评估这种方法的长期疗效，并确定网络和面对面实施PFI干预的相对疗效，用于患有合并sud的高风险赌徒。具体目标是：1)评估面对面与基于网络的pfi在减少赌博行为、AOD使用和相关后果方面的相对效果，与仅进行评估相比。被筛选为患有SUD的高风险赌徒的参与者（N=375）将被随机分配到以下三种情况之一：a)亲自动机性PFI；b)基于网络的PFI；或c)重复评估对照组，分别在干预后、3个月、6个月、12个月和24个月随访时进行评估。2)评估干预选择、赌博动机和物质使用作为疗效调节因子。3)评估干预效果的中介因素，包括感知描述性赌博规范、改变准备、控制幻觉和信息处理深度。

DESCRIPTION (provided by applicant): The broad, long-term objective of the current research is to reduce the prevalence of disordered gambling and co-morbid substance use disorders and related harm in the population, through development of efficacious and cost-effective indicated prevention/early intervention techniques. While many individuals gamble as an occasional form of entertainment, a significant subset of the population experiences substantive harm related to their gambling. Gambling has been described as a behavioral addiction, with considerable neurobiological and symptom similarity to substance use disorders (SUD). Further, disordered gambling is associated with very high rates of alcohol and drug (AOD) use and SUD co-morbidity. Gambling has been conceptualized as a continuum, from no gambling and non-problem gambling, to at-risk gambling, to diagnosable pathological gambling. Disordered gambling (at-risk and pathological) is estimated to affect 3-5% of the U. S. adult population, with higher rates often reported in young adult (college aged) populations. Disordered gambling has been associated with a host of serious consequences for the gambler and society, including financial, legal, social, familial, and work/educational difficulties as well as elevated rates of anxiety, depression, and suicidal ideation and behavior. These findings have lead to an increasing recognition of disordered gambling as a significant public health problem. The current research builds on our prior work on development of indicated prevention approaches for disordered gambling (R21 MH067026). Our findings indicate a brief, personalized feedback intervention (PFI) utilizing graphic feedback and motivational enhancement strategies is efficacious in reducing gambling and related consequences in a vulnerable population (college students) at risk for or already evidencing pathological gambling. Based on these encouraging findings, we propose to evaluate the longer-term efficacy of this approach, and determine relative efficacy of web- and in-person implementation of PFI interventions, for at-risk gamblers with co-morbid SUDs. Specific aims are: 1) Evaluate relative efficacy of in-person vs. web-based PFIs in comparison to assessment only, in reducing gambling behavior, AOD use, and related consequences of at-risk college student gamblers with SUDs. Participants (N=375) screened as at- risk gamblers with SUD will be randomly assigned to one of 3 conditions: a) in-person motivational PFI; b) web-based PFI; or c) repeated assessment comparison group, assessed at post-intervention, 3-, 6-, 12-, and 24-month follow-up. 2) Evaluate choice of intervention, gambling motives, and substance use as moderators of efficacy. 3) Evaluate mediators of intervention efficacy, including perceived descriptive gambling norms, readiness to change, illusions of control, and depth of processing of information. PUBLIC HEALTH RELEVANCE: Disordered gambling has been associated with a host of serious consequences for the gambler and society, including financial, legal, social, familial, and work/educational difficulties as well as elevated rates of substance use disorders, anxiety, depression, and suicidal ideation and behavior. These findings have lead to an increasing recognition of disordered gambling as a significant public health problem. Development of efficacious indicated prevention for disordered gamblers with co-morbid substance use disorders would result in important public health benefit.