Testing CBT models and change mechanisms for Alcohol Dependent Women

这是应用程序1 R01 AA017163-01的第一个修订版，“测试CBT模型和 改变酒精依赖妇女的机制“，最初提交于2007年2月。 拟议研究的目标是开发有经验支持的、具有成本效益的 女性酒精使用障碍的治疗。这项拟议的研究将解决三个差距 在科学文献和治疗酒精问题的临床选择中，包括一种。 对酒精依赖妇女的研究和了解有限，B.对 哪些改变机制使酒精治疗发挥作用，帮助患者减少饮酒和 保持清醒，C.缺乏临床研究来开发和测试具有成本效益的组 酒精使用障碍的治疗模式。该提案是对PA-07-066《酗酒》的回应 使用障碍：治疗、服务研究和康复“，并与几个 NIH最近的重点，包括社区友好型卫生服务研究(例如，NIDA， 2002、2003)，服务不足的人口(即妇女)(Longabaugh&Wirtz，2001)，以及对 治疗改变过程的基础机制(NIAAA，2006a)。这项研究已经 4个具体目标：(1)改变我们现有的女性个体特定认知行为 治疗(I-FSCBT)方法，以小组形式(G- FSCBT)；(2)测试个人和团体FSCBT的相对有效性；(3)测试 两种治疗方法共同存在的饮酒改变假想机制，包括 (A)应对技能和提高戒酒的自我效能；(B)增强自主感；(C) 减少负面情绪，以及(D)增加对戒酒的社会网络支持，以及(4) 评估个体治疗和集体治疗的相对成本-效果。要完成 这些具体目标，将通过报纸招募200名酒精依赖女性 广告和社区推广到我们的门诊。参赛者将完成 基线评估，然后随机分配到12周门诊手册- FSCBT个人或团体的指导课程。招聘将持续37个月，超过 我们将运行16个治疗小组，每个小组由6名女性组成，还将治疗100个人 案子。这两种治疗条件都将是认知-行为集中的，并特别适应 为女性准备的。集体和个人治疗都将以禁欲为基础，包括 增强动机、应对技能培训、负面情绪管理、 在社交网络中管理酗酒者，预防复发和与以下主题相关的主题 自主。参与者将在治疗期间接受评估，以跟踪 拟议的调解人和结果变量。参与者将完成面对面的跟进 在基线后3、9和15个月进行评估，以评估成果的维持情况。这个 拟议的临床研究与公共健康直接相关。归根结底，有效的 和负担得起的治疗酒精依赖女性的团体治疗模式 了解这种疗法是如何起作用的以及为什么会起作用，这将加强卫生服务和 帮助减少酗酒对个人和社会造成的后果。拟议研究的总体目标是开发有经验支持的、具有成本效益的 女性酒精使用障碍的治疗模式。拟议的研究将解决 治疗酒精问题的科学文献和临床选择中的三个空白， 包括A.对酒精依赖妇女的研究和了解有限，B.有限 了解是什么机制改变了酒精治疗对患者的帮助 减少饮酒和保持清醒，以及C.缺乏临床研究来开发和测试 酒精使用障碍的高性价比团体治疗模式。拟议的临床研究是 与公众健康直接相关。最终，有效和负担得起的团体治疗的可用性 基于对酒精依赖的方式和原因的理解来治疗酒精依赖女性的模型 治疗有效，将加强卫生服务，并有助于减少个人和社会 酗酒的后果。

This is a first revision of application 1 R01 AA017163-01, "Testing CBT Models and Change Mechanisms for Alcohol Dependent Women," originally submitted 02/07. The overall goal of the proposed research is to develop empirically supported and cost-effective models of treatment for women with alcohol use disorders. The proposed research will address three gaps in the scientific literature and clinical options for treatment of alcohol problems, including a. limited research on and understanding of alcohol dependent women, b. limited understanding of what change mechanisms make alcohol treatment work to help patients reduce drinking and maintain sobriety, and c. a dearth of clinical research to develop and test cost-effective group therapy models for alcohol use disorders. The proposal is in response to PA-07-066, "Alcohol Use Disorders: Treatment, Services Research, and Recovery," and is consistent with several recent emphases within NIH, including community-friendly health services research (e.g., NIDA, 2002, 2003), underserved populations (i.e. women) (Longabaugh & Wirtz, 2001), and a focus on the mechanisms that underlie the process of change in therapy (NIAAA, 2006a). The study has 4 specific aims: (1) To modify our existing Individual Female Specific Cognitive Behavioral Therapy (I -FSCBT) approach to treat women with alcohol dependence in a group format (G- FSCBT); (2) To test the relative efficacy of Individual and Group FSCBT; and (3) To test hypothesized mechanisms of change in drinking that are common to both treatments, including (a) coping skills and enhanced self-efficacy for abstinence; (b) enhanced sense of autonomy; (c) alleviation of negative affect, and (d) increased social network support for abstinence, and (4) To assess the relative cost-effectiveness of the individual and group treatment. To accomplish these specific aims, 200 alcohol dependent women will be recruited via newspaper advertisement and community outreach to our outpatient clinic. The participants will complete baseline assessments, and then will be randomly assigned to 12 weekly outpatient manual- guided sessions of either Individual or Group FSCBT. Recruitment will span 37 months, over which we will run 16 therapy groups each comprised of 6 women, and also treat 100 individual cases. Both treatment conditions will be cognitive-behavioral in focus and adapted specifically for women. Both the group and individual treatments will be abstinence based, and include motivational enhancement, coping skills training, management of negative affect, skills to manage heavy drinkers in the social network, relapse prevention and themes related to autonomy. Participants will be assessed during treatment to track temporal changes in proposed mediator and outcome variables. Participants will complete in-person follow up assessments at 3, 9, and 15 months post-baseline, to assess maintenance of gains. The proposed clinical research is directly relevant to public health. Ultimately, availability of effective and affordable group therapy models to treat alcohol dependent women based on an understanding of how and why the therapy works, will enhance health delivery services and help reduce the personal and societal consequences of alcoholism. The overall goal of the proposed research is to develop empirically supported and cost-effective models of treatment for women with alcohol use disorders. The proposed research will address three gaps in the scientific literature and clinical options for treatment of alcohol problems, including a. limited research on and understanding of alcohol dependent women, b. limited understanding of what change mechanisms make alcohol treatment work to help patients reduce drinking and maintain sobriety, and c. a dearth of clinical research to develop and test cost-effective group therapy models for alcohol use disorders. The proposed clinical research is directly relevant to public health. Ultimately, availability of effective and affordable group therapy models to treat alcohol dependent women based on an understanding of how and why the therapy works, will enhance health delivery services and help reduce the personal and societal consequences of alcoholism.