Moderators of Motivation to Maintain Sobriety over Eighteen Months

描述（由申请人提供）：改变的动机在酒精和药物文献中受到广泛关注。然而，大多数研究发现动机和结果之间只有适度的联系。大多数研究的一个局限性是动机仅在治疗开始时（即基线）测量，并根据预测随后的酒精和药物使用情况进行评估。这种方法有许多缺点。首先，当动机的影响更接近于对结果的评估时（即在随访时间点测量），人们对动机的影响知之甚少。其次，人们对动机如何随时间变化以及何时影响最大知之甚少。第三，开始治疗时的动机被概念化为改变或消除酒精和药物使用的愿望。因此，保持戒断或减少使用药物的动机被忽视了。第四，人们对动机何时影响酒精和药物使用结果（即调节因素）的情况知之甚少。最后，动机通常是在正式治疗方案的背景下进行研究的。然而，该领域越来越多地将严重成瘾障碍概念化为需要持续监测的慢性疾病。因此，评估长期和正规治疗之外的动机变得越来越重要。这个应用程序解决了这些缺点，通过研究动机如何保持清醒是与禁欲和减少物质使用超过18个月。与其在正式的治疗项目中对动机进行另一项研究，这个应用程序建议在进入清醒生活康复之家的人群中对动机进行研究。假设表明1)动机将与酒精和药物使用在时间点内和跨时间点有关；2)动机对酒精和药物使用影响的调节因素将包括社会网络中支持性对抗和饮酒和药物使用的措施。该研究将包括对先前两项资助的数据的二次分析，“清醒生活之家的评估”（R01 AA014030） （N=323）和“恢复期间的对抗测量”（R21 DA023677）。这两项研究都追踪了清醒生活之家（SLH）居民（N=323）在进门时的结果，以及6个月、12个月和18个月的随访。在功能的多个领域，包括酗酒和吸毒、逮捕、就业和精神严重程度，都注意到纵向改善。在18个月时，超过42%的人已经完全戒除了至少6个月的物质，尽管几乎所有人都离开了清醒的生活之家。这项研究的发现将大大增加我们对动机如何影响社区恢复过程的认识。研究结果还将为早期发展阶段的新干预提供信息，该干预旨在帮助维持长期恢复，即动机性访谈案例管理。关键的信息提供者访谈将增加SLH提供者和消费者对研究结果的看法，并有助于制定指导方针，以增加和维持SLH居民的动机。

DESCRIPTION (provided by applicant): Motivation for change has received extensive attention in the alcohol and drug literature. However, most studies have found only modest associations between motivation and outcome. One limitation of most studies is motivation is measured 0nly at treatment entry (i.e., baseline) and assessed in terms of predicting subsequent alcohol and drug use. There are a number of shortcomings to this approach. First, little is known about the impact of motivation when it is more proximal to assessments of outcome (i.e., measured at follow up time points). Second, little is known about how motivation can change over time and when its impact might be strongest. Third, motivation at treatment entry is conceptualized in terms of a desire to change or eliminate alcohol and drug use. Motivation to maintain abstinence or reduced use of substances is therefore ignored. Fourth, little is known about the circumstances of when motivation impacts alcohol and drug use outcome (i.e., moderators). Finally, motivation has typically been studied within the context of formal treatment programs. However, the field is increasingly conceptualizing serious addictive disorders as chronic diseases that require ongoing monitoring. Assessing motivation over time and outside the context of formal treatment is therefore increasingly important. This application addresses these shortcomings by studying how motivation to maintain sobriety is associated with abstinence and reduced substance use over 18 months. Rather than yet another study of motivation within a formal treatment program, this application proposes to study it among a population of individuals entering sober living recovery homes. Hypotheses suggest 1) motivation will be associated with alcohol and drug use within and across time points and 2) moderators of the impact of motivation on alcohol and drug use will include measures of supportive confrontation and drinking and drug use in the social network. The study will consist of a secondary analysis of data from two previous grants, "An Evaluation of Sober Living Houses" (R01 AA014030) (N=323), and "Measuring Confrontation during Recovery" (R21 DA023677). Both studies tracked outcomes of Sober Living House (SLH) residents (N=323) at entry into the house and 6-, 12-, and 18-month follow up. Longitudinal improvements were noted in multiple areas of functioning, including alcohol and drug use, arrests, employment, and psychiatric severity. At 18 months, over 42% had been completely abstinent from substances for at least 6 months even though nearly all had left the sober living houses. Findings from the study will add substantively to our knowledge about how motivation impacts the recovery process over time in the community. Findings will also inform a new intervention in the early stages of development that is designed to help sustain long term recovery, motivational interviewing case management. Key informant interviews will add SLH provider and consumer perspectives on study findings and contribute to the development of guidelines for increasing and sustaining motivation among SLH residents.