Pretreatment Change in Drinking: Relationship to Treatment Outcome

描述（由申请人提供）：本申请是对PA-10-100，酒精使用障碍：治疗，服务研究和恢复的回应。正如本项目公告所述，“因为许多患有酒精使用障碍的人在没有成瘾治疗提供者或自助团体的帮助下改变了他们的饮酒行为，因此了解人们在专业治疗环境之外如何以及为什么改变他们的饮酒行为与了解他们在自己内部一样重要。”与这种自我改变的概念相一致，一些研究，包括在美国复苏和再投资法案（RC1 AA018986; PI-Stasiewicz）下资助的一项挑战拨款，已经报告了在开始正式治疗之前就会发生行为改变。这些数据挑战了改变过程的主要部分发生在治疗开始后的假设，并建议必须通过更广泛的视角来检查行为改变（Willenbring, 2007）。因此，本研究将评估酒精使用的预处理变化，以确定不同的生长轨迹（即潜在类别），并检查预处理生长轨迹与酒精治疗结果（例如，每天饮酒的饮酒量）的关系。为了检查预处理轨迹组的潜在预测因子，将评估来自自我改变的实证研究和健康行为改变模型，自决理论（SDT）的变量（例如，自主性，对改变的承诺，自我效能）。最后，在为期12周的酒精依赖认知行为治疗过程中，将探讨预处理改变轨迹与几个治疗过程变量（如负面影响、戒酒自我效能）之间的关系。参与者将是220名酒精依赖的男性和女性，他们同意参加为期12周的酒精依赖认知行为疗法（CBT）试验。研究的预处理阶段包括最初的电话筛查和全面的基线评估。预处理饮用将在以下时间间隔内进行评估；电话筛查前2周，电话筛查至基线评估，基线至第一次治疗。治疗阶段包括为期12周的门诊酒精依赖认知行为治疗（CBT）疗程（Kadden et al., 1992）。临床研究评估将在基线、治疗结束以及治疗后3个月和6个月进行。总之，这将是第一个采用系统方法调查饮酒前处理变化的研究，并检查这种变化对治疗结果和行为治疗过程的影响。根据预处理变化的轨迹来确定个体的亚群，对于开辟治疗发展的新途径具有巨大的潜力，包括使用基于预处理变化模式的自适应治疗设计。这些可以包括旨在加强或维持已经做出的改变（例如，预防复发）的治疗方法，以及旨在促进那些以更渐进的预处理改变轨迹进入治疗的人进一步改变的干预措施。

DESCRIPTION (provided by applicant): This application is in response to PA-10-100, Alcohol Use Disorders: Treatment, Services Research, and Recovery. As stated in this Program Announcement, "because many individuals with alcohol use disorders change their drinking behavior without help from addiction treatment providers or self-help groups, it is as vital to understand how and why people change their drinking outside of specialized treatment settings as it is within them." Consistent with this notion of self-change, several studies, including a challenge grant funded under the American Recovery and Reinvestment Act (RC1 AA018986; PI-Stasiewicz), have reported that behavioral changes occur prior to initiating formal treatment. These data challenge the assumption that the major portion of the change process occurs after treatment entry and suggest that behavior change must be examined through a broader lens (Willenbring, 2007). Therefore, this study will assess pretreatment changes in alcohol use in an effort to identify different trajectories of growth (i.e., latent classes), and examine the relatioship of pretreatment growth trajectories to alcohol treatment outcomes (e.g., drinks per drinking day). To examine potential predictors of pretreatment trajectory groups, variables derived from empirical studies of self-change and a model of health-behavior change, Self-Determination Theory (SDT), will be assessed (e.g., autonomy, commitment to change, self-efficacy). Finally, the relationship between pretreatment change trajectories and several treatment process variables (e.g., negative affect, alcohol abstinence self-efficacy) measured at weekly intervals during a 12-week course of cognitive-behavioral treatment for alcohol dependence will be explored. Participants will be 220 alcohol dependent men and women who agree to participate in a 12-week trial of cognitive-behavioral therapy (CBT) for alcohol dependence. The pretreatment phase of the study includes the initial phone screen and a comprehensive baseline assessment. Pretreatment drinking will be assessed across the following intervals; 2-weeks prior to the phone screen, phone screen to baseline assessment, and baseline to the first treatment session. The treatment phase includes a 12-week course of outpatient Cognitive- Behavioral Treatment (CBT) for alcohol dependence (Kadden et al., 1992). Clinical research assessments will be conducted at baseline, end-of-treatment and at 3- and 6-months post-treatment. In summary, this would be the first study to take a systematic approach to investigating pretreatment changes in drinking and to examine the impact of such changes on treatment outcomes and behavioral treatment processes. Identifying subgroups of individuals based on their trajectory of pretreatment change has great potential for opening up new avenues of treatment development including the use of adaptive treatment designs based on pretreatment change patterns. These could include treatment approaches designed to reinforce or maintain changes already made (e.g., relapse prevention) as well as interventions that take aim at facilitating further change for those entering treatment with a more gradual trajectory of pretreatment change.