Shifts in Behavioral Allocation Patterns as an Alcohol Recovery Mechanism

描述（由申请人提供）：这项为期3年的R01申请是根据PAR-14-051提交的，提出了对四项已完成的酒精问题恢复自然过程的前瞻性研究的二次数据分析，以确定行为经济学（BE）理论和研究预测的变化机制。患有成瘾性疾病的人倾向于选择不太有价值但更直接的选择（例如，饮酒），而不是更有价值的、延迟的结果（例如，稳定的工作，为未来储蓄）。成功的恢复可能包括改变行为和资源的分配，从而导致经历延迟的非饮酒奖励（NDRs）的清醒。BE研究提出了这种假设的变化机制，但大多数研究是横断面的，不能解释机制。一个独特的重复测量前瞻性数据集（N ~ 450）汇集了四个自然恢复研究的数据，将支持由BE理论预测的纵向关系和机制研究的调查。主要是治疗幼稚的，社区居住的问题饮酒者在他们停止过量饮酒后不久被招募。使用扩展时间轴跟踪访谈收集详细的行为记录，评估每日饮酒，金钱分配和其他NDR来源（例如，积极的生活事件）在最初清醒的前一年和后一年。对货币分配模式的综合测量评估了饮酒偏好的变化，并使用一种共同的方法来参与质量不同的活动

DESCRIPTION (provided by applicant): This 3-year R01 application submitted in response to PAR-14-051 proposes secondary data analyses of four completed prospective studies of the natural course of recovery from alcohol problems to identify mechanisms of change predicted by behavioral economic (BE) theory and research. Persons with addictive disorders tend to choose less valuable but more immediate options (e.g., drinking) over more valuable, delayed outcomes (e.g., job stability, saving for the future). Successful recovery likely involves shifting allocatin of behavior and resources in ways that lead to experiencing delayed non-drinking rewards (NDRs) of sobriety. BE research suggests this hypothesized mechanism of change, but most studies were cross-sectional and cannot explicate mechanisms. A unique repeated-measures prospective data set (N ~ 450) created by pooling data from four natural recovery studies will support investigation of longitudinal relationships predicted by BE theory and research concerning mechanisms. Predominantly treatment naive, community-dwelling problem drinkers were enrolled shortly after they stopped excessive drinking. Detailed behavioral records collected using expanded Timeline Follow back interviews assessed daily drinking, monetary allocation, and other NDR sources (e.g., positive life events) during the year before and the year after initial sobriety. Comprehensive measurement of monetary allocation patterns assessed shifting preferences for drinking and engaging in qualitatively different activities using a common metric (dollars). After assessment at enrollment covering the pre-resolution year, the same variables were assessed prospectively for a year or more, yielding 2-year records surrounding sobriety onset. Two studies also offered access to sobriety support during early recovery using an Interactive Voice Response (IVR) self-monitoring system. Advanced longitudinal analysis methods will be used to model trajectories of drinking behavior change contextualized within problem drinkers' changing personal economies to: (1) identify the timing, structures, and typologies of monetary re-allocation through the pre- and post- resolution years associated with stable and unstable resolution; and (2) evaluate effects of engaging in IVR self-monitoring on allocation patterns during early recovery. The main hypotheses are: (1) Resolution stability is promoted by shifts in behavioral allocation that increase the probability of NDR experiences. (2) Beneficial effects of IVR self-monitoring on resolution stability are mediated by its effect on pos-resolution behavioral re- allocation that improves NDR experiences. Results will elucidate natural trajectories of BE mechanisms of change and support new intervention approaches, targets, and change mechanisms not tied to treatment- produced change. The research provides a unique, powerful, cost-efficient opportunity to translate and test BE theory and change mechanisms and to investigate BE mechanisms in a phone-based intervention with broad dissemination potential. This is a public health priority because gains in population health likely will come from extending care to untreated problem drinkers who contribute much harm and cost of alcohol-related problems.