Mechanisms of Behavior Change in Alcohol Use Disorder Treatment

项目摘要/摘要 已经开发了许多基于证据的行为和药物干预措施，并且一些 已经被酒精治疗提供者采用，然而，人们对为什么特定的治疗方法知之甚少 有效(即治疗中行为改变的机制是什么)，哪些治疗效果最好 对特定的个人有效。尽管越来越多的人关注行为改变的机制 酒精研究人员在过去的15年里，许多发现都没有得到复制和证据的支持 对酒精使用障碍的个体化治疗(AUD)为什么有效以及对谁有效的理解仍然存在 难以捉摸。首先，很明显，AUD在病因和治疗后的结果上都是不同的，但 AUD治疗介质的异质性尚未被考虑，主要是因为方法学的原因。 限制。总的来说，酒精治疗后行为改变的机制并不是很好。 明白了。其次，AUD治疗研究调查了行为改变的多种机制。一个问题是 缺乏理解和方法论技术来测试哪种行为改变机制是稳健的 如果要在一组不同的条件下复制它(例如，具有不同的 行为改变的机制)。为了解决这些理解上的差距，本研究将建立一个经验性的 通过确定行为变化的可靠机制(即，机制是否跨 不同的参与者？)并通过模拟酒精治疗中的异质性(即，它对谁有效/不对谁起作用) 通过最先进的方法技术的开发和应用，广泛地分析了 11项现有的AUD随机临床试验，以及基于AUD临床试验的模拟研究 数据。行为改变的候选机制，基于先前的研究和复发的动态模型 一个指导性的理论模型，将包括自我效能感、饮酒欲望、互助参与、社交 支持、治疗联盟、客户语言和应对反应。拟议研究的结果将 告知制定治疗建议的个性化方法，明确哪些治疗方法 机制(中介体)在研究中是最可靠的，并直接为临床决策提供信息。在……里面 此外，拟议的研究将提供一套广泛的数据分析工具，将被设计 具体回答关于(A)测试候选调解人的稳健性和(B)测试的问题 异质性存在下的调解。分析工具将通常适应数据的特征 在AUD临床试验中观察到的，具有回归知识的实质性研究人员将可以访问 和调解。本研究的最终目的是为了更好地了解AUD的发病机制 治疗结果，以便为精准医学倡议提供信息。

Project Summary/Abstract Numerous evidence-based behavioral and pharmacological interventions have been developed and some have been adopted by alcohol treatment providers, however very little is known why specific treatments are effective (i.e., what are the mechanisms of behavior change in treatment) and which treatments are most effective for specific individuals. Despite an increased focus on mechanisms of behavior change among alcohol researchers over the past 15 years, many findings have not been replicated and an evidence-based understanding of why and for whom individual treatments for alcohol use disorder (AUD) are effective remains elusive. First, it is clear that AUD is heterogeneous in both etiology and outcomes following treatment, yet heterogeneity in mediators of AUD treatment has not been considered, mostly because of methodological limitations. In general, the mechanisms of behavior change following alcohol treatment are not well understood. Second, AUD treatment studies investigate multiple mechanisms of behavior change. One issue is a lack of understanding and methodological techniques to test which mechanism of behavior change is robust if it were to be replicated under a different set of conditions (e.g., different participants with different mechanisms of behavior change). To address these gaps in understanding, this study will build an empirical knowledge base by identifying robust mechanisms of behavior change (i.e., do mechanisms replicate across different participants?) and by modeling heterogeneity in alcohol treatment (i.e., for whom it works/fails to work) through development and application of the state-of-the-art methodological techniques, extensive analyses of eleven existing randomized clinical trials for AUD, as well as simulation studies based on AUD clinical trial data. Candidate mechanisms of behavior change, based on prior studies and the dynamic model of relapse as a guiding theoretical model, will include self-efficacy, craving or urges to drink, mutual help involvement, social support, therapeutic alliance, client language, and coping responses. Results from the proposed study will inform an individualized approach to formulating treatment recommendations, clarify which treatment mechanisms (mediators) are most robust across studies, and directly inform clinical decision making. In addition, the proposed study will provide an extensive suite of data analytic tools that will be designed specifically to answer questions regarding (a) testing robustness of candidate mediators, and (b) testing mediation in the presence of heterogeneity. The analytic tools will accommodate features of data commonly observed in AUD clinical trials and will be accessible to substantive researchers with knowledge of regression and mediation. The ultimate goal of this study is to yield a better understanding of mechanisms of AUD treatment outcomes in order to inform precision medicine initiatives.