Recovery Adherence Therapy for Bipolar Alcoholics

描述（由申请人提供）： 我们建议调整，完善和试点测试的动机为基础的模型，坚持治疗酒精中毒和双相情感障碍的早期恢复。该提案涉及计划公告中确定的主要关注领域，即开发和评估用于参与、保留和坚持治疗共病患者的专门行为干预措施。酒精中毒和躁郁症的共病非常普遍。合并症的存在对治疗依从性、治疗反应和病程有显著的负面影响，自杀风险增加，双相情感障碍复发。尽管最近越来越多的关注与酒精中毒的精神共病的问题，令人惊讶的是，很少有研究已经进行了这种复杂形式的共病，特别是在有效的治疗方法。目前还没有针对酒精中毒和双相情感障碍共病患者的个体心理治疗干预措施。我们提出的干预措施是基于治疗模式，强调整合社会心理和药物干预的移情和动机知情的范式。我们提出了以下三个具体目标：1）开发和完善一种基于理论和程序规定的个体坚持治疗干预，用于早期康复中同时发生的酒精使用和双相情感障碍。2)制定标准化的程序，方法和技术，以便以高度的保真度和能力提供治疗。采用随机、平行组设计进行一项先导性疗效研究，将这种新干预措施与目前标准化为“按需治疗”（TAU）的常规临床护理进行比较。我们建议在所要求的支助的三年内分三个阶段实现上述目标。在第1阶段，我们将通过合作、专家评审，将拟定的治疗方法应用于8例病例，从而制定、实施并不断完善治疗方案。在第二阶段，我们将培训两名新的治疗师处理另外8个病例，并最终确定治疗手册。在第3阶段，我们将通过对32例受试者（每组16例）进行随机化、平行组初步疗效研究，初步检验我们方案的疗效，并与按剂量治疗（TAU）条件进行比较。

DESCRIPTION (provided by applicant): We propose to adapt, refine, and pilot-test a motivationally based model of adherence therapy for the dual disorders of alcoholism and bipolar disorder in early recovery. This proposal pertains to the major areas of interest identified in the Program Announcement, namely the development and evaluation of specialized behavioral interventions for the engagement, retention, and adherence of comorbid patients in treatment. Comorbid alcoholism and bipolar disorder is highly prevalent. The presence of comorbidity has a significant negative impact on treatment adherence, treatment response, and course of illness with heightened risk for suicide, recurrence of bipolar illness. Despite the substantial recent increased attention to the problem of psychiatric comorbidity with alcoholism, surprisingly little research has been conducted on this complex form of comorbidity, especially in regard to effective treatment approaches. There are no existing individual psychotherapeutic interventions that are tailored to patients with alcoholism and comorbid bipolar disorder. Our proposed intervention is based on treatment models that emphasize integrating psychosocial and pharmacotherapeutic interventions in an empathic and motivationally informed paradigm. We propose the following three specific aims: 1) To develop and refine a theoretically based and procedurally specified individual adherence therapy intervention for co-occurring alcohol use and bipolar disorder in early recovery. 2) To develop standardized procedures, methods, and techniques so that treatment is delivered with a high degree of fidelity and competence. And 3) To conduct a pilot-efficacy study with randomized, parallel-group design comparing this new intervention with current regular clinical care standardized as Treatment as Usual (TAU). We propose to achieve the above aims in three stages over three years of requested support. During Stage 1 we will develop, implement, and continuously refine the treatment protocol by collaborative, expert review by applying the proposed therapy to 8 cases. During Stage 2 we will train two new therapists on 8 additional cases, and finalize the treatment manual. During Stage 3 we will pilot-test the efficacy of our protocol as compared to the Treatment as Usual (TAU) condition by conducting a randomized, parallel group pilot-efficacy study of 32 subjects (16 in each group).