Center on Adaptive Treatments for Alcoholism

描述(申请人提供)：虽然许多针对酒精中毒的行为和药物治疗已被证明有效，但我们目前的治疗模式在社区环境中的实施和有效性仍面临几个主要挑战，包括对传统的特殊护理模式缺乏兴趣，参加传统社区计划的个人早期辍学率高，以及确实参与治疗的患者的反应相当不同。我们小组和其他人最近所做的工作表明，适应性治疗模式可以为干扰有效酒精中毒治疗的成功实施的许多问题提供解决方案。这些模式也被称为“分级护理”和“治疗算法”，旨在通过提供根据患者对治疗的反应随着时间推移量身定做的灵活护理来增加治疗的参与度。适应性方法还寻求通过尽可能指定较低强度的治疗并纳入患者偏好等因素来最大限度地参与。这一修订后的P20的目标是进一步发展以患者为中心的适应性模式，为酒精使用障碍患者提供护理。研究方法核心将解决适应性治疗中的一些方法学问题，包括确定触发治疗修改的最佳定制变量、调解的统计模型、开发计算机系统以实施复杂的适应性算法，以及确定有助于坚持的会议期间治疗过程。主要研究核心由开发项目组成，涉及我们概念模型的几个组成部分，包括为初级保健环境中被确认为酒精依赖的患者开发适应性护理模式；为进入社区专科护理的患者开发适应性治疗算法；以及创新的、基于网络的适应性持续护理方案。将在两个项目中研究患者选择在治疗选择中的影响。多学科P20将促进具有行为和药物干预、适应性设计、统计学、经济学和传播专业知识的科学家与社区项目主任、顾问和患者之间的合作。总体而言，P20的工作有望提高适应性治疗设计的可行性、可接受性和有效性。

DESCRIPTION (provided by applicant): Although a number of behavioral and pharmacological treatments for alcoholism have proven efficacy, there are several major challenges to the implementation and effectiveness of our current treatment models in community settings, including lack of interest in traditional specialty care models, high rates of early dropout in individuals who do enter traditional community programs, and considerable variability of response in patients who do become engage in treatment. Recent work done by our group and others suggests that adaptive treatment models can provide a solution to many of the problems that interfere with the successful delivery of effective alcoholism treatment. These models, which have also been referred to as "stepped care" and "treatment algorithms," are designed to increase participation in treatment by providing flexible care that is tailored over time on the basis of patient response to treatment. Adaptive approaches also seek to maximize participation by specifying lower intensity treatment whenever possible, and incorporating factors such as patient preference. The goal of this revised P20 is the further development of patient centered adaptive models of care for individuals with alcohol use disorders. The Research Methods Core will address a number of methodological issues in adaptive treatment, including identification of optimal tailoring variables that trigger modifications in treatment, statistical models for mediation, development of computer systems to implement complex adaptive algorithms, and identification of within-session therapeutic processes that facilitate adherence. The Principal Research Core consists of Developmental Projects that address several components of our conceptual model, including the development of adaptive models of care for patients identified with alcohol dependence in primary care settings; adaptive treatment algorithms for patients who enter community-based specialty care; and an innovative, web-based adaptive continuing care protocol. The impact of patient choice in treatment selection will be examined in two projects. The multidisciplinary P20 will facilitate collaborations between scientists with expertise in behavioral and pharmacological interventions, adaptive designs, statistics, economics, and dissemination, and directors of community-based programs, counselors and patients. Overall, the work of the P20 is expected to improve the feasibility, acceptability, and effectiveness of adaptive treatment designs.