A Technology-based Intervention to Reduce Alcohol Use after Bariatric Surgery

尽管减肥手术是严重肥胖患者最有效的减肥干预措施， 多达五分之一的患者会在手术后出现酒精使用障碍。新陈代谢的变化 荷尔蒙水平和减肥手术导致的行为改变了酒精的回报效应，而 同时改变其吸收率，使患者危险饮酒的风险显著增加。 仅仅向这些脆弱的患者群体提供关于手术后风险的教育并不是 足以减少酒精使用，但全面的面对面干预面临重大挑战， 包括患者和他们的减肥手术项目之间长达数小时的距离。因此，我们的长期目标是 是增加获得经验支持的干预措施的机会，以减少以下患者的酒精使用 利用技术进行减肥手术。我们的干预，植根于激励性采访和 跨理论模式是为期两节的计算机化短期干预(CBI)，辅以六个月 基于参与者的CBI结果和随后他们准备好的波动来定制文本消息 变化。拟议研究的目的是为以下患者优化这种基于技术的干预 接受减肥手术，并检查干预的可行性和可接受性。在第一阶段， 将利用患者访谈(n=20)来确定对干预内容和治疗提供的偏好。 然后，10名患者将参加干预的公开试验，该试验随后将根据 从这些病人那里得到的反馈。在第二阶段，将在3至6个月内招募患者(N=60) 减肥手术后，按常规随机分为干预或治疗对照组。所有患者 将完成基线问卷以及1、3、6和9个月的后评估。我们预计这一次 干预将是可行的，也是患者可以接受的。结果将作为初步数据，以告知 一项大型的、全能的临床试验，以测试这种干预的更大效果。尽管主要结果是 注重可行性和可接受性，我们还预计分配到干预措施的患者将有 术后第一次饮酒的时间更长，戒酒天数更多，每天饮酒更少，以及 与对照组相比，减肥手术后酒精使用障碍的患病率较低。这个项目是 创新，因为它通过实施以下方式扩展了对减肥手术患者的现有干预 酒精使用的循证策略。通过利用基于技术的方法，我们还可以达到 更多的患者，以防止开始饮酒，减少目前的酒精使用，并更好地促进 参与护理，如果个人选择传统的治疗方法。建议的线路为 这项研究对NIH的任务意义重大，因为干预预计将减少 患者在减肥手术后发展成酒精使用障碍的可能性。鉴于……的潜力 这项研究以低成本广泛传播，具有很高的潜在公共卫生和临床意义。

Despite bariatric surgery being the most effective weight loss intervention for patients who are severely obese, as many as 1 in 5 patients will develop an alcohol use disorder after their surgery. Changes in metabolism, hormone levels, and behavior as a result of bariatric surgery alter the rewarding effects of alcohol while concurrently changing its absorption rate, putting patients at significantly elevated risk of hazardous drinking. Simply providing education to this vulnerable patient population about post-surgical risks has not been sufficient to reduce alcohol use, yet comprehensive in-person interventions are met with significant challenges, including hours-long distances between patients and their bariatric surgery programs. Thus, our long-term goal is to increase access to an empirically-supported intervention for reducing alcohol use among patients who undergo bariatric surgery by leveraging technology. Our intervention, rooted in motivational interviewing and the transtheoretical model, is a two-session computerized brief intervention (CBI), supplemented by six months of tailored text messaging based on participants’ CBI results and subsequent fluctuations in their readiness to change. The purpose of the proposed study is to optimize this technology-based intervention for patients who undergo bariatric surgery and to examine feasibility and acceptability of the intervention. In the first phase, patient interviews (n= 20) will be utilized to identify preferences for intervention content and treatment delivery. Ten patients will then participate in an open trial of the intervention, which will be subsequently revised based on feedback from these patients. In Phase 2, patients (N = 60) will be recruited between 3 and 6 months following bariatric surgery and randomized to the intervention or treatment as usual control group. All patients will complete baseline questionnaires and at 1, 3, 6, and 9 month post-assessments. We expect that this intervention will be both feasible and acceptable to patients. Results will be used as preliminary data to inform a large, fully-powered clinical trial to test the larger efficacy of this intervention. Although primary outcomes focus on feasibility and acceptability, we also expect that patients assigned to the intervention will have a longer time to their first post-surgical drink, report more days of abstinence, fewer drinks per drinking day, and a lower prevalence of alcohol use disorder after bariatric surgery compared to controls. This project is innovative because it expands upon existing interventions for bariatric surgery patients by implementing evidence-based strategies for alcohol use. By utilizing a technology-based approach, we can also reach a larger number of patients to prevent initiation of drinking, reduce current alcohol use, and facilitate better engagement in care, should individuals opt into traditional treatment approaches. The proposed line of research is significant and relevant to NIH’s mission because the intervention is expected to reduce the likelihood that patients will develop an alcohol use disorder following bariatric surgery. Given the potential of wide dissemination at low cost, the proposed study has high potential public health and clinical significance.