Mindfulness-Based Relapse Prevention as Video Conferencing Continuing Care to Promote Long Term Recovery from Alcohol Use Disorder

项目摘要 酒精使用障碍（AUD）是一种普遍存在且费用高昂的疾病，并与显著的发病率和死亡率相关。 存在有效的药物和心理治疗AUD，尽管许多人没有 接受药物治疗，大多数人通过参加互助小组接受治疗。匿名戒酒会和 其他相互支持计划已被证明在支持禁欲方面非常有效， 对于那些对禁欲康复感兴趣的人来说，这是一个非常有价值的选择。然而，大约80%的 患有AUD的人从不寻求治疗，不想停止饮酒是寻求治疗的常见障碍。 治疗AA和其他相互支持计划通常是以禁欲为基础的，然而， 事实证明，减少饮酒在减少与酒精使用有关的危害方面同样有效。最近 基于人群和临床样本的研究表明减少饮酒对健康有显著的益处， 没有完全的禁欲。根据这些发现，国家酒精滥用和酒精中毒研究所 提出了一个新的恢复操作定义，定义为：从AUD缓解，停止重度 饮酒，改善功能和健康。扩大恢复的定义，将非恢复包括在内， 禁欲的结果可能会增加那些不愿意禁欲但 愿意减少饮酒，并减少未经治疗的AUD的公共卫生负担。一个程序， 促进AUD恢复的相当大的希望是基于正念的复发预防（MBRP）。疗效 MBRP用于减少大量饮酒已在几项试验中显示。此外，MBRP明确针对 成瘾的神经生物学信息领域：对行为反应的抑制控制（执行 功能）;渴望和线索反应（激励显着性）;和负面影响（负面情绪）。MBRP 在针对更广泛的健康和生命方面， 功能MBRP还具有通过视频会议广泛访问的潜力。这个目标 这项研究是为了研究通过视频会议提供的MBRP小组在促进整个- 在尝试通过治疗改变或停止饮酒后三年内从AUD中恢复的人，或 自我改变，而不是转介到网上互助小组。本研究还将探讨如何MBRP 影响基于神经生物学信息成瘾循环域的行为改变机制。我们将 使用有效性实施设计来前瞻性地测试MBRP的有效性，并确定 MBRP小组参与的障碍和促进因素，为未来实施MBRP持续护理提供信息。 这项工作的最终目标是通过视频会议评估MBRP作为一种持续护理选择， 支持全人康复，并针对成瘾循环领域，支持从 在全国各社区开展AUD，包括重点关注服务不足的地区。有效的证据， 基于持续护理的干预措施可能会减少AUD的公共卫生负担。

PROJECT SUMMARY Alcohol use disorder (AUD) is prevalent and costly, and associated with significant morbidity and mortality. Effective pharmacological and psychosocial treatments for AUD exist, although many individuals do not receive medications and most are treated via mutual support group participation. Alcoholics Anonymous and other mutual support programs have been shown to be highly effective in supporting abstinence, and they are a tremendously valuable option for those interested in abstinence-based recovery. Yet, approximately 80% of individuals with AUD never seek treatment and not wanting to stop drinking is a common barrier to seeking treatment. AA and other mutual support programs are often abstinence-based, yet programs that focus on reductions in drinking have been shown to be as effective at reducing harms related to alcohol use. Recent studies in population-based and clinical samples indicate significant health benefit from drinking reductions, without total abstinence. Aligned with these findings, the National Institute on Alcohol Abuse and Alcoholism has proposed a new operational definition of recovery defined as: remission from AUD, cessation of heavy drinking, and improvements in functioning and well-being. Expanding the definition of recovery to include non- abstinent outcomes could increase treatment seeking among those with AUD who are not willing to abstain but are willing to reduce drinking, and reduce the public health burden of untreated AUD. One program that has considerable promise for promoting AUD recovery is mindfulness-based relapse prevention (MBRP). Efficacy of MBRP for reducing heavy drinking has been shown in several trials. Further, MBRP explicitly targets neurobiologically-informed domains of addiction: inhibitory control over behavioral responses (executive function); craving and cue reactivity (incentive salience); and negative affect (negative emotionality). MBRP may also be more effective than existing continuing care options in targeting broader health and life functioning. MBRP also has the potential to be broadly accessible via video conferencing. The goal of this study is to examine the effectiveness of MBRP groups delivered via video conferencing in promoting whole- person recovery from AUD up to three years following an attempt to change or stop drinking via treatment or self-change, as compared to referral to online mutual support groups. This study will also examine how MBRP affects mechanisms of behavior change based on neurobiologically-informed addiction cycle domains. We will use an effectiveness-implementation design to prospectively test the effectiveness of MBRP, as well as identify barriers and facilitators of MBRP group participation to inform future implementation of MBRP continuing care. The ultimate goal of this work is to evaluate MBRP via video conferencing as a continuing care option that supports whole-person recovery and targets addiction cycle domains in supporting long-term recovery from AUD in communities nationwide, including a focus on underserved areas. Availability of effective, evidence- based continuing care interventions may reduce the public health burden of AUD.