Cost Effectiveness of Combined Contingency Management and Cognitive Behavioral Therapy for Alcohol Use Disorder

联合应急管理和认知行为疗法治疗酒精使用障碍的成本效益

• 批准号: 10294373
• 负责人: PATRICK S. CALHOUN
• 金额: $ 12.85万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10294373
• 关键词: Abstinence; Accounting; Acute; Address; Affect; Aftercare; Alcohol consumption; Alcohols; Ambulatory Care; Chronic; Clinical Trials; Clinical effectiveness; Cognitive Therapy; Data; Data Analyses; Data Set; Development; Diagnosis; Diagnostic; Distress; Dose; Dropout; Ecological momentary assessment; Effectiveness of Interventions; Feeling hopeless; Feeling suicidal; Future; Gender; Goals; Heavy Drinking; High Prevalence; Hospitalization; Hour; Impulsivity; Individual; Intervention; Lead; Life; Link; Literature; Mediating; Mental Depression; Mental Health; Modification; Motivation; Nature; Outcome; Outpatients; Pathway interactions; Persons; Population; Post-Traumatic Stress Disorders; Recording of previous events; Relapse; Reporting; Research; Risk; Self Efficacy; Severities; Socioeconomic Status; Stressful Event; Suicide; Suicide attempt; Surveys; Symptoms; Testing; Thinking; Time; Treatment Failure; Treatment outcome; Veterans; alcohol abuse therapy; alcohol relapse; alcohol response; alcohol risk; alcohol use disorder; behavior influence; chronic alcohol ingestion; contingency management; cost; cost effectiveness; drinking; economic cost; effectiveness testing; emotion dysregulation; experience; high risk; improved; insight; mHealth; negative affect; outcome prediction; parent grant; reduced alcohol use; response; secondary analysis; societal costs; standard of care; statistics; stressor; suicidal; suicidal behavior; suicidal risk; trait impulsivity

The parent grant plans to examine the clinical and cost-effectiveness of cognitive-behavioral therapy (CBT) combined with contingency management (CM) in reducing problematic drinking in veterans who meet diagnostic criteria for alcohol use disorder (AUD). Research suggests that those with AUD and co-occurring suicidal thoughts and behaviors are more likely to respond poorly to AUD treatment and relapse on alcohol use. This is important, given that nearly half of those with AUD who present for AUD treatment report a history of suicidal behavior, and numerous studies indicate that those with co-occurring AUD and suicidal thoughts and behaviors tend to demonstrate more severe and chronic AUD symptoms. Despite the robust association between alcohol and suicide, and the extent that co-occurring suicidal thoughts and behaviors influences the presentation and treatment of AUD, little research has examined mechanisms underlying these associations. The proposed supplement would extend the parent grant study by testing the extent that ongoing suicidal thoughts and behaviors impact the progression of and response to CBT/CM for AUD, and examine if CBT/CM leads to reduction in suicide risk in veterans over time, thereby providing a further test of the clinical and cost effectiveness of CBT/CM for AUD (Aim 1). The proposed supplement would also involve secondary analyses of data from a recently conducted ecological momentary assessment (EMA) study on veterans at high-risk for suicide. This study, which was conducted over a 4-week period, involved veterans completing multiple brief surveys per day on a number of momentary variables, including daily alcohol use, momentary suicidal ideation, and other internal (e.g., affect) and contextual (e.g., daily stressors, interpersonal problems) variables. With these variables, the proposed supplement would use advanced longitudinal statistics to examine the extent that daily alcohol use leads to subsequent increase in suicidal thoughts, as well as if suicidal thoughts lead to increase in alcohol consumption, and explore moderators of these associations (Aim 2). While there have been several studies suggesting a dose response relationship between alcohol use and subsequent suicidal desires, the proposed supplement would be the first use EMA to examine the likely bidirectional and dynamic relationship between AUA and suicidal thoughts and behaviors. This will allow us to better understand how the co-occurring mental health problem of suicidal thoughts and behaviors perpetuates and worsens AUD symptoms in real life. Overall, improved understanding of longitudinal relationships between alcohol consumption and acute fluctuations in suicidal thoughts and behaviors in daily life and in the context of treatment significantly enhances the parent grant, and could be highly informative for the future modification and development of mobile health interventions with CBT/CM.

父母赠款计划检查认知行为疗法（CBT）的临床和成本效益 结合应变管理（CM），减少遇见的退伍军人的饮酒有问题 酒精使用障碍诊断标准（AUD）。研究表明，那些具有AUD和同时发生的人 自杀的思想和行为更有可能对AUD治疗和酒精复发的反应不佳 使用。这很重要，鉴于在出席AUD治疗的AUD的人中，有将近一半 自杀行为和许多研究表明，那些具有同时发生的AUD和自杀思想的人 行为倾向于表现出更严重和慢性的症状。尽管协会稳健 在酒精和自杀之间以及共同出现的自杀思想和行为的程度影响 表现和处理AUD，很少研究这些关联的机制。 拟议的补充剂将通过测试持续自杀的程度来扩展父母的赠款研究 思想和行为会影响AUD的CBT/CM对CBT/CM的反应，并检查CBT/CM是否 随着时间的流逝，退伍军人的自杀风险降低，从而进一步测试了临床和成本 CBT/CM在AUD中的有效性（AIM 1）。提出的补充剂还将涉及次要分析 来自最近进行的生态瞬时评估（EMA）研究的数据 自杀。这项研究是在4周内进行的，涉及退伍军人完成多个摘要 每天对许多暂时变量进行调查，包括每日饮酒，暂时的自杀念头， 以及其他内部（例如情感）和上下文（例如，每日压力源，人际问题）变量。和 这些变量，拟议的补充剂将使用先进的纵向统计来检查程度 每日饮酒会导致自杀念头的增加，以及自杀思想是否导致 增加饮酒并探索这些关联的主持人（AIM 2）。那里有 一项研究表明，酒精使用与随后的自杀之间存在剂量反应关系 欲望，拟议的补充剂将是首次使用EMA检查可能的双向和动态 AUA与自杀思想和行为之间的关系。这将使我们能够更好地了解 自杀思想和行为的同时发生的心理健康问题会使AUD永存并恶化 现实生活中的症状。总体而言，对酒精之间的纵向关系的了解得到了改善 在日常生活中自杀思想和行为的消费和急性波动 治疗大大提高了父母的补助 以及使用CBT/CM开发移动健康干预措施。