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.

家长拨款计划检查认知行为疗法（CBT）的临床和成本效益 与应急管理 (CM) 相结合，减少遇到问题的退伍军人的饮酒问题 酒精使用障碍（AUD）的诊断标准。研究表明，那些患有 AUD 和同时发生的人 自杀念头和行为更有可能对 AUD 治疗反应不佳并且酗酒复发 使用。这一点很重要，因为近一半接受 AUD 治疗的 AUD 患者报告有病史 自杀行为的影响，大量研究表明，那些同时存在 AUD 和自杀念头的人 和行为往往表现出更严重和慢性的 AUD 症状。尽管关联性很强 酒精和自杀之间的关系，以及同时发生的自杀想法和行为对酒精和自杀的影响程度 尽管关于 AUD 的表现和治疗，很少有研究探讨这些关联背后的机制。 拟议的补充将通过测试持续自杀的程度来扩展家长补助金研究 思想和行为影响 AUD 的 CBT/CM 的进展和反应，并检查 CBT/CM 是否 随着时间的推移，退伍军人的自杀风险会降低，从而提供了对临床和成本的进一步测试 CBT/CM 对 AUD 的有效性（目标 1）。拟议的补充还将涉及二次分析 最近针对高风险退伍军人进行的生态瞬时评估（EMA）研究的数据 自杀。这项研究历时 4 周，退伍军人完成了多项简报 每天对一些瞬时变量进行调查，包括每日饮酒、瞬时自杀意念、 以及其他内部（例如，情感）和情境（例如，日常压力源、人际关系问题）变量。和 对于这些变量，拟议的补充将使用先进的纵向统计来检查其程度 每天饮酒会导致自杀念头增加，以及自杀念头是否会导致 饮酒量的增加，并探索这些关联的调节因素（目标 2）。虽然有 多项研究表明饮酒与随后的自杀之间存在剂量反应关系 根据愿望，拟议的补充将是第一个使用 EMA 来检查可能的双向和动态 AUA 与自杀想法和行为之间的关系。这将使我们能够更好地理解 同时发生的自杀念头和行为的心理健康问题使 AUD 持续存在并恶化 现实生活中的症状。总体而言，提高了对酒精之间纵向关系的理解 日常生活中和背景下的消费以及自杀想法和行为的剧烈波动 处理显着增加了父母补助金，并且可以为未来的修改提供大量信息 以及利用 CBT/CM 开发移动健康干预措施。