Naltrexone and CBT for problem drinking

纳曲酮和 CBT 治疗饮酒问题

• 批准号: 7047660
• 负责人: JON MORGENSTERN
• 金额: $ 58.57万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7047660
• 关键词: AIDS education /prevention; HIV infections; adult human (21+); alcoholic beverage consumption; alcoholism /alcohol abuse; alcoholism /alcohol abuse chemotherapy; clinical research; cognitive behavior therapy; combination therapy; craving; data collection methodology /evaluation; disease /disorder proneness /risk; emotions; high risk behavior /lifestyle; homosexuals; human subject; human therapy evaluation; locus of control; longitudinal human study; male; motivation; naltrexone; narcotic antagonists; sex behavior

DESCRIPTION (provided by applicant): Problem drinking MSM are at risk for relapse because their social milieux are often associated with alcohol, and are at elevated risk for HIV because of high base rates of HIV and because drinking is associated with HIV-risk behavior. Although substantial research exists on HIV risk reduction in MSM alone or in combination with alcohol abuse treatment, few studies have examined the impact of alcohol-only treatment on HIV risk. Problem drinkers are most receptive to interventions focused on moderation of drinking rather than abstinence; however moderation-oriented cognitive-behavior therapy (CBT) is limited in that success depends on the successful implementation of new coping strategies for urges to drink and development of self-efficacy for coping. Naltrexone (NTX) is also a well established treatment for problem drinkers with moderated drinking goals, but its effects diminish after treatment is discontinued. The limitations of these treatments suggest that their combination might enhance the efficacy of both. We propose combining moderation-oriented CBT with NTX in the treatment of problem drinking, HIV positive and -negative MSM, to evaluate their efficacy alone and in combination. We also propose to utilize new data collection technology, Interactive Voice Response, to collect data on daily relations among drinking, sexual behavior and psychological variables thought to mediate treatment response. Our objectives are to: 1) enroll a sample of 240 problem drinking MSM using active and passive recruitment strategies; 2) evaluate the efficacy of 12 weeks of randomly assigned treatment, with 50 mg of NTX or placebo, combined with modified, behavioral self-control therapy or brief supportive therapy; 3) evaluate conditional relationships between heavy drinking and likelihood of HIV risk behavior; 4) evaluate daily associations among mood, craving, self-efficacy, motivation, and drinking. Assessments will include baseline, 3, 6, & 9 month follow-up. This application is of tremendous relevance to alcoholism treatment and HIV prevention. First, we will evaluate established treatments for problem drinking in an under-studied but unique population, namely MSM. Second, we will examine the impact of alcohol-focused treatment on HIV risk behavior in a very high risk population. Third, we will use new data collection technology to examine complex relationships among drinking, HIV risk, and psychological factors to better inform future interventions.

描述（由申请人提供）：饮酒MSM的问题可能有复发的风险，因为他们的社会环境通常与酒精有关，并且由于艾滋病毒的基本率高，并且由于饮酒与艾滋病毒风险行为有关，因此患艾滋病毒的风险较高。尽管对单独MSM或与酒精滥用治疗结合的HIV风险降低存在大量研究，但很少有研究检查仅酒精治疗对HIV风险的影响。饮酒者最接受的是专注于饮酒而不是戒酒的干预措施。但是，以节制为导向的认知行为疗法（CBT）受到限制，因为成功取决于成功实施了敦促饮酒和发展自我效能的新应对策略。 Naltrexone（NTX）也是针对饮酒目标的问题饮用者的良好治疗方法，但在治疗后其影响减弱。这些治疗方法的局限性表明它们的组合可能会增强两者的功效。我们建议将面向适中的CBT与NTX相结合，以治疗饮酒，HIV阳性和阴性MSM的问题，以单独评估其疗效并结合使用。我们还建议利用新的数据收集技术，交互式语音响应，收集有关饮酒，性行为和心理变量之间的日常关系的数据，以介导治疗反应。我们的目标是：1）使用主动和被动招聘策略招募240个问题的样本； 2）用50 mg的NTX或安慰剂评估12周随机分配的治疗的功效，并结合经过改进的行为自我控制疗法或短暂的支持疗法的疗效； 3）评估大量饮酒与艾滋病毒风险行为的可能性之间的有条件关系； 4）评估情绪，渴望，自我效能，动机和饮酒之间的日常联系。评估将包括基线，3、6和9个月的随访。 该应用与酒精中毒治疗和预防HIV相关。首先，我们将评估在未经研究但独特的人群中尚待饮酒的既定治疗方法，即 MSM。其次，我们将研究以酒精为中心的治疗对非常高风险人群中艾滋病毒风险行为的影响。第三，我们将使用新的数据收集技术来检查饮酒，艾滋病毒风险和心理因素之间的复杂关系，以更好地为将来的干预提供信息。