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）：饮酒问题男男性行为者面临旧病复发的风险，因为他们的社会环境通常与酒精有关，并且由于艾滋病毒基础感染率高以及饮酒与艾滋病毒危险行为相关，因此他们感染艾滋病毒的风险较高。尽管存在大量关于 MSM 单独治疗或与酒精滥用治疗相结合降低 HIV 风险的研究，但很少有研究探讨仅酒精治疗对 HIV 风险的影响。有饮酒问题的人最容易接受以适度饮酒而非戒酒为重点的干预措施；然而，以适度为导向的认知行为疗法（CBT）的局限性在于，其成功取决于成功实施新的饮酒冲动应对策略以及应对自我效能的发展。纳曲酮 (NTX) 也是针对有适度饮酒目标的饮酒问题者的一种行之有效的治疗方法，但其效果在治疗停止后会减弱。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疗效。我们建议将适度导向的 CBT 与 NTX 结合起来治疗酗酒问题、HIV 阳性和阴性 MSM，以评估其单独和联合治疗的疗效。我们还建议利用新的数据收集技术“交互式语音响应”来收集有关饮酒、性行为和被认为可以调节治疗反应的心理变量之间的日常关系的数据。我们的目标是： 1) 使用主动和被动招募策略招募 240 名有饮酒问题的 MSM 样本； 2) 评估 12 周随机分配治疗（使用 50 mg NTX 或安慰剂）结合改良的行为自我控制治疗或简短支持治疗的疗效； 3) 评估酗酒与艾滋病毒危险行为可能性之间的条件关系； 4) 评估情绪、渴望、自我效能、动机和饮酒之间的日常关联。评估将包括基线、3、6 和 9 个月的随访。 该应用对于酗酒治疗和艾滋病毒预防具有极大的相关性。首先，我们将评估针对尚未充分研究但独特的人群的饮酒问题的既定治疗方法，即 男同性恋者。其次，我们将研究以酒精为重点的治疗对极高危人群中艾滋病毒危险行为的影响。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，以便更好地为未来的干预措施提供信息。