Improving brief alcohol interventions with a behavioral economic supplement

通过行为经济补充改善短暂的酒精干预

• 批准号: 8371808
• 负责人: JAMES G. MURPHY
• 金额: $ 45.73万
• 依托单位: UNIVERSITY OF MEMPHIS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8371808
• 关键词: Administrator; Adopted; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Behavior; Behavioral; Caring; Control Groups; Controlled Study; Cost-Benefit Analysis; Costs and Benefits; Development; Drug Controls; Economics; Evaluation; Feedback; Female; Goals; Heavy Drinking; Individual; Intervention; Intervention Trial; Measures; Mediating; Mediation; Mediator of activation protein; Methods; Minority; Modality; National Institute on Alcohol Abuse and Alcoholism; Neurobiology; Outcome; Participant; Pattern; Persons; Preventive; Preventive Intervention; Psychological reinforcement; Randomized; Randomized Clinical Trials; Recruitment Activity; Relative (related person); Relaxation; Relaxation Therapy; Reporting; Research; Research Proposals; Rewards; Risk Factors; Students; Substance abuse problem; Testing; Time; Translational Research; Universities; active control; alcohol demand; alcohol intervention; alcohol related problem; base; brief alcohol intervention; brief motivational intervention; career; college; cost; cost effective; cost effectiveness; discounting; drinking; follow-up; heavy drinking college student; improved; innovation; pilot trial; post intervention; public health priorities; reduced alcohol use; response; success; theories; treatment response; university student; young adult

DESCRIPTION (provided by applicant): Brief motivational interventions (BMIs) for young adult alcohol abuse are among the most cost-effective preventive care measures, yet there has been relatively little theory-based research aimed at improving their efficacy and identifying mechanisms of change. Based on research indicating that low-levels of substance-free reinforcement is a risk factor for poor BMI response, this research team developed and pilot tested a supplemental session to traditional feedback and MI-based alcohol interventions. This session directly targets the behavioral economic mechanisms of substance-free reinforcement and delayed reward discounting by encouraging the development of and commitment to academic and career goals, and by and highlighting the impact of day-to-day patterns of heavy drinking and academic engagement on these goals. A pilot trial (R21AA016304) found that a two session (alcohol BMI + Substance-Free Activity Session; SFAS) intervention resulted in significantly greater reductions in alcohol problems (p = .01, db= .52) relative to a two session (alcohol BMI + Relaxation) active control condition. The BMI + SFAS was also associated with significantly greater reductions in heavy drinking for participants with lower levels of substance-free reinforcement at baseline. This was the first controlled study to demonstrate that a supplement to traditional BMIs can improve outcomes. The current proposal would improve and more extensively evaluate the efficacy of the SFAS in a randomized 3-group (BMI + SFAS vs. BMI + Relaxation Training vs. Assessment only) trial with 425 first and second year college students (projected 50% female and 20% minority) who report recent heavy drinking recruited from two large public universities. The results will determine whether the SFAS enhances the efficacy of a standard BMI while controlling for total contact time. Drinking and substance-free activity outcomes will be assessed 1, 4, 12 and 16 months post-intervention. It is hypothesized that at follow-up BMI + SFAS participants will report significantly lower levels of drinking and alcohol-related problems, and higher levels of constructive substance-free activities, than BMI + Relaxation and assessment only participants, and that the predicted advantage for BMI + SFAS will be mediated by increased participation in substance-free activities and reduced delay discounting. It is further hypothesized that the BMI + SFAS intervention will be more effective for participants who report high baseline alcohol reinforcing efficacy (measured using demand curve and proportional substance-related reinforcement measures) and greater delayed reward discounting than those who report low reinforcing efficacy and delayed reward discounting. This study will also evaluate the economic costs and benefits associated with the BMI + SFAS intervention relative to an active control condition. Should this behavioral economic supplement demonstrate efficacy and cost-effectiveness then clinicians would have a more effective modality for attempting to reduce alcohol use in young adult drinkers, and administrators would have an economic rationale for adopting the intervention in their universities. PUBLIC HEALTH RELEVANCE: Relevance Brief motivational interventions (BMIs) for alcohol abuse are among the most cost-effective preventive care measures, and the development and evaluation of innovative methods for improving BMIs is one of the public health priorities highlighted in the 2010 National Drug Control Strategy. The goal of this research is to improve BMIs by adding a session focused on increasing engagement in constructive alternatives to alcohol use.

描述（由申请人提供）：针对年轻人酗酒的简短动机干预措施（BMI）是最具成本效益的预防性护理措施之一，但旨在提高其功效和确定变化机制的基于理论的研究相对较少。研究表明，低水平的无物质强化是 BMI 反应不佳的一个风险因素，该研究团队开发并试点测试了传统反馈和基于 MI 的酒精干预措施的补充课程。本次会议通过鼓励学术和职业目标的发展和承诺，以及强调日常大量饮酒和学术参与模式的影响，直接针对无物质强化和延迟奖励折扣的行为经济机制。这些目标。一项试点试验 (R21AA016304) 发现，与两个疗程（酒精 BMI + 无物质活动疗程；SFAS）干预相比，两个疗程（酒精 BMI + 无物质活动疗程；SFAS）干预可显着减少酒精问题（p = .01，db= .52） BMI+放松）主动控制状况。 BMI + SFAS 还与基线时无物质强化水平较低的参与者的酗酒显着减少相关。这是第一项证明补充传统体重指数可以改善结果的对照研究。目前的提案将改进并更广泛地评估 SFAS 在一项随机 3 组（BMI + SFAS 与 BMI + 放松训练与仅评估）试验中的功效，该试验有 425 名一年级和二年级大学生（预计 50% 为女性和20% 的少数民族）从两所大型公立大学招募了最近酗酒的人。结果将确定 SFAS 是否在控制总接触时间的同时增强标准 BMI 的功效。将在干预后 1、4、12 和 16 个月评估饮酒和无物质活动结果。假设在后续的 BMI + SFAS 参与者中，与仅 BMI + 放松和评估参与者相比，饮酒和酒精相关问题的水平明显较低，而建设性的无物质活动水平较高，并且预测的优势BMI + SFAS 将通过增加对无物质活动的参与和减少延迟折扣来调节。进一步假设 BMI + SFAS 干预对于 与那些报告低强化功效和延迟奖励折扣的参与者相比，报告高基线酒精强化功效（使用需求曲线和比例物质相关强化措施测量）和更大延迟奖励折扣的参与者。这项研究还将评估与主动控制条件相关的 BMI + SFAS 干预相关的经济成本和效益。如果这种行为经济补充剂表现出功效和成本效益，那么临床医生将有一种更有效的方式来尝试减少年轻成年饮酒者的饮酒，而管理人员也将有经济理由在他们的大学采取干预措施。 公共卫生相关性：相关性针对酒精滥用的简短动机干预措施 (BMI) 是最具成本效益的预防保健措施之一，开发和评估改善 BMI 的创新方法是 2010 年国家药物管制中强调的公共卫生优先事项之一战略。这项研究的目标是通过增加一个专注于增加对酒精使用的建设性替代方案的参与度的会议来改善体重指数。