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: 8698679
• 负责人: JAMES G. MURPHY
• 金额: $ 42.41万
• 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/8698679
• 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.

描述（由申请人提供）：针对年轻的成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，但基于理论的研究旨在提高其疗效和确定变化机制。基于研究表明，低水平的无物质加固是BMI反应不佳的危险因素，该研究团队开发了并试点测试了对传统反馈和基于MI的酒精干预措施的补充会议。本届会议直接针对无物质增强的行为经济机制，并通过鼓励对学术和职业目标的发展和承诺，并强调大量饮酒和学术参与对这些目标的日常影响，从而推迟奖励折扣。一项初步试验（R21AA016304）发现，相对于两次疗程（酒精BMI +松弛）活动条件，相对于酒精问题（P = .01，db = .52）的两次疗程（酒精BMI +无物质活动疗法； SFA）干预显着减少了酒精问题（p = .01，db = .52）。 BMI + SFA还与基线时无物质加固水平较低的参与者的大量饮酒量显着减少有关。这是第一项对传统BMI的补充可以改善预后的对照研究。当前的提案将改善，并更广泛地评估SFA在随机的3组中的功效（BMI + SFA与BMI + BMI +放松培训与评估培训与评估）试验与425名第一年和第二年的大学生（预计为50％的女性和20％的少数族裔），他们最近从两名大型公立大学招募了最近的大量饮酒。结果将确定SFA在控制总接触时间时是否增强了标准BMI的功效。干预后，将评估1、4、12和16个月的无饮酒活动结果。假设在随访中，BMI + SFAS的参与者将明显降低饮酒和酒精相关问题的水平，而仅比BMI +放松和评估参与者更高的无建设性物质活动水平，并且BMI + SFA的预测优势将通过在物质中的参与增加而介导的BMI + SFA的优势。进一步假设BMI + SFAS干预对 报告了高基线酒精增强功效的参与者（使用需求曲线和与物质相关的增强措施测量），并且比报告低增强功效和延迟奖励折扣的参与者更大的延迟奖励折扣。这项研究还将评估与主动控制条件相对于BMI + SFA干预相关的经济成本和收益。如果这种行为经济补充剂表现出功效和成本效益，那么临床医生将具有更有效的方式来试图减少年轻成年饮酒者的饮酒方式，而管理人员将有一种经济理由来采用对大学的干预。