Individualized Assessment and Treatment Program for Alcoholism: Treatment and Mechanisms

酗酒个体化评估和治疗方案：治疗和机制

• 批准号: 9976405
• 负责人: MARK D. LITT
• 金额: $ 56.03万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9976405
• 关键词: Abstinence; Adoption; Affect; Attention; Behavior; Behavioral Mechanisms; Case Management; Clinical; Cognition; Cognitive Therapy; Coping Behavior; Coping Skills; Data; Development; Distal; Effectiveness; Enrollment; Evaluation; Exposure to; Feeling; Health behavior; Home environment; Lead; Light; Literature; Maintenance; Measures; Mediating; Modeling; Modification; Moods; Motivation; Outcome; Participant; Patients; Pattern; Pilot Projects; Play; Procedures; Process; Reporting; Research; Role; Sampling; Self Efficacy; Self-control as a personality trait; Social support; Testing; Therapeutic; Thinking; Time; Training; Treatment outcome; Work; alcohol abuse therapy; alcohol intervention; alcohol use disorder; alcoholism therapy; base; behavior change; coping; design; drinking; effective therapy; experience; follow-up; high risk; high risk drinking; improved; in vivo; individualized medicine; mindfulness; programs; psychosocial; response; skill acquisition; skills; sobriety; time use; treatment effect; treatment planning; treatment program; treatment services

Our 2009 R-21 pilot project developed a cognitive-behavioral treatment for alcohol use disorders that employs cellphone-based experience sampling (ES) to collect detailed patient data in near real-time, and uses those data to direct treatment for each patient based on his/her specific patterns of drinking and specific coping actions during actual high-risk situations. ES data included situations, thoughts and feelings antecedent to drinking episodes, and any use of coping skills. The object was to create a CB treatment that was more relevant for each patient and more effective than current treatments. In our initial study the Individualized Assessment and Treatment Program (IATP) yielded better drinking rates at posttreatment, and more adaptive changes in coping, than a conventional manualized CBT program. Moreover, changes in drinking were partly mediated by pre-to-posttreatment changes in coping with high-risk situations. Questions unanswered included: 1. Because the pilot study only collected data pre and posttreatment, with no follow-ups, it is not clear whether use of coping skills reduced drinking, or whether reduced drinking led to more adaptive coping. 2. We do not know which coping skills or other factors drive outcomes in the long-term. To answer these and other questions we propose to enroll 207 patients in a full-scale trial of IATP with extended follow-ups to examine determinants of outcomes over time. IATP will be compared to a more conventional packaged CB treatment (PCBT), and to a Case Management Control condition (CaseM), in a dismantling design. In addition to coping, we intend to evaluate a number of other possible treatment mechanisms suggested by the literature including motivation, self-efficacy, self-control, social support, alliance with the therapist, AA involvement, mindfulness, and utilization of other treatment services. By specifically training coping skills for use in high-risk for drinking situations, we will be able to assess how skills per se contribute to initiation and long-term maintenance of behavior change. The use of ES during treatment will allow us to determine what patients are actually doing, in close to real time, to initiate and maintain their own sobriety. The use of ES in the follow-up period will allow us to determine whether coping skills that were active in initiation of reduced drinking continue to be active in the long-term, as well as the extent to which other mechanisms may come into play. In this way we can develop a clearer picture than ever before of the processes that affect outcomes of CBT, and will enable clinicians to focus more precisely on the most relevant mechanisms of change. Comparing IATP with PCBT will test effects of tailoring skills. The use of CaseM will control for the general effects of study participation (i.e., “common factors”), especially therapist support. The study builds on pilot data and on procedures that have already been developed but not fully tested. This would be the first study to evaluate effects of treatment on actual behaviors and cognitions in high- risk situations as they occur.

我们2009年R-21试点项目开发了一种针对员工饮酒障碍的认知行为治疗 基于手机的体验抽样（ES）以接近实时收集详细的患者数据，并使用这些数据 根据他/她的特定饮酒模式和特定应对的数据来指导每个患者的治疗 在实际高风险情况下的行动。 ES数据包括前提的情况，思想和感受 喝酒情节以及任何应对技巧的使用。目的是创建一种CB治疗 与每个患者有关，比目前的治疗更有效。在我们的初步研究中 评估和治疗计划（IATP）在治疗后产生更好的饮酒率，并且更适应性 应对的变化，而不是传统的手动CBT程序。而且，饮酒的变化部分是 通过在应对高风险情况下的应对前进行术前处理的变化介导。未解决的问题包括： 1。由于试验研究仅收集了治疗前和治疗后的数据，因此尚不清楚 是否使用应对技巧可以减少饮酒，还是减少饮酒会导致更适应性应对。 2。我们不知道长期以来哪些应对技巧或其他因素会带来结果。 要回答这些问题和其他问题，我们建议将207名患者招募参加IATP的全面试验 扩展的随访，以检查随着时间的推移结果确定结果。将IATP与更多 常规包装的CB治疗（PCBT），以及案例管理控制条件（CASEM） 拆卸设计。除了应对外，我们还打算评估许多其他可能的治疗方法 文献提出的机制，包括动机，自我效能，自我控制，社会支持，联盟 与治疗师，AA的参与，正念和其他治疗服务的利用。 通过专门培训应对技巧以用于饮酒情况的高风险使用，我们将能够评估如何评估 技能本身有助于行为改变的倡议和长期维护。在期间使用ES 治疗将使我们能够确定患者实际在实时做什么，以启动和 保持自己的清醒。在后续期间使用ES的使用将使我们能够确定是否应对 从长远来看，积极开始饮酒的技能继续保持活跃， 其他机制可能发挥作用的程度。这样，我们可以比以往任何时候都更清晰 在影响CBT结果的过程之前，将使临床医生更加精确地专注于 最相关的变化机制。将IATP与PCBT进行比较将测试调整技巧的效果。使用 CASEM将控制研究参与的一般影响（即“共同因素”），特别是治疗师 支持。该研究以试点数据和已经开发但尚未完全开发的程序为基础 测试。这将是第一个评估治疗对高级行为和认知影响的影响的研究 发生风险情况。