Time Horizons and the Behavioral Economics of Recovery from Drinking Problems

饮酒问题恢复的时间范围和行为经济学

• 批准号: 7933528
• 负责人: JALIE A TUCKER
• 金额: $ 57.29万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-15 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7933528
• 关键词: Abstinence; Address; Alcohol abuse; Alcohols; Behavior; Behavior Control; Behavioral; Benchmarking; Clinical; Clinical Treatment; Communities; Dimensions; Economics; Effectiveness; Enrollment; Equilibrium; Evaluation; Expenditure; Foundations; Future; Goals; Heavy Drinking; Individual; Intervention; Knowledge; Measurement; Measures; Mediating; Methods; Outcome; Participant; Pathway interactions; Pattern; Persons; Population; Process; Prospective Studies; Public Health; Questionnaires; Recording of previous events; Recovery; Regulation; Relapse; Relative (related person); Research; Resolution; Rewards; Risk; Sampling; Savings; Services; Severities; Shapes; Time; Time Study; addiction; alcohol related problem; alcohol services; cost; design; discounting; drinking; experience; help-seeking behavior; improved; indexing; interest; outcome forecast; problem drinker; psychologic; public health relevance; research study; restraint; social

DESCRIPTION (provided by applicant): Persons with addictive disorders tend to favor discrete choices involving less valuable, more immediate options (e.g., drinking) over engaging in behavior patterns with delayed positive consequences that are more valuable overall and more conducive to recovery. Behavioral economics provides new concepts and methods to study how the "time horizons" of problem drinkers serve to organize their behavior around present vs. future goals and whether these choice processes serve as a mechanism of change in recovery. This 5-year R01 application will evaluate whether changes in time horizons are temporally related to changes in drinking in community- dwelling problem drinkers who recently stopped excessive drinking on their own (N = 265). Use of a natural recovery sample will maximize variability in dimensions of interest and will address unsettled issues about non- abstinent resolutions, which are more common among natural than treatment-assisted recoveries. Participants will be enrolled soon after resolution onset when initial changes are unstable and relapse risk is high. Drinking problem severity, help-seeking history, and behavioral economic and other measures of time-sensitivity to delayed outcomes will be assessed at baseline, and then time horizon and drinking variables will be assessed prospectively at 3, 6, 9, and 12-months. Three hypotheses will be addressed: (1) Even when drinking heavily, are problem drinkers with greater sensitivity to longer term contingencies more likely to maintain stable resolutions? (2) Do drinkers who maintain stable non-abstinent resolutions organize their behavioral allocation over longer intervals compared to those who remain abstinent or relapse? (3) Do changes in sensitivity to delayed contingencies predict subsequent changes in drinking, including ability to reach and maintain non- abstinent resolutions? The first two hypotheses replicate and extend previous research on stable abstinent and non-abstinent resolutions. The third hypothesis addresses whether changes in time horizons precede changes in drinking and will evaluate the time horizon construct as a potential mechanism of change. The study also will establish how the multiple time sensitivity measures inter-relate and change over time, which will inform method selection in clinical and public health settings. To our knowledge, the study offers the first longitudinal multivariate evaluation of whether changes in time horizons are temporally related to changes in drinking among recently resolved problem drinkers. In addition to elucidating mechanisms of change, the results have potential for increasing the appeal and population impact of services for alcohol problems. PUBLIC HEALTH RELEVANCE: The pathways, processes, and mechanisms of change by which problem drinkers resolve their alcohol-related problems will be investigated prospectively using a large, diverse community sample of problem drinkers who recently stopped excessive drinking on their own. Most problem drinkers do not seek help, many recover on their own, and studying natural recoveries has potential for increasing the appeal, effectiveness, and population impact of services for alcohol-related problems. The proposed research will focus on drinkers' "time horizons," or the extent to which they organize their behavior around present vs. future goals, because successful recoveries likely involve a shift from a shorter to a longer view of the future and organizing behavior accordingly.

描述（由申请人提供）：患有成瘾性疾病的人倾向于选择涉及价值较低、更直接的选择（例如饮酒）的离散选择，而不是参与具有延迟的积极后果的行为模式，这些行为模式总体上更有价值，更有利于康复。行为经济学提供了新的概念和方法来研究有问题的饮酒者的“时间范围”如何围绕当前与未来的目标组织他们的行为，以及这些选择过程是否作为恢复过程中的变化机制。这项为期 5 年的 R01 应用程序将评估时间范围的变化是否与最近自行停止过量饮酒的社区居住问题饮酒者的饮酒变化暂时相关（N = 265）。使用自然恢复样本将最大限度地提高感兴趣维度的可变性，并将解决有关非戒断解决方案的未解决问题，这些问题在自然恢复中比治疗辅助恢复中更常见。当最初的变化不稳定且复发风险很高时，参与者将在解决方案开始后立即入组。将在基线时评估饮酒问题的严重程度、寻求帮助的历史以及行为经济学和其他对延迟结果时间敏感性的衡量标准，然后在 3、6、9 和 12 个月时前瞻性评估时间范围和饮酒变量。将讨论三个假设：（1）即使大量饮酒，有问题的饮酒者对长期突发事件更敏感，是否更有可能保持稳定的解决方案？ (2) 与保持戒酒或复发的饮酒者相比，保持稳定的非戒酒决心的饮酒者是否会在更长的时间间隔内组织他们的行为分配？ (3) 对延迟突发事件的敏感性的变化是否可以预测饮酒的后续变化，包括达到和维持非禁欲决心的能力？前两个假设复制并扩展了先前关于稳定禁欲和非禁欲决议的研究。第三个假设涉及时间范围的变化是否先于饮酒的变化，并将评估时间范围的构建作为潜在的变化机制。该研究还将确定多重时间敏感性测量如何随着时间的推移相互关联和变化，这将为临床和公共卫生环境中的方法选择提供信息。据我们所知，该研究首次对时间范围的变化是否与最近解决的饮酒问题的饮酒者的饮酒变化有关进行了纵向多变量评估。除了阐明变化机制外，研究结果还有可能增加酗酒问题服务的吸引力和人口影响。公共卫生相关性：将使用最近自行停止过度饮酒的大量、多样化的社区样本，对问题饮酒者解决酒精相关问题的途径、过程和机制进行前瞻性调查。大多数有问题的饮酒者不会寻求帮助，许多人会自行康复，研究自然恢复有可能增加酒精相关问题服务的吸引力、有效性和人口影响。拟议的研究将重点关注饮酒者的“时间范围”，或者说他们围绕当前与未来目标组织行为的程度，因为成功的康复可能涉及从对未来的较短看法转向长期看法，并相应地组织行为。