Clinical Course of Alcohol Use Disorder Recovery

酒精使用障碍康复的临床过程

基本信息

批准号：
10707414
负责人：
STEPHEN A MAISTO
金额：
$ 60.14万
依托单位：
UNIVERSITY OF SOUTH FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-20 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10707414
关键词：
Abstinence Address Adult Affective Aftercare Age Alcohol consumption American Area Behavior Behavior Therapy Behavioral Behavioral Mechanisms Behavioral inhibition Categories Clinical Clinical Markers Clinical Research Cognitive Communities DSM-V Data Analyses Data Collection Diagnosis Dimensions Disease remission Enrollment Frequencies Goals Grant Heavy Drinking Impulsivity Individual Interview Knowledge Literature Measures Modeling Monitor Motivation National Institute on Alcohol Abuse and Alcoholism Nature Outcome Participant Patient Recruitments Pattern Personal Satisfaction Persons Phase Probability Process Psychotherapy ROC Curve Recommendation Recovery Recurrence Relapse Research Self Efficacy Severities Structure Subgroup Survival Analysis Symptoms Testing Theoretical model Therapeutic Time Treatment Protocols Treatment outcome alcohol abuse therapy alcohol use disorder base behavior change clinical decision-making clinical practice clinically relevant craving depression model design effective intervention follow-up heuristics improved insight interest meetings negative affect novel partial recovery person centered primary outcome recruit response sustained recovery therapy design treatment duration treatment program treatment response

项目摘要

Project Summary/Abstract Alcohol use disorder (AUD) continues to be a widespread problem with an estimated 29% of all Americans ages 12 and up meeting DSM-5 criteria for diagnosis during their lifetime (13.9% within the past 12 months; Grant et al., 2015). Although abstinence remains as the primary outcome for many treatment programs, such definitions of “recovery” remain far too narrow. Recently, NIAAA disseminated a definition of recovery aimed at addressing limitations of past research, stimulating new research, and better operationalizing recovery (NIAAA, 2020). Specifically, NIAAA defines recovery as “a process through which an individual pursues both remission from AUD and cessation from heavy drinking.” They further go on to state that “an individual may be considered recovered if both remission from AUD and cessation from heavy drinking are achieved and maintained over time.” Although this new operational definition will help to organize the existing literature and provide guidance for future research, several questions remain. First, categorization of recovery as initial, early, sustained, and stable requires further research to establish whether such thresholds are meaningful in both clinical practice and research. Second, the utility of heavy drinking thresholds to define recovery remains questionable at best. Finally, the new definition does not provide a conceptual framework for which recovery is a “process” requiring continual monitoring for clinical markers (clinical change points) that may impact recovery status. The aim of the current application is to examine the utility and validity of this new definition within the context of a novel theoretical model of AUD recovery. The proposed study will recruit participants seeking treatment for AUD from the community. Participants will complete a structured clinical interview and provide information on their current alcohol use and related behaviors. All participants will receive 12 weeks of AUD psychotherapy and complete brief assessments at the end of each treatment session and biweekly during the first 12-months post treatment. In addition, participants will complete in-person interviews at 3-month and 6- month intervals post-treatment for the duration of the study (for up to 24-54 months post treatment depending on time of enrollment). Findings from the proposed research have the potential to increase understanding of the dynamic nature of recovery and thereby improve clinical decision-making and generate future research. Specifically, our goal is to address the question of “Are the constructs of relapse, recurrence remission, or recovery useful heuristics for clinical practice and research, and if so, how?” Identification of the processes important for each type of change in clinical course may help in designing adaptive treatments that capitalize on our current knowledge of the treatment literature. For example, people may need to use different strategies (e.g., weighing pros/cons, substituting new behaviors) for different phases of recovery. To our knowledge, this application is the first to test NIAAA’s new definition and the dynamic nature of recovery, as well as cognitive, behavioral, and affective processes hypothesized to be important for initiating versus maintaining change.

项目概要/摘要酒精使用障碍 (AUD) 仍然是一个普遍存在的问题，估计有 29% 的美国人患有酒精使用障碍 (AUD) 12 岁及以上一生中符合 DSM-5 诊断标准的人（13.9% 是在过去 12 个月内； Grant 等人，2015）。尽管戒酒仍然是许多治疗方案的主要结果，例如最近，NIAAA 发布了旨在恢复的定义。解决过去研究的局限性，激发新的研究，并更好地实施恢复（NIAAA，具体而言，NIAAA 将康复定义为“个人追求缓解的过程”。他们进一步指出，“一个人可能会如果 AUD 得到缓解并戒掉酗酒，则视为已康复，并且尽管这个新的操作定义将有助于组织现有的文献和为未来的研究提供指导，但仍然存在几个问题：首先，将恢复分类为初始，早期、持续和稳定需要进一步研究以确定这些阈值在其次，重度饮酒阈值对于定义恢复的作用仍然存在。最后，新的定义并没有提供恢复的概念框架。需要持续监测可能影响康复的临床标志物（临床变化点）的“过程” 当前申请的目的是检查这个新定义在范围内的实用性和有效性。拟议的研究将招募寻求澳元复苏的新颖理论模型的背景。参与者将完成结构化的临床访谈并提供来自社区的 AUD 治疗。有关其当前饮酒情况和相关行为的信息所有参与者都将收到 12 周的澳元。在每次治疗结束时以及治疗期间每两周进行一次心理治疗并完成简短评估此外，参与者将在治疗后 3 个月和 6 个月完成面对面访谈。在研究期间，治疗后间隔一个月（治疗后长达 24-54 个月，具体取决于拟议研究的结果有可能增加对以下问题的理解：恢复的动态性质，从而改善临床决策并产生未来的研究。具体来说，我们的目标是解决“复发、复发缓解或恢复对临床实践和研究有用的启发式方法，如果是的话，如何识别过程？” 对于临床过程中的每种类型的变化都很重要，可能有助于设计利用这些变化的适应性治疗例如，根据我们目前对治疗文献的了解，人们可能需要使用不同的策略。据我们所知，针对不同的恢复阶段（例如，权衡利弊、替代新行为）。该应用程序是第一个测试 NIAAA 的新定义和恢复的动态性质以及认知、行为和情感过程的发展对于发起和维持变革非常重要。