Harm-reduction treatment for homeless adults with alcohol-use disorders (HaRT-A)

对患有酒精使用障碍的无家可归成年人进行减害治疗 (HaRT-A)

• 批准号: 8854001
• 负责人: Susan E Collins
• 金额: $ 25.41万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8854001
• 关键词: Abstinence; Achievement; Address; Adherence; Adult; Advocate; Affect; Aftercare; Alcohol consumption; Alcohol dependence; Alcohols; Anus; Behavior Therapy; Behavioral; Client; Code; Communities; Competence; Criminal Justice; Data; Development; Disadvantaged; Drops; Ensure; Evaluation; Evidence based practice; Feedback; Focus Groups; Foundations; General Population; Glean; Goals; Guidelines; Harm Reduction; Health; Healthcare; Homelessness; Individual; Intervention; Interview; Manuals; Measurement; Measures; Morbidity - disease rate; Motivation; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Phase; Population; Positioning Attribute; Process; Public Health; Qualitative Evaluations; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Research; Research Personnel; Research Project Grants; Sampling; Services; Staging; Testing; Time; Treatment Efficacy; United States National Institutes of Health; Work; alcohol use disorder; base; behavior change; community based participatory research; comparative; design; drinking; efficacy testing; evidence base; flexibility; health care service utilization; health related quality of life; improved; innovation; interest; member; programs; response; skills; theories; therapy design; therapy development; treatment as usual

DESCRIPTION (provided by applicant): Homelessness and alcohol-use disorders (AUDs) are commonly co-occurring and serious public health issues. Unfortunately, abstinence-based treatment approaches are generally ineffective in engaging and successfully treating homeless individuals with AUDs. There have therefore been calls for more flexible and client-centered approaches tailored to this population. In response to this need, we are proposing the development and pilot evaluation of a harm-reduction treatment for homeless individuals with AUDs (HaRT-A) as an innovative, empirically informed and client-driven alternative to abstinence-based AUD treatment. As initially planned, the HaRT-A will comprise a 3-session, individual, behavioral intervention. Preliminary components include providing personalized alcohol feedback, eliciting clients' harm-reduction goals, building motivation to change, and encouraging safer drinking using a nonjudgmental, empathetic stance, and acceptance of clients wherever they are along the spectrum of behavior change. To maximize its efficacy, the HaRT-A is being collaboratively designed with a community advisory board (CAB) made up of homeless advocates as well as staff, management and clients (i.e., homeless individuals with AUDs) at two, nonprofit agencies on the forefront of harm reduction oriented supportive service provision for homeless individuals. Consistent with NIH Stage I treatment development guidelines, we will develop and pilot test the HaRT-A in four phases. In Phase I, we will collect qualitative data via interviews and focus groups with agency clients and staff. Grounded theory analyses will yield a conceptual/thematic description of key alcohol themes and will thereby identify potential points for intervention to be addressed in the HaRT-A. In Phase II, we will develop the HaRT-A treatment manual using qualitative data gleaned from Specific Aim 1; evidence-based, best-practice approaches; and guidance of the CAB. Phase III will feature a small, pilot RCT (N=160) of the HaRT-A at the two agencies. Participants will be randomized to receive either the HaRT-A or agency services as usual (TAU), and will be assessed at baseline, posttest (immediately following treatment end), 1-month and 3-month follow-ups. Quantitative analyses will test the efficacy of the HaRT-A compared to TAU. It is hypothesized that HaRT-A participants will show significantly greater improvements on alcohol outcomes, motivation to change, and health-related quality of life (HRQoL) compared to TAU participants. Secondary, exploratory analyses will preliminarily test HaRT-A effects on health-care and criminal justice utilization outcomes up to 6 months posttreatment. Consistent with NIH treatment fidelity recommendations, treatment integrity will be tested in Phase IV of this project. In achieving these specific aims, this project will lay the groundwork for longer-term research objectives, including a larger RCT of the HaRT-A and dissemination of this intervention to researchers, clinicians and community-based organizations to improve outcomes for affected individuals and their communities.

描述（由申请人提供）：无家可归和酒精使用障碍 (AUD) 是常见的同时发生的严重公共卫生问题。不幸的是，基于禁欲的治疗方法通常无法有效地利用 AUD 吸引和成功治疗无家可归者。因此，有人呼吁针对这一人群采取更灵活、以客户为中心的方法。为了满足这一需求，我们提议开发并试点评估一种针对无家可归者的 AUD 减害治疗 (HaRT-A)，作为基于戒断的 AUD 治疗的一种创新的、基于经验的、以客户为导向的替代方案。按照最初计划，HaRT-A 将包括 3 个疗程的个人行为干预。初步组成部分包括提供个性化的酒精反馈，激发客户的减少伤害目标，建立改变的动力，以非评判性、同理心的立场鼓励更安全的饮酒，并接受客户在行为改变过程中的任何阶段。为了最大限度地提高其功效，HaRT-A 正在与一个社区咨询委员会 (CAB) 合作设计，该委员会由无家可归者倡导者以及两个最前沿的非营利机构的员工、管理层和客户（即持有澳元的无家可归者）组成。为无家可归者提供以减少伤害为导向的支持服务。根据 NIH 第一阶段治疗开发指南，我们将分四个阶段开发和试点测试 HaRT-A。在第一阶段，我们将通过与代理客户和员工的访谈和焦点小组收集定性数据。扎根理论分析将得出关键酒精主题的概念/主题描述，从而确定 HaRT-A 中要解决的潜在干预点。在第二阶段，我们将使用从特定目标 1 收集的定性数据来制定 HaRT-A 治疗手册；基于证据的最佳实践方法；和 CAB 的指导。第三阶段将在两个机构进行 HaRT-A 的小型试点随机对照试验 (N=160)。参与者将被随机分配接受 HaRT-A 或照常机构服务 (TAU)，并将在基线、后测试（治疗结束后立即）、1 个月和 3 个月随访时进行评估。定量分析将测试 HaRT-A 与 TAU 相比的功效。据推测，与 TAU 参与者相比，HaRT-A 参与者在酒精结果、改变动机和健康相关生活质量 (HRQoL) 方面将表现出显着更大的改善。其次，探索性分析将初步测试 HaRT-A 在治疗后 6 个月内对医疗保健和刑事司法利用结果的影响。根据 NIH 治疗保真度建议，治疗完整性将在该项目的第四阶段进行测试。为了实现这些具体目标，该项目将为长期研究目标奠定基础，包括对 HaRT-A 进行更大规模的随机对照试验，并向研究人员、临床医生和社区组织传播这种干预措施，以改善受影响个人及其健康状况。社区。