Project Details
Description
Project Summary
The broad goal of the proposed work is to conduct a randomized controlled trial of a specialized computer-
delivered cognitive-behavioral therapy (CBT) to supplement standard alcohol use disorder (AUD) treatment in
patients with a co-occurring anxiety disorder (“comorbidity”). Comorbidity is both common in AUD treatment
patients (up to 50%) and confers a substantial increase in the risk of a return to drinking in the months
following treatment. Because research shows that simply adding a standard psychiatric treatment does not
substantially improve the AUD outcomes of comorbid individuals, we developed a CBT-based intervention
aimed at disrupting the positive-feedback loop (“vicious cycle”; VC) of mutually aggravating negative affect and
drinking behavior/urges (the “VC-CBT”). In an RCT, AUD treatment patients who received the therapist-
delivered VC-CBT demonstrated significantly improved alcohol use outcomes as compared to those who
received a standard anxiety treatment. Unfortunately, most community-based AUD treatment programs do not
have clinical staff with the specialized training and technical expertise needed to deliver the VC-CBT. To help
bridge this “research-to-practice” gap, we went on to develop a fully autonomous and interactive computer-
delivered version of the VC-CBT and have demonstrated its functionality in AUD patients. Now, we propose to
test the clinical efficacy of the computer-delivered VC-CBT, as well as the mechanisms and processes by
which it is hypothesized to work. Aim I is a randomized controlled trial comparing the computer-delivered VC-
CBT to an intensity-matched computer-delivered active control intervention that focuses on healthy lifestyles.
256 individuals in residential AUD treatment who have a comorbid anxiety disorder will receive either the VC-
CBT or the active control intervention to obtain 200 cases that complete a 1-, 4- and 8-month follow-up. We
predict the VC-CBT group will demonstrate superior alcohol-related outcomes at follow-up relative to the
control group. Aim II evaluates the extent to which the computer-delivered VC-CBT selectively imparts the
skills and knowledge targeted and whether they convey (mediate) the interventions therapeutic effect. This
entails a formal series of “causal steps” analyses of the associations of: treatmentskills/knowledge;
skills/knowledge outcomes; and, treatmentoutcomes with vs. without statistically controlling the effect of
skills/knowledge. Aim III will test the theoretically-derived prediction that the computer-delivered VC-CBT
moderates (i.e., weakens) the association between levels of real-time negative affect and drinking behavior/
urge. This will be accomplished by analyzing a series of twice-daily ecological momentary assessments
(EMAs) that participants record in their natural environment for the 7 days prior to each of the three follow-up
assessments. The impact of this work would be to provide a scalable and inexpensive means of improving
the otherwise poor AUD treatment outcomes of comorbid AUD treatment patients. The work will also provide
new scientific knowledge about the mechanisms and processes of change in comorbidity treatment.
Status | Finished |
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Effective start/end date | 5/15/21 → 3/31/24 |
Funding
- National Institute on Alcohol Abuse and Alcoholism: $436,500.00
- National Institute on Alcohol Abuse and Alcoholism: $458,211.00
- National Institute on Alcohol Abuse and Alcoholism: $455,930.00
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