UNIVERSITY OF TENNESSEE
Grant: $73,500 - National Institutes of Health - May. 4, 2009
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Award Description: Although advances in the treatment of alcohol and drug dependence have led to major reductions in substance use, relapse remains a prevalent national problem. Commonly espoused theories of relapse and relapse prevention have long suggested that background or distal factors (e.g., psychopathology, chronic stress) interact with proximal factors (e.g., cravings, negative affect) to increase risk for a lapse or relapse. While researchers have linked a number of these important distal and proximal factors with risk for lapse and relapse, most studies typically assessed proximal variables using retrospective reports rather than prospective reports of momentary behaviors, affect, cognitions, and situational factors. Unlike retrospective methodologies which cannot provide direct evidence of the variables present in the hours preceding a lapse or relapse, experience sampling methodology allows researchers to assess real-time reports of affect and behavior that can be used to establish a temporal connection between proximal variables and lapses/relapse with great precision. To the extent that such factors precede and predict lapses and relapse, they may be appropriate targets for relapse prevention. To date, experience sampling technology has been used mostly to better understand relapse to smoking. These techniques have just begun to be used in research on relapse to alcohol and other drugs, and thus, the extent to which distal factors interact with proximal variables in predicting lapse and relapse with these substances using experience sampling technology is grossly understudied. Therefore, we propose to conduct a prospective, longitudinal pilot study of the feasibility of using experience sampling to assess the proximal variables surrounding relapse using a sample of 100 patients entering intensive outpatient treatment for alcohol and/or drug dependence. Men and women will complete a baseline assessment to gather demographic and other distal information, including psychopathology, substance use patterns, copying styles, relationship functioning, etc. Fifty patients will be randomized to use handheld computers for 4 months to respond to random and scheduled prompts asking them to chronicle experiences with substance-related cues, cravings, negative affect, interpersonal experiences, lapses and relapse. All participants will participate in a follow-up session at 2 and 4 months following treatment entry to complete additional questionnaires. The long-term purpose of this study is to identify methods to best examine the interactive influence of distal and proximal variables on lapse and relapse to substance use in order to enhance relapse prevention efforts. The specific purposes/aims of the present application are: Aim A.1. To establish feasibility to conduct a larger trial examining risk factors for relapse by demonstrating high recruitment, retention, and experience sampling compliance rates among patients involved in substance abuse treatment. Aim A.2. To examine the extent to which distal and proximal factors vary over time within and between participants and interact to increase risk for lapses and relapse. This information will be used to establish a stable effect size estimate for use in a larger trial. This study holds the promise of identifying risk factors involved in the temporal sequence of events that may lead to a lapse or relapse. Men and women in treatment for substance dependence are especially important to study because upwards of 60% of these patients will reenter treatment after experiencing a relapse. Thus, substance dependent patients are an at-risk group who may benefit if provided with more effective relapse prevention strategies. Identifying the factors that are distally and proximally related to the onset of a lapse and/or relapse could lead to inform relapse prevention efforts, leading to significant reductions in relapse.
Project Description: To achieve the specific aims noted above, we propose to conduct a prospective, longitudinal pilot study of the feasibility of using experience sampling to assess the proximal variables surrounding relapse using a sample of 100 patients entering intensive outpatient treatment for alcohol and/or drug dependence. Men and women will complete a baseline assessment to gather demographic and other distal information. Fifty patients will be randomized to use handheld computers for 4 months to respond to random and scheduled prompts asking them to chronicle experiences with substance-related cues, cravings, negative affect, interpersonal experiences, and relapse. All participants will participate in a follow-up session at 2 and 4 months following treatment entry to complete additional questionnaires. To date, we have recruited and completed baseline assessments with 90 of the 100 proposed participants. Forty-five of these participants have been randomized to receive the handheld computers and complete random and daily surveys on their cravings, negative affect, etc. We have completed 2 month follow-ups with 34 participants, and 4 month follow-ups with 19 participants. Most importantly, we have received over 6,000 random and daily surveys from participants during this relatively brief study period. Participants are completing an average of 50% of the surveys, or 2 surveys each day for 4 months. Analyses examining relapse are pending additional follow-up data, but initial compliance rates are very promising and suggest that we will be able to achieve the primary goals of the study.
Infrastructure Description: This is a conditional field. This grant is NOT for Infrastructure projects.
Jobs Summary: It is important to note that the current proposal was originally submitted and awarded by the National Institute on Drug Abuse (NIDA) in response to PAR-06-541-Behavioral Science Track Award for Rapid Transition (B/START). Thus, it was not originally submitted as an ARRA proposal nor did it propose to create or retain jobs. Though the current project did not specifically create a job as defined by ARRA, we have hired a technical consultant from the study recruitment site to provide intermittent programming of handheld computers and assist with technical problems with the computers. He is not on payroll and works on an as-needed basis. No other jobs have been created or retained within this project. However, given the nature of this one-year, low-budget project, we anticipate and fully intend to use the data to establish stable effect sizes for use in proposing a larger study examining risk for relapse. This proposal will likely be submitted in 2010, and if funded, will aim to create at least one full-time position to assist with the logistical and technical issues involved in using handheld computers to assess relapse. (Total jobs reported: 0)
Project Status: Less Than 50% Completed
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