The following modified versionofthe original application's Abstract gives a succinct description of the proposed researCI:l: ', This application'slong-ferl11'goal is toenharice the effectiveness of AUD relapse prevention interventions lhroughadVaricing understanding of the relationships among interpersonal stress, affect regulation, alc()hollapse, 81ld pat~erns of alcohol 'usefoHowing AUD treatment. This qpplicatipnha? two major aims: (1) To investigate the association ofAgonistic$triving (defined as a 'preoccupationwithpersonalgpalsthat involve controlling, managing, ordomiqating other 'people), affect regulation, and their interaction, with time to first lapse,and overallalcohpl use, """""""" respectively, and (2)To investi!:jate the role of interpersonal events as mediatprs of the relationship , among Agonistic Striving, affect regulation, andi3lcohol consumption in the second and third monthspost-treatrnent. The application also has 2 exploratory aims that concern the investigation of cardiac vagal tone (Vagal tone 'isthought to reflecttheabiiitytoniaintain hOJl1eQstasis)as a 'possipleindicator of affect regulation,and the relationship among Agonistic Strivi'lg, affect , regulation, and the content of perceived lapse preCipitants, fflspectively. In this study, 156 men and women,admitted to AUD h1patient treatment will be assessed at treatment entry on their alcohol 'use and related functioning, the Social Cqmpetence Interview, and Anger Transcendence Challenge. The Social Competence Interview and Anger Transcendence Challenge wiU provide . self-report, behavi()ral, and physiological data on affective responses tointerpersbr18lstressors and are the sources:of measures of Agonistic Striving and affect regulatibn,respectively. The - . assessment protocol 3lso Will include measurement of the perceivedstressfulness of interpersonal events in thenaturalenvironmentthrough the collection 6fecological momentary assessment data, . Which will be obtained by use of Interactive Voice Response technology;The eCQlogical . . momentary~ assessment will occur for 4 weeksfcillowing treatment discharge. participants will. be re'-assesseq oil their alcohol use, alcohoUapses, and relClted information biweekly following ? treatment discharge over the course of12weeks. Additionalvariables related to alco~oluse ahd relat~d functioning wHl be reassessed at6 and 12 weeks. . . . In the proposed two-ye.ar version ofthis study;
the specific aims will? not change. In effect, we propose toaccomplish~he same aims with a sample size reduced by about 28 percent (newN= 156)~Given the research design of this study, the time difference will pose little difficulty;? it simply will be a matter ofending patient recruitment earlier than we had planned origirially.On the other hand, we Will. nof have to reduce recruitment by half (2 years of fundingasopposed to 4), because We will be. able to hi.re additional research st~ff to accelerate participant recruitment rate to achieve . a sample-size thafis72percentoJ the originally proposed N= 216. Note that the proposed budget forYear 1 and Year 2 ofARRA funds reflects the hiring 'ofmorestaffthan originally proposed for the4-yearprotocolsothat recrui.tment can be accelerated. We expectsuffident patient flow Citthe . clinical site of participalitrecruitmenUo achieve this accelerated recruitment rate. We estimate that the revised sample size will allow sufficient power to detect medium effect sizes _ of interest. In this regard, the original application's proJectedsample size requirementswere conservatively based on small-medium effect size estimates, and calculations, even at that, showed power equal to 1.00 for ? 'Some of the effects tested;We expect actual critical effect Sizes closer to medium magnitude.
In recent years there have been significant advances in treatment of alcohol problems, but maintenance of change still is elusive for many, as reflected in the high rate of relapse. This application proposes a study that has the potential to significantly advance knowledge about alcohol relapse and improve the effectiveness of interventions for it, with the result of savings in costs to society and in human suffering.
