This revised competing renewal application continues research aimed at understanding resolution processes in problem drinkers and promoting resolution efforts in the community. The research is guided by behavioral economics, which provides a powerful framework for understanding substance use disorders, the hallmark of which is a persistent preference for short-term rewards (i.e., drinking) that lead to long-term costs, and a devaluation of delayed alternatives that support positive functioning. Behavioral economic theory and research support new matching hypotheses based on measures of the temporal intervals over which problem drinkers organize their behavior. Substance abusers tend to devalue or """"""""discount"""""""" delayed rewards, but those who organize their behavior over longer """"""""time horizons"""""""" are more likely to recover, and lengthening time horizons may enhance positive outcomes. The time horizon variable thus may have moderating and mediating effects on natural and intervention-assisted recovery attempts. Two interventions suitable for use in community settings, motivational interviewing (Ml) and extended self-monitoring (SM), appear to reduce problem drinking by shifting behavior allocation away from drinking and toward delayed, non-drinking rewards. But they differ in their timeframe of application, and this may interact with the time horizon variable, such that drinkers with shorter time horizons may benefit most from Ml followed by extended SM. The proposed study will evaluate these hypotheses using untreated problem drinkers (N = 330) who have quit recently or are considering quitting. They will be randomly assigned to 1 of 3 groups (n = 110) (natural resolution control, Ml only, or Ml plus SM for 6 months) and will be followed for 2 years. Structural equation modeling will be used to evaluate the moderation and mediation hypotheses. Support for the hypotheses will yield a new basis for matching based on behavior economic variables that differ than those studied in Project MATCH and will advance knowledge about mechanisms of action of these established but poorly understood interventions. Investigating these questions with an eye toward developing appealing community services for the under-served majority of problem drinkers addresses a public health priority, since this population segment contributes the bulk of harm and cost of drinking problems. The proposed research appropriately models an """"""""open economy"""""""" in which drinking problems are developed, maintained, and must be resolved.
Showing the most recent 10 out of 20 publications
