Jeremiah Weinstock, Ph.D. - US grants

DESCRIPTION (provided by applicant): College students have high rates of alcohol problems, and the National Institute on Alcohol Abuse and Alcoholism has targeted this age group for a number of intervention initiatives designed to reduce alcohol use (NIAAA, 2002). Substance use, including heavy drinking, often occurs at the expense of other, substance-free, activities. This Stage 1 therapy development project will examine the promotion of one specific substance-free activity - exercise - as an intervention for hazardous drinking. Exercise has numerous physical and mental health benefits, and data suggest that students who engage in exercise regularly are less likely to drink heavily. Seventy hazardous drinking (AUDIT scores >8) college students who are sedentary will be randomized to one of two conditions: (1) two 50-minute sessions of motivational enhancement therapy (MET) focused on increasing exercise spaced one month apart plus 8 weeks of exercise contracting, or (2) two 50-minute sessions of MET focused on increasing exercise plus 8 weeks of contingency management (CM) for adhering to specific exercise activities. MET is a client-centered, directive method of enhancing intrinsic motivation to change by exploring and resolving ambivalence, and CM is a behavioral treatment that offers individuals tangible reinforcement such as prizes for completion of specific target behaviors. All participants will meet briefly with a therapist once per week to review the prior week's exercise contract and complete an exercise contract for the upcoming week. Those in the CM intervention will also receive any reinforcement earned for verified exercise (e.g., pedometer readings, attendance records from campus gym) in the prior week. Assessments of all participants will take place at baseline, 2-months (post-treatment), and 6-months (follow-up) with primary outcome measures being objective and subjective indices of physical activity and exercise, and self-reported alcohol use. Secondary outcomes include health-related physical fitness (e.g., tests of body composition, cardiovascular endurance, and muscle strength). We hypothesize that the MET+CM intervention will show increased levels of physical activity, exercise, physical fitness, and reductions in alcohol use in comparison to the MET intervention. Results from this Stage 1 therapy development study will guide future investigations of exercise-related motivational interventions as a method for reducing hazardous drinking in college students. PUBLIC HEALTH RELEVANCE: The National Institute of Alcohol Abuse and Alcoholism has identified hazardous drinking in college students as a significant concern and a research priority due to its significant prevalence on many college campuses and its association with many adverse consequences. Research suggests that engaging college students in activities unrelated to drinking decreases alcohol use. This pilot study will seek to decrease alcohol use by engaging sedentary hazardous drinking college students in an exercise program. Exercise has numerous mental and physical health benefits. Exercise is hypothesized to reduce hazardous drinking due to its function as a coping mechanism.

DESCRIPTION (provided by applicant): About 26 million Americans (8.5%) meet criteria for an alcohol use disorder (AUD;i.e., abuse or dependence), and most with an AUD will not ever seek help. A variety of reasons exist for not seeking help, with stigma and desire to handle the problem on one's own being primary among them. Therefore, offering interventions for AUD that do not stigmatize or require an individual to see a mental health professional may increase the utility and acceptability of AUD interventions and ultimately increase the number of individuals effectively treated. This pilot study evaluates exercise as an AUD intervention. Exercise has been proposed as a potential treatment for AUD due to its numerous mental and physical health benefits. SOAR funds will augment existing pilot and start-up funds and enable an additional thirty sedentary non-treatment seeking AUD individuals to be recruited from the community via advertisements. Participants will be given a four month YMCA gym membership and will be randomized to one of two conditions: (1) assessment only (AO), or (2) a combination of two motivational enhancement therapy (MET) sessions focused on increasing exercise spaced two months apart and four months of weekly contingency management (CM) for adhering to specific exercise activities. MET is a client-centered, directive method of enhancing intrinsic motivation to change by exploring and resolving ambivalence, and CM is a behavioral treatment offering individuals tangible reinforcers such as prizes for completion of specific target behaviors. Assessments of all participants will take place at baseline, 2-months (mid-treatment), and 4-months (post- treatment) with primary outcome measures being indices of alcohol use and engagement in exercise. Secondary outcomes include health-related physical fitness (e.g., tests of body composition, cardiovascular endurance, and muscle strength). We hypothesize that MET+CM will show increased levels of exercise and physical fitness and reductions in alcohol use in comparison to AO. Results from this pilot study will guide future investigations of exercise as a method for intervening with non-treatment seeking AUD individuals. PUBLIC HEALTH RELEVANCE: Alcohol use disorders are common and few individuals with the disorder ever seek help. This study proposes to intervene in a novel way - exercise, as it has many mental and physical health benefits and is an activity that is incompatible with simultaneous alcohol use. If effective, this non-stigmatizing intervention may increase the utility and acceptability of interventions for alcohol use disorders and ultimately increase the number of individuals effectively treated.

DESCRIPTION (provided by applicant): About half of all individuals who receive treatment for substance use disorders (SUD) relapse within a year. Stress and an individual's biological response to it are significant predictors of relapse. Thus, interventions that decrease stress and normalize an individual's biological response to stress are desperately needed. An exercise decreases stress and improves the body's regulation of stress. The proposed project will utilize exercise as a novel relapse prevention intervention with individuals who have recently completed inpatient SUD treatment. NIDA has targeted exercise as a topic worthy of investigation, as exercise has a myriad of physical and mental health benefits and potentially reduces drug use. Historically, exercise interventions have suffered from significant attrition and poor adherence, however behavioral interventions for exercise show promise in addressing these limitations. Our pilot data suggests that relapse is common and motivational interventions significantly increase individuals' engagement in exercise and that drug-abusing patients who exercise have longer durations of abstinence relative to those who do not engage in exercise. This project will evaluate the efficacy of a motivational intervention for exercise in a randomized clinical trial of 150 SUD patients beginning Aftercare treatment. Participants will be randomized to one of two interventions: (1) standard care (SC), or (2) standard care plus three sessions of motivational enhancement therapy for exercise spaced 12 weeks apart combined with 24 weeks of contingency management reinforcing exercise (MET+CM). MET is a client-centered, directive method of enhancing intrinsic motivation for change by exploring and resolving ambivalence, and CM is a behavioral treatment that utilizes extrinsic motivation by offering individuals tangibl rewards such as prizes for completion of specific target behaviors (e.g., exercise). Across 24 weeks, the MET+CM participants will contract weekly for exercise and will receive prizes for completed and verified exercise. Physical activity levels, overall stress, and stress reactivity (e.g., cortisol, heart rate), substance use, psychosocial functioning, quality of life, and subjectve and objective indicators of health (e.g., self-report, cardiovascular endurance) will be measured at baseline, mid-, and post- treatment (months 0, 3, and 6), and at follow-ups (months 9 and 12). It is expected that the MET+CM intervention will increase physical activity, improve stress and stress reactivity, psychosocial functioning and indicators of health, while decreasing substance use and risk of relapse relative to SC. Participant characteristics will be examined in association with treatment response, including self-efficacy and craving. Results from this study will advance exercise as a new strategy for enhancing physiological stress regulation and prevention of relapse in SUD populations.