Dynamic Multilevel Processes of Recovery in Therapeutic Communities in Mexico (DICO Model)

Official title

Comprehensive Behavioral Community Dynamics (DICO): A Prospective Longitudinal Study of Multilevel Community Processes in Therapeutic Communities for Substance Use Treatment in Mexico

Overview

This study aims to develop and empirically evaluate the Dinámica Integral Conductual Comunitaria (DICO) model, a multilevel framework that conceptualizes recovery from substance use disorders as a dynamic process emerging from the interaction between individual behavioral variables, social contingencies, and community-level factors within therapeutic communities in Mexico. A prospective longitudinal design with intensive repeated measures will be implemented over 8 to 12 weeks. Data will be collected using ecological momentary assessment (EMA), psychometric instruments, behavioral records, and semi-structured interviews. The study seeks to model recovery trajectories as nonlinear dynamic systems, identifying critical transitions, instability patterns, and contextual moderators associated with treatment adherence and relapse risk.

Detailed description

The study integrates three analytical levels:

1. Individual behavioral processes (e.g., craving, psychological flexibility) 2. Community-level dynamics (e.g., cohesion, reinforcement contingencies) 3. Cultural-contextual factors relevant to Mexican therapeutic communities

Quantitative data will be collected through high-frequency EMA and longitudinal assessments, enabling the estimation of dynamic parameters using nonlinear modeling techniques (e.g., differential equations, network analysis).

Qualitative data from semi-structured interviews will provide contextual interpretation of observed behavioral trajectories and system transitions.

The study does not involve manipulation or assignment to interventions; it is designed to observe naturally occurring processes within residential treatment settings.

Interventions

• Other Ecological Momentary Assessment (EMA)
  Real-time data collection method using mobile devices to assess momentary fluctuations in craving, psychological flexibility, and social context multiple times per day. This procedure is used for observational measurement only and does not constitute a therapeutic intervention.

Primary outcome measures

• Treatment Adherence - Length of Stay [Time frame: From admission to discharge (up to 12 weeks)]
• Disengagement - Total Score on Brief Disengagement Scale [Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Craving Intensity - Single-Item Scale [Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Contextual Rumination - Total Score on the Brief Contextual Rumination Scale (BCRS-10) [Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Temporal Variability of Craving [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Autocorrelation of Craving (Lag-1) [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]

Secondary outcome measures (12)

• Psychological Flexibility - Total Score on the Acceptance and Action Questionnaire-II (AAQ-II) [Time frame: Week 1 (baseline) and Week 12 (discharge).]
• Community Cohesion - Mean Score on the Brief Cohesion Scale (RBDC-2D) [Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Perceived Social Support - Single-Item Score [Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Prosocial Behavior - Participation and Cooperation Index (RBDC-2D) [Time frame: Every 48 hours from Day 1 through Week 12 (up to 12 weeks).]
• Perceived Institutional Punitiveness - Single Item from RBDC-2D [Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Global Network Strength derived from Temporal Network Analysis (graphical VAR) of RBDC-2D and EBRC-10 Time Series [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Node Centrality of Craving derived from Temporal Network Analysis (graphical VAR) of RBDC-2D and EBRC-10 Data [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Node Centrality of Contextual Rumination derived from Temporal Network Analysis (graphical VAR) of RBDC-2D and EBRC-10 Data [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Node Centrality of Disengagement - Temporal Network Analysis (gVAR Model) [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Node Centrality of Disengagement - Temporal Network Analysis (gVAR Model) [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Node Centrality of Perceived Institutional Punitiveness - Temporal Network Analysis (gVAR Model) [Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Perceived Social Support - Total Score on Multidimensional Scale of Perceived Social Support (MSPSS) [Time frame: Week 1 (baseline), Week 4, Week 8, and Week 12]

Eligibility criteria

Inclusion criteria

• Adults aged 18 years or older
• Currently enrolled in a residential therapeutic community for substance use treatment
• Minimum stay of at least 7 days prior to baseline assessment
• Ability to understand and provide informed consent
• Expected availability for participation during the 8-12 week follow-up period

Exclusion criteria

• Acute psychotic symptoms or severe psychiatric decompensation that interferes with participation
• Severe cognitive impairment limiting comprehension of study procedures
• Current medical instability requiring immediate external intervention
• Refusal to participate in any component of the study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Mexico · 1 center

• Comunidad Terapéutica Under The Tree — Ajijic

Publications

• Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol. 2008;4:1-32. doi: 10.1146/annurev.clinpsy.3.022806.091415. PMID 18509902
• Borsboom D, Cramer AO. Network analysis: an integrative approach to the structure of psychopathology. Annu Rev Clin Psychol. 2013;9:91-121. doi: 10.1146/annurev-clinpsy-050212-185608. PMID 23537483
• Scheffer M, Bascompte J, Brock WA, Brovkin V, Carpenter SR, Dakos V, Held H, van Nes EH, Rietkerk M, Sugihara G. Early-warning signals for critical transitions. Nature. 2009 Sep 3;461(7260):53-9. doi: 10.1038/nature08227. PMID 19727193
• Hofmann SG, Hayes SC. The Future of Intervention Science: Process-Based Therapy. Clin Psychol Sci. 2019 Jan;7(1):37-50. doi: 10.1177/2167702618772296. Epub 2018 May 29. PMID 30713811
• Korecki JR, Schwebel FJ, Votaw VR, Witkiewitz K. Mindfulness-based programs for substance use disorders: a systematic review of manualized treatments. Subst Abuse Treat Prev Policy. 2020 Jul 29;15(1):51. doi: 10.1186/s13011-020-00293-3. PMID 32727559
• Society for Community Research and Action-Community Psychology, Division 27 of the American Psychological Association. The role of recovery residences in promoting long-term addiction recovery. Am J Community Psychol. 2013 Dec;52(3-4):406-11. doi: 10.1007/s10464-013-9602-6. No abstract available. PMID 24081318

Identifiers

NCT: NCT07588516 · DICO-CT-MX-01

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗