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

Официальное название

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

Обзор

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.

Подробное описание

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.

Вмешательства

• Другое 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.

Первичные конечные точки

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

Вторичные конечные точки (12)

• Psychological Flexibility - Total Score on the Acceptance and Action Questionnaire-II (AAQ-II) [Срок оценки: Week 1 (baseline) and Week 12 (discharge).]
• Community Cohesion - Mean Score on the Brief Cohesion Scale (RBDC-2D) [Срок оценки: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Perceived Social Support - Single-Item Score [Срок оценки: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)]
• Prosocial Behavior - Participation and Cooperation Index (RBDC-2D) [Срок оценки: Every 48 hours from Day 1 through Week 12 (up to 12 weeks).]
• Perceived Institutional Punitiveness - Single Item from RBDC-2D [Срок оценки: 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 [Срок оценки: 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 [Срок оценки: 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 [Срок оценки: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Node Centrality of Disengagement - Temporal Network Analysis (gVAR Model) [Срок оценки: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12]
• Node Centrality of Disengagement - Temporal Network Analysis (gVAR Model) [Срок оценки: 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) [Срок оценки: 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) [Срок оценки: Week 1 (baseline), Week 4, Week 8, and Week 12]

Критерии участия

Критерии включения

• 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

Критерии исключения

• 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

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Мексика · 1 центр

• Comunidad Terapéutica Under The Tree — Ajijic

Публикации

• 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

Идентификаторы

NCT: NCT07588516 · DICO-CT-MX-01

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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