Substance Use Disorder (SUD), Treatment Adherence
Conditions
Keywords
Therapeutic Communities, Ecological Momentary Assessment (EMA), Psychological Flexibility, Craving, Community Reinforcement, Acceptance and Commitment Therapy, Multilevel Modeling, Dynamic Systems
Brief summary
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
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.
Sponsors
Under The Tree Therapeutic Community
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disengagement - Total Score on Brief Disengagement Scale | Every 48 hours from Week 1 through Week 12 (up to 12 weeks) | Total score on the Brief Disengagement Scale (3 items, each scored from 0 to 10; total range: 0 to 30). Higher scores indicate greater disengagement from treatment. |
| Craving Intensity - Single-Item Scale | Every 48 hours from Week 1 through Week 12 (up to 12 weeks) | Self-reported craving intensity using a single-item scale (0 to 10; 0 = no craving, 10 = extreme craving). |
| Contextual Rumination - Total Score on the Brief Contextual Rumination Scale (BCRS-10) | Every 48 hours from Week 1 through Week 12 (up to 12 weeks) | Total score on the Brief Contextual Rumination Scale (EBRC-10). Range: 0 to 40. Higher scores indicate greater rumination associated with substance use. |
| Temporal Variability of Craving | Derived from repeated measurements collected every 48 hours from Week 1 through Week 12 | Within-participant temporal variance of craving scores derived from repeated measurements. Higher values indicate greater instability. |
| Autocorrelation of Craving (Lag-1) | Derived from repeated measurements collected every 48 hours from Week 1 through Week 12 | Lag-1 autocorrelation coefficient of craving time series. Higher values indicate greater temporal persistence of craving states. |
| Treatment Adherence - Length of Stay | From admission to discharge (up to 12 weeks) | Length of stay in treatment (number of days from admission to discharge), obtained from clinical records. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perceived Social Support - Single-Item Score | Every 48 hours from Week 1 through Week 12 (up to 12 weeks) | Single-item score (0 to 10): perceived support from peers or staff. Higher scores indicate greater perceived support. |
| Prosocial Behavior - Participation and Cooperation Index (RBDC-2D) | Every 48 hours from Day 1 through Week 12 (up to 12 weeks). | Composite index calculated as the sum of three items (each scored 0 to 3): participation in activities, cooperation with peers, and mutual help. Total range: 0 to 9. Higher scores indicate greater prosocial behavior. |
| Perceived Institutional Punitiveness - Single Item from RBDC-2D | Every 48 hours from Week 1 through Week 12 (up to 12 weeks) | Single-item score (0 to 10): perceived harshness or unfairness of rules or sanctions. Higher scores indicate greater perceived punitiveness. |
| Global Network Strength derived from Temporal Network Analysis (graphical VAR) of RBDC-2D and EBRC-10 Time Series | Derived from repeated measurements collected every 48 hours from Week 1 through Week 12 | Global strength (sum of absolute edge weights) estimated using graphical vector autoregression (gVAR). Unit: standardized Z-score. Higher values indicate greater overall connectivity among behavioral variables. |
| Node Centrality of Contextual Rumination derived from Temporal Network Analysis (graphical VAR) of RBDC-2D and EBRC-10 Data | Derived from repeated measurements collected every 48 hours from Week 1 through Week 12 | Standardized Z-score representing node centrality (expected influence) of contextual rumination (EBRC-10) within the temporal network. |
| Node Centrality of Craving derived from Temporal Network Analysis (graphical VAR) of RBDC-2D and EBRC-10 Data | Derived from repeated measurements collected every 48 hours from Week 1 through Week 12 | Standardized Z-score representing node centrality (expected influence) of craving within the temporal network. Higher values indicate greater influence on other variables. |
| Node Centrality of Disengagement - Temporal Network Analysis (gVAR Model) | Derived from repeated measurements collected every 48 hours from Week 1 through Week 12 | Standardized Z-score representing node centrality (expected influence) of impulse/urgency within the temporal network |
| Node Centrality of Perceived Institutional Punitiveness - Temporal Network Analysis (gVAR Model) | Derived from repeated measurements collected every 48 hours from Week 1 through Week 12 | Standardized Z-score representing node centrality (expected influence) of perceived institutional punitiveness within the temporal network. |
| Perceived Social Support - Total Score on Multidimensional Scale of Perceived Social Support (MSPSS) | Week 1 (baseline), Week 4, Week 8, and Week 12 | Total score on the Multidimensional Scale of Perceived Social Support (MSPSS). Range: 12 to 84. Higher scores indicate greater perceived social support. |
| Psychological Flexibility - Total Score on the Acceptance and Action Questionnaire-II (AAQ-II) | Week 1 (baseline) and Week 12 (discharge). | Total score on the Acceptance and Action Questionnaire-II (AAQ-II). Range: 7 to 49 points. A higher score indicates a worse outcome (greater experiential avoidance, lower psychological flexibility). |
| Community Cohesion - Mean Score on the Brief Cohesion Scale (RBDC-2D) | Every 48 hours from Week 1 through Week 12 (up to 12 weeks) | Mean score of two items (each scored 0 to 10): perceived group belonging and trust in peers, derived from the Brief Community Dynamics Record (RBDC-2D). Range: 0 to 10. Higher scores indicate greater cohesion. |
Countries
Mexico
Contacts
CONTACTLauro Gutiérrez Castro, Mtro.
CONTACTRicardo Fernandez
PRINCIPAL_INVESTIGATORLauro Gutiérrez Castro, Mtro.
Under The Tree Miller A.C.
PRINCIPAL_INVESTIGATOROswaldo Barrera Torres
Amanecer entre nubes
PRINCIPAL_INVESTIGATORErick Rodolfo Guerrero Manjarrez
Universidad Autónoma Indígena de México
PRINCIPAL_INVESTIGATORDenisse Lizeth Mares Ramírez
Centro de Estudios e Investigaciones en Comportamiento (CEIC)
Outcome results
None listed