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.
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.
Study Type
OBSERVATIONAL
Enrollment
60
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.
Comunidad Terapéutica Under The Tree
Ajijic, Jalisco, Mexico
Treatment Adherence - Length of Stay
Length of stay in treatment (number of days from admission to discharge), obtained from clinical records.
Time frame: From admission to discharge (up to 12 weeks)
Disengagement - Total Score on Brief Disengagement Scale
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.
Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)
Craving Intensity - Single-Item Scale
Self-reported craving intensity using a single-item scale (0 to 10; 0 = no craving, 10 = extreme craving).
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)
Total score on the Brief Contextual Rumination Scale (EBRC-10). Range: 0 to 40. Higher scores indicate greater rumination associated with substance use.
Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)
Temporal Variability of Craving
Within-participant temporal variance of craving scores derived from repeated measurements. Higher values indicate greater instability.
Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12
Autocorrelation of Craving (Lag-1)
Lag-1 autocorrelation coefficient of craving time series. Higher values indicate greater temporal persistence of craving states.
Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12
Psychological Flexibility - Total Score on the Acceptance and Action Questionnaire-II (AAQ-II)
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).
Time frame: Week 1 (baseline) and Week 12 (discharge).
Community Cohesion - Mean Score on the Brief Cohesion Scale (RBDC-2D)
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.
Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)
Perceived Social Support - Single-Item Score
Single-item score (0 to 10): perceived support from peers or staff. Higher scores indicate greater perceived support.
Time frame: Every 48 hours from Week 1 through Week 12 (up to 12 weeks)
Prosocial Behavior - Participation and Cooperation Index (RBDC-2D)
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.
Time frame: Every 48 hours from Day 1 through Week 12 (up to 12 weeks).
Perceived Institutional Punitiveness - Single Item from RBDC-2D
Single-item score (0 to 10): perceived harshness or unfairness of rules or sanctions. Higher scores indicate greater perceived punitiveness.
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
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.
Time frame: Derived from repeated measurements collected every 48 hours from Week 1 through Week 12
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Node Centrality of Craving derived from Temporal Network Analysis (graphical VAR) of RBDC-2D and EBRC-10 Data
Standardized Z-score representing node centrality (expected influence) of craving within the temporal network. Higher values indicate greater influence on other variables.
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
Standardized Z-score representing node centrality (expected influence) of contextual rumination (EBRC-10) within the temporal network.
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)
Standardized Z-score representing node centrality (expected influence) of impulse/urgency within the temporal network
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)
Standardized Z-score representing node centrality (expected influence) of disengagement within the temporal network.
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)
Standardized Z-score representing node centrality (expected influence) of perceived institutional punitiveness within the temporal network.
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)
Total score on the Multidimensional Scale of Perceived Social Support (MSPSS). Range: 12 to 84. Higher scores indicate greater perceived social support.
Time frame: Week 1 (baseline), Week 4, Week 8, and Week 12