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

NCT07588516 | Not Yet Recruiting DMC

• 1 other identifier: DICO-CT-MX-01
• Study Type: observational
• Target: 60
• Locations: 1 country
• Sites: 1

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.

Conditions

Substance Use Disorder (SUD); Treatment Adherence

Keywords

Therapeutic Communities; Ecological Momentary Assessment (EMA); Psychological Flexibility; Craving; Community Reinforcement; Acceptance and Commitment Therapy; Multilevel Modeling; Dynamic Systems

Outcome Measures

Primary Outcomes (6)

• Treatment Adherence - Length of Stay

  Length of stay in treatment (number of days from admission to discharge), obtained from clinical records.

  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.

  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).

  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.

  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.

  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.

  Derived from repeated measurements collected every 48 hours from Week 1 through Week 12

Secondary Outcomes (12)

• Psychological Flexibility - Total Score on the Acceptance and Action Questionnaire-II (AAQ-II)

  Week 1 (baseline) and Week 12 (discharge).

• Community Cohesion - Mean Score on the Brief Cohesion Scale (RBDC-2D)

  Every 48 hours from Week 1 through Week 12 (up to 12 weeks)

• Perceived Social Support - Single-Item Score

  Every 48 hours from Week 1 through Week 12 (up to 12 weeks)

• Prosocial Behavior - Participation and Cooperation Index (RBDC-2D)

  Every 48 hours from Day 1 through Week 12 (up to 12 weeks).

• Perceived Institutional Punitiveness - Single Item from RBDC-2D

  Every 48 hours from Week 1 through Week 12 (up to 12 weeks)

Study Arms (1)

Therapeutic Community Residents

Adult residents undergoing residential treatment for substance use in therapeutic communities in Mexico. Participants are followed prospectively for 8-12 weeks using intensive longitudinal assessment, including ecological momentary assessment (EMA), psychometric measures, behavioral logs, and qualitative interviews. No experimental manipulation or assignment to interventions is performed.

Other: Ecological Momentary Assessment (EMA)

Interventions

Ecological Momentary Assessment (EMA) OTHER

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.

Therapeutic Community Residents

Eligibility Criteria

• Age: 18 Years+
• Sex: male
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult individuals undergoing residential treatment for substance use disorders in therapeutic communities in Mexico. The population is characterized by varying levels of substance dependence severity, psychosocial vulnerability, and exposure to structured community-based treatment environments that emphasize behavioral regulation, peer support, and institutional norms. Participants are embedded in a communal living setting where daily routines, social interactions, and reinforcement contingencies are structured by the therapeutic model, providing a naturalistic context for observing multilevel behavioral and recovery processes.

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Under The Tree Therapeutic Community: lead

Study Sites (1)

Comunidad Terapéutica Under The Tree

Ajijic, Jalisco, 45920, Mexico

Location

Related Publications (6)

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

MeSH Terms

Conditions

Substance-Related Disorders; Treatment Adherence and Compliance

Interventions

Ecological Momentary Assessment

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders; Mental Disorders; Health Behavior; Behavior

Intervention Hierarchy (Ancestors)

Psychological Tests; Behavioral Disciplines and Activities

Study Officials

• Lauro Gutiérrez Castro, Mtro.

  Under The Tree Miller A.C.

  PRINCIPAL INVESTIGATOR

• Oswaldo Barrera Torres

  Amanecer entre nubes

  PRINCIPAL INVESTIGATOR

• Erick Rodolfo Guerrero Manjarrez

  Universidad Autónoma Indígena de México

  PRINCIPAL INVESTIGATOR

• Denisse Lizeth Mares Ramírez

  Centro de Estudios e Investigaciones en Comportamiento (CEIC)

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Lauro Gutiérrez Castro, Mtro.

CONTACT

+523314696107; saraqael_sefer@hotmail.com

Ricardo Fernandez

CONTACT

+52 1 33 1544 5474

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 12 Weeks
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: April 20, 2026
• First Posted: May 14, 2026
• Study Start: May 15, 2026
• Primary Completion (Estimated): September 26, 2026
• Study Completion (Estimated): October 2, 2026
• Last Updated: May 14, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
• Time Frame: De-identified individual participant data and supporting materials will be available beginning 6 months after study completion and will remain accessible for 5 years following publication of the primary results.
• Access Criteria: Access to de-identified individual participant data (IPD) and supporting materials will be granted to qualified researchers affiliated with academic or clinical institutions. Requests must include a brief research proposal outlining objectives, methodology, and intended use of the data. Proposals will be reviewed by an independent committee to ensure scientific merit and ethical compliance. Approved users will have access to de-identified datasets, metadata, codebooks, and analytic code necessary for reproducibility. Data will be provided via secure, encrypted transfer after execution of a Data Sharing Agreement (DSA) prohibiting re-identification and unauthorized redistribution.

Locations

ME (1)