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NCT Number: NCT07588516

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

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.

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Key information

Conditions

Substance Use Disorder (SUD) Behavior Chemically-Induced Disorders Health Behavior Mental Disorders Substance-Related Disorders Treatment Adherence Treatment Adherence and Compliance

Age range

18 year and older

Sex eligibility

Male

Study type

Observational

Primary location

About this study

The study integrates three analytical levels:

  • Individual behavioral processes (e.g., craving, psychological flexibility)
  • Community-level dynamics (e.g., cohesion, reinforcement contingencies)
  • 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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

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.

Primary outcomes

  1. Treatment Adherence - Length of Stay

    Time frame: From admission to discharge (up to 12 weeks)

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

  2. Disengagement - Total Score on Brief Disengagement Scale

    Time frame: 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.

  3. Craving Intensity - Single-Item Scale

    Time frame: 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).

  4. 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)

    Total score on the Brief Contextual Rumination Scale (EBRC-10). Range: 0 to 40. Higher scores indicate greater rumination associated with substance use.

  5. Temporal Variability of Craving

    Time frame: 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.

  6. Autocorrelation of Craving (Lag-1)

    Time frame: 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.

Secondary outcomes

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

    Time frame: 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).

  2. 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)

    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.

  3. Perceived Social Support - Single-Item Score

    Time frame: 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.

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

    Time frame: 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.

  5. Perceived Institutional Punitiveness - Single Item from RBDC-2D

    Time frame: 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.

  6. 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

    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.

  7. 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

    Standardized Z-score representing node centrality (expected influence) of craving within the temporal network. Higher values indicate greater influence on other variables.

  8. 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

    Standardized Z-score representing node centrality (expected influence) of contextual rumination (EBRC-10) within the temporal network.

  9. 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

    Standardized Z-score representing node centrality (expected influence) of impulse/urgency within the temporal network

  10. 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

    Standardized Z-score representing node centrality (expected influence) of disengagement within the temporal network.

  11. 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

    Standardized Z-score representing node centrality (expected influence) of perceived institutional punitiveness within the temporal network.

  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

    Total score on the Multidimensional Scale of Perceived Social Support (MSPSS). Range: 12 to 84. Higher scores indicate greater perceived social support.

Study contacts

Contact information is provided by the study sponsor or research team.

Lauro Gutiérrez Castro, Mtro.

CONTACT

[email protected]

+523314696107

Ricardo Fernandez

CONTACT

+52 1 33 1544 5474

Sponsors and collaborators

Lead sponsor

Under The Tree Therapeutic Community

Other

Registry information

Official study title

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

Acronym: DICO

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
May 14, 2026
Registry last updated
May 14, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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