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

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

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Treatment Adherence; Substance Use Disorder (SUD)
• Intervention / Treatment: Other: Ecological Momentary Assessment (EMA)

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.

• Study Type: Observational
• Enrollment (Estimated): 60

Contacts and Locations

• Study Contact: Name: Lauro Gutiérrez Castro, Mtro.; Phone Number: +523314696107; Email: saraqael_sefer@hotmail.com
• Study Contact Backup: Name: Ricardo Fernandez; Phone Number: +52 1 33 1544 5474

Study Locations

• Mexico
  • Jalisco
    • Ajijic, Jalisco, Mexico, 45920
      • Comunidad Terapéutica Under The Tree
      • Contact: Ricardo Fernandez; Phone Number: +52 1 33 1544 5474; Email: saraqael_sefer@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• 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.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

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); 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
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).	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.	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.	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.	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.	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.	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	Standardized Z-score representing node centrality (expected influence) of craving within the temporal network. Higher values indicate greater influence on other variables.	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.	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	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.	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.	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.	Week 1 (baseline), Week 4, Week 8, and Week 12

Collaborators and Investigators

• Sponsor: Under The Tree Therapeutic Community
• Investigators: Principal Investigator: 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)

Publications and helpful links

General Publications

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.

Study record dates

Study Major Dates

• Study Start (Estimated): May 15, 2026
• Primary Completion (Estimated): September 26, 2026
• Study Completion (Estimated): October 2, 2026

Study Registration Dates

• First Submitted: April 20, 2026
• First Submitted That Met QC Criteria: May 8, 2026
• First Posted (Actual): May 14, 2026

Study Record Updates

• Last Update Posted (Actual): May 14, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Acceptance and Commitment Therapy; Craving; Psychological Flexibility; Ecological Momentary Assessment (EMA); Dynamic Systems; Therapeutic Communities; Community Reinforcement; Multilevel Modeling
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Behavior; Health Behavior; Substance-Related Disorders; Treatment Adherence and Compliance; Behavioral Disciplines and Activities; Psychological Tests; Ecological Momentary Assessment
• Other Study ID Numbers: DICO-CT-MX-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

De-identified individual participant data (IPD) underlying the results reported in this study will be available, including ecological momentary assessment (EMA) data, psychometric measures, and behavioral records.

Data will be provided in a secure, encrypted format along with associated metadata, codebooks, and documentation necessary to reproduce the dynamic and network-based analyses.

• IPD Sharing 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.
• IPD Sharing 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.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No