Mutual Help Alternatives for Alcohol Problems: Benefits and Causal Mechanisms

酒精问题的互助替代方案：好处和因果机制

• 批准号: 10413241
• 负责人: SARAH E. ZEMORE
• 金额: $ 36.05万
• 依托单位: PUBLIC HEALTH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10413241
• 关键词: Abstinence; Address; Adult; Affect; Alcohol abuse; Alcoholics Anonymous; Alcohols; Amendment; Caring; Clinical; Clinical Trials; Cognition; Collaborations; Comparative Study; Continuity of Patient Care; Coping Skills; Data; Drug usage; Effectiveness; Funding; Growth; Health; Individual; Influentials; Intervention; Lead; Longitudinal Studies; Measures; Mediation; Mediator of activation protein; Minority Groups; Motivation; National Institute on Alcohol Abuse and Alcoholism; Nature; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Planning Theory; Population; Process; Protocols documentation; Provider; Publishing; Quality of life; Recovery; Recovery Support; Regulation; Religion and Spirituality; Research; Resources; Rights; Sampling; Self Efficacy; Severities; Stress; Substance Use Disorder; Surveys; Targeted Research; Testing; Time; Woman; Women' s Group; addiction; alcohol use disorder; base; behavior change; cohesion; comparative efficacy; court; design; improved; individualized medicine; innovation; meetings; member; model design; mortality; novel; online resource; peer networks; satisfaction; sobriety; social engagement; substance use; support network; theories; treatment planning; virtual

ABSTRACT Rationale: Mutual help groups represent an important and unique resource on the recovery care continuum, and Alcoholics Anonymous and other 12-step groups have been well-studied and found to be highly effective. Yet, very little is known about the nature and effectiveness of mutual help alternatives for addiction. This is a critical gap because 12-step groups remain unappealing for most people with substance use disorders (SUDs), even following 12-step facilitation interventions, and because those deterred by 12-step groups may be attracted to alternatives. Understanding 12-step alternatives is also important because a sizeable minority of people with SUDs are mandated to treatment, and numerous higher courts have ruled that mandating 12-step attendance violates First Amendment rights, stipulating that mandated attendance is permissable only given secular options. Accordingly, the current R01 proposes a national, longitudinal study of the largest known secular, abstinence- based alternatives to 12-step groups: Women for Sobriety (WFS), LifeRing Secular Recovery (LifeRing), and SMART Recovery (SMART). Approach: Our NIAAA-funded R21 was the first longitudinal, comparative study of 12-step groups and 12-step alternatives, and surveyed U.S. adults with lifetime alcohol use disorders attending WFS, LifeRing, SMART, and 12-step groups. This R01 will capitalize on and extend our R21 data by adding 800 new cases collected using parallel protocols and measures, permitting us to combine data. Data will be collected at baseline via collaboration with mutual help group directors and IntheRooms, an online meeting hub for those in recovery. Follow-ups will be collected at 6 and 12 months. Leveraging these well-powered data, we will 1) examine associations between both in-person and online involvement and substance use outcomes over time. We incorporate study of online involvement because extremely little is known on this topic, and because online resources have great potential where meeting access is limited. We will also 2) compare mechanisms of action across mutual help groups, testing a novel theory of behavior change—the Affect, Cognition, Motivation, and social Engagement in recovery (ACME) model—designed to predict sustained recovery. Tests will help determine whether 12-step alternatives have common or distinct mechanisms of action, and will inform interventions for SUDs broadly. Finally, we will 3) examine participant-level moderators of the benefits of mutual help involvement, informing treatment tailoring. In anticipation of this R01, R21 surveys included most key measures. Innovation and Significance: Evidence on 12-step alternatives is severely lacking: Other than our team’s R21, there are no published longitudinal, comparative studies of 12-step groups and secular alternatives. Results of this study, led by experts in mutual help groups for addiction, will contribute substantially to understanding whether, when, and why mutual help alternatives are effective. Findings should inform court referrals and treatment planning, and may enhance the growth of effective alternatives. Results may also help to identify core drivers of recovery that can be targeted in diverse interventions for SUDs.

抽象的 理由：互助小组是康复护理连续体中重要且独特的资源， 戒酒互诫协会和其他 12 步小组经过深入研究，发现非常有效。 然而，人们对成瘾互助替代方案的性质和有效性知之甚少。 存在重大差距，因为 12 步小组对于大多数患有药物滥用障碍 (SUD) 的人来说仍然没有吸引力， 即使采取了 12 步促进干预措施，并且因为那些被 12 步小组吓倒的人可能会被吸引 了解 12 步骤替代方案也很重要，因为相当一部分人有这种情况。 SUD 必须接受治疗，许多高等法院已裁定强制进行 12 步出勤 违反了第一修正案的权利，规定只有在世俗选择的情况下才允许强制出勤。 因此，当前的 R01 提议对已知最大的世俗禁欲活动进行全国性纵向研究。 基于 12 步小组的替代方案：Women for Sobriety (WFS)、LifeRing Seular Recovery (LifeRing) 和 SMART 恢复 (SMART)：我们的 NIAAA 资助的 R21 是第一个纵向比较研究。 12步组和12步替代方案，并对患有终生酒精使用障碍的美国成年人进行了调查 WFS、LifeRing、SMART 和 12 步组将通过添加来利用和扩展我们的 R21 数据。 使用并行协议和措施收集 800 个新病例，使我们能够合并数据。 通过与互助小组主管和在线会议中心 IntheRooms 合作在基线收集 我们将在 6 个月和 12 个月时收集这些数据。 将 1) 检查现场和在线参与与物质使用结果之间的关联 我们将在线参与的研究纳入其中，因为人们对这个主题知之甚少，也因为 在会议访问受限的情况下，在线资源具有巨大潜力。我们还将 2) 比较以下机制。 跨互助团体的行动，测试一种新的行为改变理论——情感、认知、动机、 康复中的社会参与（ACME）模型——旨在预测持续康复，测试将有所帮助。 确定 12 步替代方案是否具有共同或独特的作用机制，并将告知 最后，我们将 3) 检查参与者层面的共同利益调节者。 帮助参与，为治疗定制提供信息 在此次 R01、R21 调查中包括了最关键的内容。 创新和意义：除了我们的方案外，严重缺乏 12 步替代方案的证据。 团队的 R21 中，还没有发表关于 12 步组和世俗替代方案的纵向比较研究。 这项由成瘾互助小组专家领导的研究结果将大大有助于 了解互助替代方案是否有效、何时有效以及为何有效，调查结果应告知法庭。 转诊和治疗计划，并可能促进有效替代方案的发展。结果也可能有所帮助。 确定可针对 SUD 的各种干预措施的复苏核心驱动因素。