Intensive Referral to Al-Anon: Benefits to Concerned Others and Their Drinkers

密集转介给 Al-Anon：对关心他人及其饮酒者的好处

• 批准号: 9337318
• 负责人: Michael Anthony Cucciare
• 金额: $ 42.25万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9337318
• 关键词: Abstinence; Address; Adherence; Adoption; Adult; Affect; Al-Anon; Alcohol abuse; Alcoholics Anonymous; Alcoholism; Clinical; Data; Disease; Domestic Violence; Effectiveness; Equation; Family; Family member; Foundations; Friends; Funding; Gender; Goals; Health; Health Personnel; Hybrids; Individual; Intake; Intervention; Knowledge; Life; Literature; Longitudinal Studies; Mediator of activation protein; Medical; Mental disorders; Methodology; Methods; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Patients; Persons; Public Health; Published Comment; Quality of life; Randomized Controlled Trials; Recovery; Research; Resources; Rewards; Site; Social Functioning; Source; Substance Addiction; Substance Use Disorder; Support Groups; Training; United States; Veterans; Work; World Health Organization; addiction; alcohol abuse therapy; alcohol use disorder; base; community based treatment; coping; design; drinking; evidence base; help-seeking behavior; improved; improved outcome; innovation; interest; intervention effect; meetings; member; negative affect; peer; problem drinker; programs; psychological symptom; research study; treatment as usual; treatment program; trial design; uptake

Project Abstract: At least 100 million adults worldwide are adversely affected by the substance addiction of a close relative. Al-Anon Family Groups, a 12-step mutual-help program for people concerned about another’s drinking, is widely available and effective. However, there is a critical lack of knowledge about how to facilitate Al-Anon participation among concerned others (COs), and the extent to which Al-Anon also benefits drinkers. This unique study will examine the effectiveness of Al-Anon Intensive Referral (AIR) with COs of individuals in treatment for alcohol use disorders (“drinkers”). AIR’s goal is to facilitate Al-Anon participation and positive outcomes (e.g., better quality of life, active coping) among COs. The project will also examine the extent to which AIR is associated with treatment engagement, Alcoholics Anonymous (AA) participation, and positive outcomes among drinkers. Although literature on alcoholism as a family disorder frequently states that COs positively influence drinkers’ outcomes, data from methodologically strong studies are sorely lacking. This project builds on two main lines of research by this study team: (1) implementing and showing the effectiveness of Intensive Referral, a 12-step facilitation method, to increase AA participation and improve outcomes among patients in treatment for substance use disorders, and their COs; and (2) a recent NIAAA longitudinal R21 study to identify the benefits and mechanisms of Al-Anon participation to newcomers, members, and their drinkers. In a randomized controlled trial of AIR, this 4-year project has three Specific Aims. Aim 1: Implement AIR at three sites (Little Rock, AR; Omaha, NE; Palo Alto, CA) to evaluate AIR’s effectiveness for COs. COs (N=534) and their drinkers (N=534) will be assessed at baseline and 3-month, 6-month, and 1-year follow-ups. Hypotheses are that, compared to usual care, AIR will (1A) accelerate help-seeking and increase Al-Anon participation, and (1B) improve CO outcomes. Aim 2: Evaluate AIR’s effectiveness for drinkers. Hypotheses are that AIR will be associated with drinkers having (2A) more treatment and AA participation, and (2B) better drinking outcomes. We will examine Aims 1 and 2 using generalized mixed-effects regression models (GLMM). Aim 3: Examine AIR’s mechanisms of action (mediators and moderators). In addition, we will examine reciprocal effects of CO and drinker functioning using Structural Equation Modeling (SEM). This project is built on the foundation that it is essential to help COs because of their own suffering. In addition, it is essential to help COs in order to help drinkers (whose better functioning, in turn, also helps COs). In contrast to other family-based approaches to addiction treatment, AIR is feasible to deliver in real-world treatment programs, requiring few resources. After completing this RCT, if AIR is shown to be effective, the next step in this research program will be to conduct an implementation study (Hybrid Type 2) to disseminate and sustain AIR across treatment programs, thereby helping COs and drinkers.

项目摘要：全世界至少有 1 亿成年人受到物质成瘾的不利影响。 Al-Anon 家庭团体，这是一个针对关心他人的人的 12 步互助计划。 饮酒是广泛存在且有效的，但是，人们对如何促进饮酒却严重缺乏了解。 Al-Anon 在相关其他方 (CO) 中的参与情况，以及 Al-Anon 在多大程度上也使饮酒者受益。 这项独特的研究将检验 Al-Anon 强化转诊 (AIR) 的有效性 AIR 的目标是促进 Al-Anon 的参与。 CO 的积极成果（例如，更好的生活质量、积极应对）。 AIR 与治疗参与、戒酒互诫协会 (AA) 参与的关联程度，以及 尽管有关酗酒作为家庭障碍的文献经常指出， 一氧化碳对饮酒者的结果产生积极影响，但方法论上强有力的研究数据却非常缺乏。 该项目建立在该研究团队的两条研究主线之上：（1）实施并展示 密集推荐（一种 12 步促进方法）对于增加 AA 参与度和改善的有效性 接受物质使用障碍治疗的患者的结果及其 CO；以及 (2) 最近的 NIAAA 纵向 R21 研究，以确定 Al-Anon 参与对新人的好处和机制， 成员及其饮酒者。 在 AIR 的一项随机对照试验中，这个为期 4 年的项目有三个具体目标 1：实施。 在三个地点（阿肯色州小石城；内布拉斯加州奥马哈；加利福尼亚州帕洛阿尔托）评估 AIR 对 CO 的有效性。 (N=534) 及其饮酒者 (N=534) 将在基线和 3 个月、6 个月和 1 年随访时进行评估。 假设与常规护理相比，AIR 将 (1A) 加速寻求帮助并增加 Al-Anon 参与，以及 (1B) 改善 CO 结果 目标 2：评估 AIR 对饮酒者的有效性。 AIR 与饮酒者 (2A) 更多治疗和 AA 参与有关，以及 (2B) 更好 我们将使用广义混合效应回归模型来检验目标 1 和 2。 (GLMM) 目标 3：检查 AIR 的作用机制（中介者和调节者）。 使用结构方程模型 (SEM) 检查二氧化碳和饮酒者功能的相互影响。 该项目建立在这样的基础上：有必要帮助那些遭受苦难的 CO。 此外，为了帮助饮酒者，必须帮助 COs（反过来，饮酒者的更好的功能也有助于 COs）。 与其他基于家庭的成瘾治疗方法相比，AIR 在现实世界中是可行的 治疗计划，需要很少的资源 完成此随机对照试验后，如果 AIR 被证明是有效的，则 该研究计划的下一步将是进行实施研究（混合类型 2）以传播 并在整个治疗计划中维持 AIR，从而帮助 CO 和饮酒者。