Development of a Comprehensive and Dynamic AA Process Model: One Day at a Time

开发全面、动态的 AA 流程模型：一次一天

• 批准号: 9887056
• 负责人: J. SCOTT TONIGAN
• 金额: $ 51.25万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9887056
• 关键词: Abstinence; Accounting; Achievement; Address; Adolescent; Adult; Alcoholics Anonymous; Alcohols; Behavior; Behavioral Mechanisms; Client; Cognition; Communities; Data; Data Collection; Development; Disease model; Ecological momentary assessment; Effectiveness; Evaluation; Frequencies; Goals; Heterogeneity; Impulsivity; Intercept; Interview; Investigation; Longitudinal Studies; Measurement; Mediating; Mediator of activation protein; Modeling; Outcome; Persons; Population Heterogeneity; Process; Property; Protocols documentation; Provider; Randomized; Recording of previous events; Research; Research Personnel; Research Support; Resources; Sampling; Self Efficacy; Social support; Testing; Time; Treatment Step; Treatment outcome; United States; Work; alcohol abstinence; alcohol abuse therapy; alcohol related problem; base; behavior change; catalyst; comparison group; cost; critical period; design; drinking; ethnic diversity; improved; innovation; longitudinal design; meetings; multi-site trial; problem drinker; programs; rate of change; self help; substance abuse treatment; success

Alcoholics Anonymous (AA) is one of the most popular resources for dealing with alcohol-related problems, and 12-step therapy (TS), based upon AA doctrine and practice, is one of the prevailing alcohol treatment approaches in the United States. Two large multisite trials, one high in internal validity (PMRG, 1997) and the second high in external validity (VA Substance Abuse Treatment Study; Quimette, 1997) came to the same conclusion, TS was equally effective as more research supported therapies, and may actually be superior when total abstinence is the treatment goal. A primary objective of TS is to facilitate AA affiliation and strong evidence suggests that this aim is a major factor accounting for the effectiveness of TS (e.g., Tonigan, 2005). High priority has therefore been assigned to the investigation of what actually occurs in AA, with a special focus on identifying prescribed AA behaviors and processes that are predictive of drinking reduction. The guiding assumption of these efforts is that the key to improve TS is to first understand AA better. To this end, this study will generate, for the first time, a comprehensive and definitive process model of AA-related behavior change. This objective will be realized through the highly innovative use of EMA data collection among early AA affiliates. Using real-time daily data, aim 1 will determine if four MOBC identified by AA researchers (gains in social support, increased abstinence self-efficacy, spiritual practices, and negative urgency) mediate the linkage between three types of AA prescribed behaviors and drinking outcome. Noteworthy, these analyses will include the first rigorous testing of six of seven of Kazdin's (2007) criteria to confirm (or reject) that these four statistical mediators are MOBC. Aim 2 will investigate whether the actions of the AA active ingredients on mediators (a path) and the actions of the mediators (b path) are constant over time or, alternatively, if there are critical periods of influence. Last, aim 3 will determine if the four MOBC operate differently across distinct subpopulations. To achieve study aims, we propose a two-group randomized longitudinal study (N = 190). In one group (n = 130) we will collect 6-months of continuous EMA data, allowing us to examine near real-time associations between AA active ingredients in three domains, four MOBC, and drinking. In tandem, we will also conduct in-person interviews at baseline, 3, and 6-months. Assessment reactivity is a concern, especially so because this will be the first study to use EMA in addition to in-person interviews in AA research. We will therefore include a traditional fixed assessment group (n = 60) also interviewed at baseline, 3, and 6-months to identify potential measurement biases introduced in our innovative approach. Achievement of study aims will generate the first empirically validated AA process model that will inform TS with critical information for improving treatment outcomes.

酗酒者匿名（AA）是处理与酒精有关的问题的最受欢迎的资源之一， 基于AA学说和实践的12步疗法（TS）是普遍的酒精治疗方法之一 在美国的接近。两项大型多站点试验，一个高度的内部有效性（PMRG，1997）和 外部有效性的第二高（VA药物滥用治疗研究； Quimette，1997年）相同 结论，TS与更多的研究疗法一样有效，实际上可能是优越的 当总戒酒为治疗目标时。 TS的主要目的是促进AA隶属关系和强大 证据表明，该目标是TS有效性的主要因素（例如Tonigan，2005年）。 因此，高优先级已被分配给对AA中实际发生的情况的调查， 专注于确定可预测减少饮酒的规定的AA行为和过程。这 指导这些努力的假设是，改善TS的关键是首先更好地了解AA。为此， 这项研究将首次产生与AA相关行为的全面和确定的过程模型 改变。该目标将通过早期对EMA数据收集的高度创新使用来实现 AA分支机构。使用实时数据，AIM 1将确定四个MOBC是否由AA研究人员确定（收益 在社会支持方面，增加的戒酒自我效能，精神实践和负面紧迫性）调解 三种类型的AA规定行为与饮酒结果之间的联系。值得注意的是，这些分析将 包括Kazdin（2007）七个标准中六个的严格测试，以确认（或拒绝）这四个 统计调解人是MOBC。 AIM 2将调查AA活性成分的作用是否 介体（A路径）和调解人的动作（B路径）是恒定的，或者，如果有的话 关键时期。最后，AIM 3将确定四个MOBC在不同的不同 亚群。为了实现研究目标，我们提出了一项两组随机纵向研究（n = 190）。在 一组（n = 130）我们将收集6个月的连续EMA数据，使我们能够接近实时检查 三个域，四个MOBC和饮酒中的AA活性成分之间的关​​联。同时，我们也将 在基线，第3个月和6个月进行面对面访谈。评估反应性是一个问题，尤其是这样 因为这将是AA研究中的面对面访谈之外的第一项使用EMA的研究。我们将 因此，包括一个传统的固定评估组（n = 60），在基线，第3个月和6个月时采访了 确定我们创新方法中引入的潜在测量偏见。学习目标的成就将 生成第一个经验验证的AA过程模型，该模型将为TS提供关键信息的信息 改善治疗结果。