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: 10544294
• 负责人: J. SCOTT TONIGAN
• 金额: $ 50.44万
• 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/10544294
• 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; 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; Spirituality; Testing; Time; Treatment Step; Treatment outcome; United States; Work; alcohol abstinence; alcohol abuse therapy; alcohol related problem; 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.

戒酒互诫协会 (AA) 是处理酒精相关问题最受欢迎的资源之一， 基于 AA 理论和实践的 12 步疗法 (TS) 是流行的酒精治疗方法之一 美国的方法。两项大型多中心试验，其中一项具有较高的内部效度（PMRG，1997）， 外部效度第二高（VA 药物滥用治疗研究；Quimette，1997）也达到了同样的效果 结论是，TS 与更多研究支持的疗法同样有效，而且实际上可能更优越 当完全戒断是治疗目标时。 TS 的主要目标是促进 AA 的加入并建立强大的 有证据表明，这一目标是 TS 有效性的一个主要因素（例如，Tonigan，2005）。 因此，我们高度重视对 AA 中实际发生的情况进行调查，并采取了特殊措施 重点关注确定可预测饮酒减少的规定 AA 行为和过程。这 这些努力的指导假设是，提高 TS 的关键是首先更好地理解 AA。为此， 这项研究将首次生成一个全面且明确的 AA 相关行为过程模型 改变。这一目标将通过在早期阶段高度创新地使用 EMA 数据收集来实现。 AA 附属机构。使用实时每日数据，目标 1 将确定 AA 研究人员是否识别出四个 MOBC（收益） 在社会支持、提高禁欲自我效能、精神实践和消极紧迫感方面）调节 AA 规定的三种行为与饮酒结果之间的联系。值得注意的是，这些分析将 包括对 Kazdin (2007) 的七项标准中的六项进行首次严格测试，以确认（或拒绝）这四项标准 统计中介是 MOBC。目标 2 将研究 AA 活性成分是否对 中介者（a 路径）和中介者的行为（b 路径）随着时间的推移是恒定的，或者，如果有 影响的关键时期。最后，目标 3 将确定四个 MOBC 是否在不同的领域以不同的方式运作 亚人群。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 对于一组（n = 130），我们将收集 6 个月的连续 EMA 数据，使我们能够近乎实时地检查 AA 活性成分在三个领域、四个 MOBC 和饮酒之间的关联。与此同时，我们还将 在基线、3 个月和 6 个月时进行面对面访谈。评估反应性是一个问题，尤其是 因为这将是 AA 研究中除了面对面访谈之外首次使用 EMA 的研究。我们将 因此，包括一个传统的固定评估小组（n = 60），也在基线、3 个月和 6 个月进行访谈，以 识别我们的创新方法中引入的潜在测量偏差。学习目标的实现将 生成第一个经过经验验证的 AA 过程模型，该模型将为 TS 提供关键信息 改善治疗效果。