Investigating impulsivity and social network changes as novel mechanisms of behavior change for Alcoholics Anonymous' (AA) positive effects

摘要 匿名酗酒者协会（AA）现在已经建立了帮助个人从酒精使用中恢复的能力 疾病（AUD），但在理解其机制方面存在重大差距。最近 研究提出了两个新的机制领域：1）减少冲动; 2）增加有益的 社交网络。然而，这些机制仅在少数研究中进行了研究， 现有的研究采用低分辨率测量和次优研究设计。拟定研究 我将解决这些限制，系统地研究冲动和社会网络的组成，作为新的 行为改变机制（MOBCs）对AA对AUD恢复的积极影响。第一个主要目标是 为了研究冲动性，将这一概念分为三种不同的形式：1）对未来的急剧贴现 奖励（即，延迟折扣）; 2）差的行为抑制（即，不能抑制优势反应）;和 3)冲动的人格特质（即，自我归因于监管能力）。第二个主要目标是 研究社会网络属性，通过正式的自我中心的社会量化参与者的社会关系 网络组成分析第三个主要目的是检验这些机械关系是否 根据三个重要的主持人：年龄，性别和研究地点，系统地不同。探索性 次要目标是挖掘主要目标的发现，以产生具体的建议， 应用于临床实践。这些目标将在优化的前瞻性队列设计中执行 用于表征MOBC中的滞后动态变化。具体而言，研究设计将检查这些 在新参与社区门诊AUD治疗的AUD患者中， 受试者将在基线、6周、3个月、6个月、9个月和12个月时接受评估。机管局的参与将 可以使用传统的会议出席频率测量和新的会议出席频率测量来测量。 AA计划参与。结果变量将包括戒酒天数百分比和酗酒百分比 天将通过一项全面的知识转化计划传播调查结果。统称 一项拟议中的研究有可能为了解AA如何帮助人们恢复做出重大贡献 从AUD反过来，这项研究的见解有可能大大有助于AA的使用， 临床实践中的其他相互恢复服务。

ABSTRACT Alcoholics Anonymous (AA) is now well-established in its capacity to help individuals recover from alcohol use disorder (AUD), but there are substantial gaps in understanding the mechanisms by which it does so. Recent studies suggest two novel domains of mechanisms: 1) decreases in impulsivity; and 2) increases in salutary social networks. However, these mechanisms have been investigated in only a small number of studies and the extant studies employed low resolution measurement and suboptimal study designs. The proposed study will address these limitations to systematically investigate impulsivity and social network composition as novel mechanisms of behavior change (MOBCs) for AA’s positive effects on AUD recovery. The first primary aim is to examine impulsivity, fractionating the concept into three distinct forms: 1) steep discounting of future rewards (i.e., delay discounting); 2) poor behavioral inhibition (i.e., inability to inhibit a prepotent response); and 3) impulsive personality traits (i.e., self-attributions about regulatory capacity). The second primary aim is to examine social network properties, quantifying participant social relationships via formal egocentric social network composition analysis. The third primary aim is to examine whether these mechanistic relationships systematically differ according to three important moderators: age, sex, and study site. An exploratory secondary aim is to mine the findings from the primary aims to generate specific recommendations and applications for clinical practice. These aims will be executed in a prospective cohort design that is optimized for characterizing lagged dynamic changes in MOBCs. Specifically, the study design will examine these processes in individuals with AUD who are newly engaging in community outpatient AUD treatment. Participants will receive assessments at baseline, 6-weeks, and 3-, 6-, 9- and 12-months. AA involvement will be measured using both the traditional measure of frequency of meeting attendance and a novel measure of AA program engagement. Outcome variables will include percent days abstinent and percent heavy drinking days. The findings will be disseminated using a comprehensive knowledge translation plan. Collectively, the proposed study has the potential to make major contributions to understanding how AA helps people recover from AUD. In turn, the insights from the study have the potential to substantially contribute to the use of AA and other mutual recovery services in clinical practice.