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.

摘要 理论基础：互助小组是康复护理连续体中重要而独特的资源， 戒酒互助会和其他12个步骤的小组已经得到了很好的研究，并发现非常有效。 然而，人们对治疗上瘾的互助替代品的性质和有效性知之甚少。这是一个 关键差距，因为12步小组对大多数物质使用障碍(SUD)患者来说仍然没有吸引力， 即使在12步促进干预之后，因为那些被12步组吓倒的人可能会被吸引 敬其他的选择。了解12步替代方案也很重要，因为相当一部分人有 肥皂泡被强制治疗，许多更高级别的法院已经裁定，强制12步出席 违反了第一修正案的权利，规定只有在给予世俗选择的情况下，才允许强制参加。 因此，目前的R01建议对已知的最大规模的世俗禁欲进行全国性的纵向研究- 基于12步组的替代方案：妇女戒酒(WFS)、生命环长期康复(LifeRing)和 智能恢复(SMART)。方法：我们由NIAAA资助的R21是第一个纵向的比较研究 12步小组和12步替代方案，并调查了患有终生酒精使用障碍的美国成年人参加 WFS、LifeRing、SMART和12步组。此R01将利用并扩展我们的R21数据， 使用平行协议和措施收集的800个新病例，使我们能够合并数据。数据将是 通过与互助小组主任和在线会议中心IntheRoom的合作，在Baseline收集到的信息 对那些正在康复的人来说。随访将在6个月和12个月收集。利用这些强大的数据，我们 将1)检查面对面和在线参与与物质使用结果之间的关联 时间到了。我们纳入了对在线参与的研究，因为对这一主题知之甚少，而且因为 在会议访问受限的情况下，在线资源具有巨大的潜力。我们还将比较 在互助小组中采取行动，测试一种关于行为改变的新理论--情感、认知、动机 和社会参与复苏(ACME)模型--旨在预测持续的复苏。测试会有帮助的 确定12步替代方案是否具有共同或不同的行动机制，并将向 对肥皂泡的广泛干预。最后，我们将检查参与者级别的主持人，了解双方的利益 帮助参与，告知治疗剪裁。在对R01的预期中，R21调查包括最关键的 措施。创新和意义：关于12步替代方案的证据严重缺乏：除了我们的 在团队的R21中，还没有发表关于12步组和长期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对以下方面做出重大贡献 了解互助性替代方案是否有效、何时有效以及为什么有效。调查结果应通知法庭 转诊和治疗计划，并可能促进有效替代品的增长。结果可能也会有所帮助 确定可在针对肥胖症的不同干预措施中作为目标的核心复苏驱动因素。