Mutual Help Alternatives for Alcohol Problems: Benefits and Causal Mechanisms

摘要 理由：互助小组是康复护理连续体的一个重要和独特的资源， 匿名戒酒会和其他12步小组已经得到了很好的研究，并发现非常有效。 然而，很少有人知道的性质和有效性的互助替代成瘾。这是一 关键的差距，因为12步组仍然没有吸引力的大多数人与物质使用障碍（SUD）， 即使在12步促进干预之后，因为那些被12步小组阻止的人可能会被吸引 到替代品。理解12步替代方案也很重要，因为相当多的少数人 SUD被要求接受治疗，许多高等法院已经裁定，强制12步出勤 违反了第一修正案的权利，规定强制出席是允许的，只有给予世俗的选择。 因此，目前的R 01提出了一个全国性的，纵向研究的最大已知的世俗，禁欲- 12步组的替代方案：妇女清醒（WFS），生命环世俗恢复（生命环）， 智能恢复（SMART）。方法：我们的NIAAA资助的R21是第一个纵向比较研究。 12步组和12步替代方案，并调查了美国成年人与终身酒精使用障碍参加 WFS、LifeRing、SMART和12步组。此R 01将利用和扩展我们的R21数据， 800个新病例使用并行协议和措施收集，使我们能够联合收割机数据。数据将 通过与互助小组主管和IntheRooms（一个在线会议中心）合作，在基线时收集 对于那些在恢复。将在6个月和12个月时收集随访数据。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， 时间我们纳入在线参与的研究，因为对这个主题知之甚少， 在会议机会有限的情况下，在线资源具有很大的潜力。我们还将2）比较 行动在互助组，测试一种新的理论的行为改变的影响，认知，动机， 和社会参与恢复（ACME）模型，旨在预测持续的恢复。测试将帮助 确定12步替代方案是否具有共同或独特的作用机制，并将告知 广泛地干预SUD。最后，我们将3）检查参与者级别的主持人的利益， 帮助参与，提供治疗定制信息。在R 01的预期中，R21调查包括了大多数关键的 措施创新和意义：12步替代方案的证据严重缺乏：除了我们的 研究团队的R21，没有发表的纵向，比较研究的12步组和世俗的替代品。 这项由成瘾互助小组专家领导的研究结果将大大有助于 了解互助方案是否、何时以及为什么有效。调查结果应告知法院 转诊和治疗规划，并可能促进有效替代品的增长。结果也可能有所帮助 确定可在针对SUD的各种干预措施中针对的恢复的核心驱动因素。

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.