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

摘要 戒酒互助会(AA)现在以其帮助个人戒酒的能力而闻名 无序(AUD)，但在理解它的机制方面有很大的差距。近期 研究提出了两个新的机制领域：1)冲动的减少；2)有益的增加 社交网络。然而，只有少数研究和研究对这些机制进行了研究。 现有的研究采用低分辨率测量和次优研究设计。建议进行的研究 我将解决这些限制，系统地研究冲动和社交网络构成，作为一种新的 AA对AUD恢复的积极作用的行为改变机制(MOBC)第一个主要目标是 考察冲动，将概念细分为三种截然不同的形式：1)对未来的大幅贴现 奖励(即延迟打折)；2)较差的行为抑制(即无法抑制优势反应)；以及 3)冲动性人格特质(即对调节能力的自我归因)。第二个主要目标是 检查社交网络属性，通过正式的自我中心社交量化参与者的社会关系 网络构成分析。第三个主要目标是检查这些机械性的关系 根据三个重要的调节因素系统地不同：年龄、性别和研究地点。探索性的 次要目标是从主要目标中挖掘结果，以产生具体的建议和 应用于临床实践。这些目标将在优化的前瞻性队列设计中实现 用于表征MOBC的滞后动态变化。具体地说，研究设计将检查这些 新近参与社区门诊AUD治疗的AUD患者的治疗过程。 参与者将接受基线、6周、3个月、6个月、9个月和12个月的评估。机管局的参与将 使用传统的会议出席频率衡量标准和一种新的 AA计划接洽。结果变量将包括戒酒天数百分比和酗酒百分比 几天。调查结果将使用一项全面的知识转化计划进行传播。总体而言， 拟议中的研究有可能对理解再生障碍性贫血如何帮助人们康复做出重大贡献 来自澳元。反过来，这项研究的见解有可能极大地促进AA和 临床实践中的其他相互康复服务。

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.