Making Alcoholics Anonymous Easier: A Group TSF Approach

描述（由申请人提供）：本拨款申请响应 NIAAA PA 02-167，寻求对提供者高度优先的协作治疗和服务研究，并强调对管理式护理和少数群体有效的团体治疗。该申请提出了一项健康服务试验，以测试一种人工指导、面向团体的 12 步促进干预措施，称为 MAAEZ（让酗酒者匿名更容易）。基于 AA 可以增强治疗效果的证据，该干预措施旨在帮助以团体为导向的治疗计划吸引客户参与 AA。到目前为止，还没有针对 12 步促进的小组格式手册经过测试并可用于治疗计划。 MAAEZ 以 Ajzen 的计划行为理论为基础，专注于影响患者对 AA 参与的态度、主观规范和控制感。 MAAEZ 的 6 场会议帮助参与者了解他们在 AA 遇到的人、观点和会议的多样性；找到他们喜欢的方便的会议；并在 AA 中建立联系，引导参与者完成在会议上与 AA 成员交谈、给他们打电话以及请求某人作为临时赞助商的过程。拟议的试验（n=630）将在三个 Kaiser 门诊诊所进行。在招募的前 10 周，地点 1、地点 2 和地点 3 的参与者将接受常规治疗（关闭条件）。在接下来的 10 周内，站点 1 和 2 的新队列将接受每周 6 次 MAAEZ 课程，以代替 6 次常规护理课程 (ON)，而新站点 3 队列则继续接受 OFF，以便研究可以排除 MAAEZ 影响的历史记录。新的 Site 3 参与者将在第三个 10 周招募期内收到 MAAEZ。参与者将在基线时以及基线后 6 周、6 个月和 12 个月接受采访。调查措施包括 AA 的参与；关于 AA 参与的态度、主观规范、感知控制和意图；和饮酒结果（主要是戒酒）。自我报告的酒精和药物使用情况将通过尿液检测进行验证。该研究旨在测试 MAAEZ 是否会增加 AA 参与和戒酒，以确定 MAAEZ 对哪些亚组最有效，并评估与 MAAEZ 对 AA 参与和饮酒结果影响相关的作用机制。分析将包括混合模型ANCOVA 和线性回归。与 PA 目标一致，Kaiser 项目主管和临床医生参与了研究问题，并将从实施到传播积极合作。如果有效，MAAEZ 应该会引起医疗服务提供者的广泛兴趣，因为它可以快速纳入现有计划，为面向团体的治疗提供简短干预的简洁手册。

DESCRIPTION (provided by applicant): This grant application responds to NIAAA PA 02-167 seeking collaborative treatment and services studies of high priority to providers, and emphasizing group therapies effective for managed care and minority populations. The application proposes a health services trial to test a manual-guided, group-oriented 12-step facilitation intervention called MAAEZ (Making Alcoholics Anonymous Easier). Based on evidence that AA can potentiate treatment effects, this intervention aims to help group-oriented treatment programs engage clients in AA. To this point, no group format manual for 12-step facilitation has been tested and made available to treatment programs. MAAEZ is grounded in Ajzen's Theory of Planned Behavior, and focuses on influencing patient attitudes, subjective norms, and sense of control regarding AA involvement. MAAEZ's 6 sessions help participants to appreciate the diversity of people, opinions and meetings that they encounter at AA; find convenient meetings that they like; and make connections at AA, walking participants through the process of talking to AA members at meetings, calling them on the telephone, and asking someone to be a temporary sponsor. The proposed trial (n=630) will be undertaken in three Kaiser outpatient clinics. For the first 10 weeks of recruitment, participants at Sites 1, 2 and 3 will receive usual treatment (OFF condition). During the next 10 weeks, a new cohort at Sites 1 and 2 will receive 6 weekly MAAEZ sessions in place of 6 usual care sessions (ON), while OFF continues for the new Site 3 cohort so that the study can rule out historical accounts of MAAEZ's effects. New Site 3 participants will receive MAAEZ during a third 10-week recruitment period. Participants will be interviewed at baseline, and at 6 weeks, 6 months, and 12 months post-baseline. Survey measures include AA involvement; attitudes, subjective norms, perceived control, and intentions regarding AA involvement; and drinking outcomes (primarily abstinence). Self-reported alcohol and drug use will be validated by urine testing. The study aims to test whether MAAEZ increases AA involvement and abstinence, to identify subgroups for whom MAAEZ is most effective, and to evaluate mechanisms of action associated with MAAEZ's influence on AA involvement and drinking outcomes. Analyses will include mixed-model ANCOVA's and linear regressions. Consistent with the PA goals, Kaiser program directors and clinicians have been involved in the research questions and will actively collaborate from implementation through dissemination. If effective, MAAEZ should be of wide interest to providers, as it can be rapidly incorporated into existing programs, offering a succinct manual for brief interventions in group-oriented treatment.