A Transtheoretical Model of AA-Related Behavior Change

描述(由申请人提供)：关于再生障碍性贫血患者的行为改变是如何被动员和维持的，人们知之甚少，更不知道共同发生的精神疾病严重程度是如何调节这种改变的。这是值得注意的，因为十二步(TS)疗法是美国流行的酒精治疗模式，大多数接受酒精治疗(TS和非TS)的人将参加AA，即使只是有限的时间。在确定以下方面取得了重大进展：(1)最有可能参加再生障碍性贫血的人的特征，以及(2)了解与再生障碍性贫血相关的益处的性质和程度。然而，再生障碍性贫血究竟发生了什么，以及这些特定行为是如何预测功能改善的，仍然知之甚少，研究也很少。这项研究的总体目标是测试再生障碍性贫血行为改变的跨理论模型，并确定促使这种改变的特定再生障碍性贫血相关行为。这项申请建议对AA暴露者进行为期2年的纵向研究(N=300)，参与者从AA和门诊治疗中招募。这项研究有五个目标，旨在前瞻性地测试规定的AA相关行为如何动员AA特有的和非特有的变化机制，以及一旦这些机制被动员起来 预测饮酒和其他药物使用的减少。这项申请的一个主题是支持生态上合理的AA研究，但不能以牺牲严谨设计和执行的科学为代价。为此，使用具有很强心理测量学特性的评估，对与AA相关的行为、行为改变机制和物质使用都进行了多维度的定义。对再生障碍性贫血行为改变的一般和中介过程的新认识对于改进基于TS的治疗至关重要。研究结果将为以TS为导向的治疗提供循证反馈，这有助于改进干预策略。

DESCRIPTION (provided by applicant): Little is known about how behavior change is mobilized and sustained in AA, and even less is known about how co-occurring psychiatric severity may mediate such changes. This is remarkable given that Twelve-step (TS) therapy is the prevailing alcohol treatment model in the United States and a majority of persons receiving alcohol treatment (TS and non-TS) will attend AA, if only for a limited time. Significant gains have been made in identifying the: (1) characteristics of people most likely to attend AA, and (2) understanding the nature and magnitude of benefits associated with AA exposure. What actually occurs in AA, and how these specific behaviors may predict improved functioning, however, remains poorly understood and rarely investigated. The overall aim of this study is to test a transtheoretical model of behavior change in AA, and to identify the specific AA-related behaviors that mobilize such change. This application proposes a 2-year longitudinal study (N = 300) of AA-exposed individuals, with participants recruited from AA and out-patient treatment. The study has five aims that prospectively test how prescribed AA-related behaviors mobilize AA-specific and non-specific change mechanisms, and how such mechanisms once mobilized predict reductions in drinking and other drug use. A theme in this application is to argue for ecologically sound AA studies, but not at the expense of sacrificing rigorously designed and executed science. To this end, AA-related behaviors, behavior change mechanisms, and substance use are each defined multi-dimensionally, using assessments with strong psychometric properties. New knowledge of the general and mediational processes of behavior change in AA is critical for improvement of TS-based therapy. Study findings will provide TS oriented therapies with evidenced-based feedback that is instrumental for improving intervention strategies.