Therapeutic Mechanisms in AA

描述（由申请人提供）：本申请的一个基本前提是AA是一个手动引导的自助计划，这一事实在几乎所有的AA调查中都被忽视了。例如，AA文献对期望的AA行为提供了明确的处方，如12步，改变的治疗机制和预期的结果。本研究旨在探讨，如果有的话，规定的AA实践是如何调动AA手册（大书）中确定的三种治疗机制的：(1)自私自恋，(2)社会依恋和(3)灵性（宗教行为和精神应对）。本研究的四个目的是：(1)确定这三种AA特异性治疗机制的测量结构和轨迹；(2)确定这三种AA机制是否介导AA获益，并确定触发这些机制的AA规定行为；(3)确定AA治疗机制是否与AA获益的对立解释（特别是禁欲的社会支持）相关，或者是其后果；(4)确定酒精问题的严重程度是否会减缓所调查的过程。采用单组（N = 128）纵向设计，招募将在AA俱乐部和门诊治疗中心进行。很少有人知道，如果有的话，以前戒酒的历史可能会影响兴趣过程。因此，研究纳入-排除标准旨在招募处于改变酒精使用早期阶段的个体，这些个体在改变过去的酒精使用方面最多取得有限的成功，并且他们很少接触AA和治疗。感兴趣的构念将以多维术语定义，包括物质使用和后果。研究结果将阐明长期持有的AA处方的有效性，并将导致扩大和/或强化12步治疗实践，以更有效地促进长期AA参与。

DESCRIPTION (provided by applicant): A basic premise of this application is that AA is a manual guided self-help program, a fact that is overlooked in nearly all investigations of AA. For example, AA literature provides clear prescriptions about desired AA behaviors, e.g., 12-steps, therapeutic mechanisms of change, and intended outcomes. This study aims to investigate how, if at all, prescribed AA practices mobilize three therapeutic mechanisms identified in the manual of AA, the Big Book: (1) selfish-narcissism, (2) social attachment, and (3) spirituality (religious behavior and spiritual coping). The four study aims are to: (1) determine the measurement structure and trajectory of these three AA-specific therapeutic mechanisms, (2) determine whether these three AA mechanisms mediate AA benefit, and identify the AA prescribed behaviors that kindle these mechanisms, (3) determine if AA therapeutic mechanisms are correlated with, or are consequences of, rival explanations for AA benefit (specifically, social support for abstinence); and (4) determine if alcohol problem severity moderates the processes under investigation. A single-group (N = 128) longitudinal design will be used and recruitment will occur in AA clubs and an outpatient treatment center. Little is known about how, if at all, history of prior alcohol quit efforts may influence processes of interest. Therefore, study inclusion-exclusion criteria are intended to recruit individuals in early stages of changing alcohol use who have had, at most, limited success in changing past alcohol use and who have had minimal exposure to AA and treatment. Constructs of interest will be defined in multidimensional terms, including substance use and consequences. Findings will shed light on the validity of long-held AA prescriptions, and will lead to an enlarging and/or sharpening of 12-step therapeutic practices to more effectively facilitate long-term AA participation.