Within- and Post-Session Change Mechanisms in Treatment for Alcohol Use Disorders

描述（由申请人提供）：本提案的目的是为候选人Molly Magill博士做好准备，使其成为一名独立的临床科学家，专门研究酒精使用障碍心理社会治疗中行为改变机制的研究。Magill博士是一名临床社会工作者，她的职业生涯专注于科学和实践层面的药物使用治疗。候选人迄今为止的经历使他相信，对变化机制的研究可以增强从临床试验研究中获得的知识。这是治疗结果等效或差异的研究结果。此类信息可通过确定共同治疗因素、治疗特定成分，从而确定传播重点，从而提高治疗效率。Magill博士在这一研究领域有一个初步的基础，但在她的学术和研究训练中存在重要的差距。Magill博士在以下方面受过高级培训：(1)注重观察性测量发展的变化过程研究设计，(2)注重纵向方法的变化机制统计分析，他将为这一研究领域和改善酒精使用障碍的社会心理治疗做出贡献。拟议的培训计划将在布朗大学酒精和成瘾研究中心进行，由Robert Stout博士指导，Richard Longabaugh博士和Timothy Apodaca博士共同指导，Kathleen Carroll博士和Carlo DiClemente博士提供咨询。拟议的研究计划将直接应用从培训活动中产生的技能。具体而言，它将采用观察性编码方法对纵向项目MATCH会话数据进行编码，以了解酒精使用障碍术后护理的治疗内机制。提议的主要目的将通过两个新的子维度（关于饮酒，关于应对）来研究行为改变语言的结构（承诺，能力，采取步骤的陈述），这两个子维度预计将特别有用，用于建模关于客户会后近端和远端改变行为的共同因素假设。拟议的次要目标将从一般的心理治疗和成瘾文献中提取，以检查客户机制的两个治疗师共同因素预测因子（客户自我效能的支持，技能焦点）。拟议的研究计划与拟议的培训目标很好地结合在一起，它有可能为临床实践提供信息，并将为后续研究酒精使用障碍治疗中客户近端和远端行为改变的共同因素奠定基础。

DESCRIPTION (provided by applicant): The goal of this proposal is to prepare the candidate, Molly Magill, Ph.D., for a career as an independent clinical scientist specializing in the study of mechanisms of behavior change in psychosocial treatment for alcohol use disorders. Dr. Magill is a clinical social worker who has focused her career on substance use treatment at the level of science and practice. The candidate's experiences to date have led to a belief that research on change mechanisms can enhance the knowledge that is gained from clinical trials research. This is the case for findings of treatment outcome equivalence or difference. Such information can lead to greater treatment efficiency by identifying common treatment factors, treatment-specific ingredients, and thus, dissemination priorities. Dr. Magill has a beginning foundation in this area of research, but there are important gaps in her academic and research training. With advanced training in: (1) the design of change process research with an emphasis on observational measurement development and (2) the statistical analysis of change mechanisms with an emphasis on longitudinal methods, Dr. Magill will contribute to this area of study and to the improvement of psychosocial treatment for alcohol use disorders. The proposed Training Plan will occur at the Brown University Center for Alcohol and Addiction Studies under the mentorship of Dr. Robert Stout, with co-mentorship provided by Dr. Richard Longabaugh and Dr. Timothy Apodaca and consultation provided by Dr. Kathleen Carroll and Dr. Carlo DiClemente. The proposed Research Plan will directly apply skills that arise from training activities. Specifically, it will employ observational coding methods on longitudinal Project MATCH session data to inform knowledge of within-treatment mechanisms in aftercare for alcohol use disorders. The proposed Primary Aims will examine the construct of behavior change language (statements of commitment, ability, taking steps) with two novel sub-dimensions (regarding drinking, regarding coping) that are expected to be particularly useful for modeling common factor hypotheses about client post-session proximal and distal change behavior. The proposed Secondary Aims will draw from the general psychotherapy and addictions literature to examine two therapist common factor predictors (support of client self-efficacy, skills focus) of client mechanisms. The proposed Research Plan is well integrated with the proposed Training Goals, it has the potential to inform clinical practice, and it will ground subsequent research on common factors of client proximal and distal behavior change in treatment for alcohol use disorders. PUBLIC HEALTH RELEVANCE: Alcohol use is a substantial public health issue that has resulted in countless societal and familial costs. Research on change process mechanisms can improve our understanding of how to best treat alcohol problems. Findings from the proposed research will not only inform future methods in this area of study, but will also provide data on predictors of client change that cut across three established treatments for alcohol abuse and dependence.