Review of the AA Literature: Clinical and Research Implications

描述(申请人提供)：本修订申请符合PA-10-069。戒酒互助会(AA)是为有酒精相关问题的人提供的最受欢迎的自助计划，基于戒酒互助会的理论和实践的12步疗法是美国流行的酒精治疗模式。因此，可以理解的是，已经对基于社区的再生障碍性疾病进行了数百次调查，最近对这些经验性文献的叙述性评论相对常见。叙述性审查的价值有限，因为它们往往只审查“具有统计意义的”发现，它们不提供对影响大小的估计，而且由于没有提供这种估计，这些审查错失了提醒研究人员注意未来调查最肥沃领域的机会。为了克服这些限制，我们建议使用先进的荟萃分析技术对经验性AA文献(1993-2009年)进行全面回顾。自上一次这类全面审查以来(Emrick等人，1993年)已经过去了19年，在此期间发表了大约450-500篇AA同行审查论文。这篇综述有三个目的：(1)我们将总结1993-2009年AA的文献，重点是AA的从属关系以及AA相关益处的大小和性质。我们将通过与1993年和1996年的元分析审查相比大大改进的程序和统计方法来做到这一点。(2)我们将审查AA研究的三个新领域，这是由于自1993年以来AA研究的激增而成为可能的元分析综合。这些领域是：(A)再生障碍性疾病的变化机制，(B)特殊人群和再生障碍性贫血，以及(C)再生障碍性贫血的长期从属关系和结果。这些新领域的总结将为从业者和研究人员提供一个独特的视角，以理解AA如何以及对谁可能有帮助。相关的，我们计划识别、编码和分析非AA自助同行评审的论文。(3)我们将向影响较大的期刊传播元分析论文，向调查人员提供数据集，并免费分发一张光盘，其中包含一个PDF文件，其中载有在元分析搜索中确定的所有定性和定量论文的参考文献，并在版权法允许的情况下随附PDF复制的文章。 公共卫生相关性：该项目将应用先进的荟萃分析技术来回顾和总结1993至2009年间基于AA的研究文献。我们将审查英语和西班牙语的同行评议论文，我们还将包括非12步自助论文。除了确定AA的从属关系和与AA相关的益处的性质和大小外，这项全面的综述还将综合自1993年以来激增的AA研究的三个新领域的发现：(1)AA的变化机制，(2)特殊人群和AA，以及(3)长期的AA职业和结果。这些发现将提供两个方面：(1)向临床医生提供关于谁受益于再生障碍性贫血的循证建议，以及(2)向研究人员提供关于未来互助研究最肥沃的领域的明确建议。

DESCRIPTION (provided by applicant): This revised application responds to PA-10-069. Alcoholics Anonymous (AA) is the most popular self-help program for persons with alcohol-related problems, and 12-step therapy, based on AA doctrine and practice, is the prevailing alcohol treatment model in the United States. Understandably, then, hundreds of investigations on community-based AA have been conducted, and recent narrative reviews of this empirical literature are relatively common. Narrative reviews are of limited value as they tend to review only "statistically significant" findings, they do not provide estimates of the magnitude of effects and, by not providing such estimates, these reviews miss the opportunity to alert researchers to the most fertile areas for future investigations. To overcome these limitations we propose to do a comprehensive review of the empirical AA literature (1993- 2009) using advanced meta-analytic techniques. It has been 19 years since the last comprehensive review of this kind (Emrick et al., 1993), and in that time about 450-500 AA peer- reviewed papers have been published. This review has three aims: (1) we will summarize the AA literature from 1993-2009 focusing on AA affiliation profiles and the magnitude and nature of AA- related benefit. We will do this with much improved procedural and statistical approaches relative to our 1993 and 1996 meta-analytic reviews, (2) we will review three new areas of AA research, a meta-analytic synthesis made possible because of the surge of AA research since 1993. The areas are: (a) mechanisms of change in AA, (b) special populations and AA, and (c) long-term AA affiliation and outcome. Summaries of these new areas will provide practitioners and researchers with a unique perspective in understanding how, and for whom, AA may be helpful. Related, we plan to identify, code, and analyze non-AA self-help peer-reviewed papers. (3) We will disseminate meta-analytic papers to high impact journals, make available the data set to investigators, and distribute, free of charge, a CD that contains a PDF file with the references for all qualitative and quantitative papers identified in the meta-analytic search, with accompanying PDF reproduced articles when copyright laws permit. PUBLIC HEALTH RELEVANCE: This project will apply advanced meta-analytic techniques to review and summarize the AA-based research literature from 1993 to 2009. We will review English and Spanish peer-reviewed papers, and we will also include non-12 step self-help papers. In addition to identifying AA affiliation profiles and the nature and magnitude of AA-related benefit, this comprehensive review will synthesize findings in three new areas of AA research that have proliferated since 1993: (1) mechanisms of change in AA, (2) special populations and AA, and (3) long-term AA careers and outcome. Findings will provide both: (1) evidence-based recommendations to clinicians about who does and does not benefit from AA, and (2) clear recommendations to researchers about the most fertile areas for future mutual-help investigations.