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

描述(由申请人提供)：本提案的目标是为候选人Molly Magill博士的职业生涯做好准备，她将成为一名独立的临床科学家，专门研究酒精使用障碍的心理社会治疗中行为变化的机制。马吉尔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。到目前为止，候选人的经验使人们相信，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。治疗结果相同或不同的发现就是这种情况。这些信息可以通过确定共同的治疗因素、特定于治疗的成分以及传播优先事项，从而提高治疗效率。马吉尔博士在这一领域拥有初步的研究基础，但在她的学术和研究培训方面存在着重要的空白。马吉尔博士在以下方面接受了高级培训：(1)改变过程研究的设计，重点是观察性测量的发展；(2)改变机制的统计分析，重点是纵向方法，马吉尔博士将为这一研究领域和改善酒精使用障碍的心理社会治疗做出贡献。拟议的培训计划将在布朗大学酒精和成瘾研究中心进行，由罗伯特·斯托特博士指导，理查德·朗博博士和蒂莫西·阿波达卡博士共同指导，凯瑟琳·卡罗尔博士和卡洛·迪克莱门特博士提供咨询。拟议的研究计划将直接应用培训活动中产生的技能。具体地说，它将在纵向项目比赛会议数据上使用观察性编码方法，以告知酒精使用障碍的后续护理中的内部治疗机制的知识。拟议的主要目标将考察行为改变语言(承诺、能力、采取措施的声明)的结构，以及两个新的子维度(关于饮酒和关于应对)，预计这两个子维度对于模拟关于患者会后近端和远端改变行为的共同因素假设特别有用。建议的二级目标将从一般心理治疗和成瘾文献中提取，以检验客户机制的两个治疗师共同因素预测因素(客户自我效能的支持、技能重点)。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，并将为后续关于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的研究奠定基础。

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.