Development of a Comprehensive and Dynamic AA Process Model: One Day at a Time

戒酒互助会(AA)是处理酒精相关问题的最受欢迎的资源之一， 基于戒酒理论和实践的12步疗法(12-Step Treatment，TS)是目前流行的酒精疗法之一 在美国的做法。两项大型多点试验，一项内部效度高(PMRG，1997)和 第二高的外部效度(VA物质滥用治疗研究；Quimette，1997)得出了同样的结论 结论，TS与更多的研究支持的治疗方法一样有效，实际上可能更好 当完全戒酒是治疗目标的时候。TS的主要目标是促进AA从属关系和强大的 有证据表明，这一目标是解释技术有效性的一个主要因素(例如，Tonigan，2005)。 因此，对再生障碍性疾病中实际发生的情况的调查被赋予了高度优先的地位，特别是 重点识别可以预测饮酒减少的规定的AA行为和过程。这个 这些努力的指导性假设是，提高TS的关键是首先更好地了解AA。为此， 这项研究将第一次产生一个全面和明确的AA相关行为的过程模型 变化。这一目标将通过高度创新地使用早期环境管理数据收集来实现。 AA附属公司。使用实时每日数据，AIM 1将确定AA研究人员确定的四个MOBC(收益 在社会支持方面，节欲自我效能感、精神实践和消极紧迫感的增加)在 三种类型的AA处方行为与饮酒结果之间的联系。值得注意的是，这些分析将 包括对Kazdin(2007)标准中七个标准中的六个进行第一次严格测试，以确认(或拒绝)这四个标准 统计调解人是MOBC。目标2将调查AA活性成分是否对 介体(a路径)和介体的动作(b路径)随时间而恒定，或者，如果存在 影响的关键时期。最后，目标3将确定四个MOBC在不同地区的运行方式是否不同 亚群。为了达到研究目的，我们提出了一项两组随机纵向研究(N=190)。在……里面 其中一组(n=130)我们将收集6个月的连续均线数据，使我们能够近乎实时地检查 AA活性成分在三个领域、四个MOBC与饮酒之间的关系。同时，我们还将 在基线、3个月和6个月进行面谈。评估的反应性是一个令人担忧的问题，尤其是 因为这将是第一次在AA研究中使用EMA，而不是面对面访谈。我们会 因此，包括一个传统的固定评估小组(n=60)，也在基线、3个月和6个月到 识别我们创新方法中引入的潜在测量偏差。学习目标的实现将 生成第一个经过经验验证的AA流程模型，该模型将向TS提供以下关键信息 改善治疗结果。

Alcoholics Anonymous (AA) is one of the most popular resources for dealing with alcohol-related problems, and 12-step therapy (TS), based upon AA doctrine and practice, is one of the prevailing alcohol treatment approaches in the United States. Two large multisite trials, one high in internal validity (PMRG, 1997) and the second high in external validity (VA Substance Abuse Treatment Study; Quimette, 1997) came to the same conclusion, TS was equally effective as more research supported therapies, and may actually be superior when total abstinence is the treatment goal. A primary objective of TS is to facilitate AA affiliation and strong evidence suggests that this aim is a major factor accounting for the effectiveness of TS (e.g., Tonigan, 2005). High priority has therefore been assigned to the investigation of what actually occurs in AA, with a special focus on identifying prescribed AA behaviors and processes that are predictive of drinking reduction. The guiding assumption of these efforts is that the key to improve TS is to first understand AA better. To this end, this study will generate, for the first time, a comprehensive and definitive process model of AA-related behavior change. This objective will be realized through the highly innovative use of EMA data collection among early AA affiliates. Using real-time daily data, aim 1 will determine if four MOBC identified by AA researchers (gains in social support, increased abstinence self-efficacy, spiritual practices, and negative urgency) mediate the linkage between three types of AA prescribed behaviors and drinking outcome. Noteworthy, these analyses will include the first rigorous testing of six of seven of Kazdin's (2007) criteria to confirm (or reject) that these four statistical mediators are MOBC. Aim 2 will investigate whether the actions of the AA active ingredients on mediators (a path) and the actions of the mediators (b path) are constant over time or, alternatively, if there are critical periods of influence. Last, aim 3 will determine if the four MOBC operate differently across distinct subpopulations. To achieve study aims, we propose a two-group randomized longitudinal study (N = 190). In one group (n = 130) we will collect 6-months of continuous EMA data, allowing us to examine near real-time associations between AA active ingredients in three domains, four MOBC, and drinking. In tandem, we will also conduct in-person interviews at baseline, 3, and 6-months. Assessment reactivity is a concern, especially so because this will be the first study to use EMA in addition to in-person interviews in AA research. We will therefore include a traditional fixed assessment group (n = 60) also interviewed at baseline, 3, and 6-months to identify potential measurement biases introduced in our innovative approach. Achievement of study aims will generate the first empirically validated AA process model that will inform TS with critical information for improving treatment outcomes.