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

匿名戒酒会（AA）是处理酒精相关问题的最受欢迎的资源之一， 12步疗法（TS）是基于AA理论和实践，是目前流行的酒精治疗方法之一 方法在美国。两个大型多中心试验，一个内部效度高（PMRG，1997）， 第二高的外部效度（VA物质滥用治疗研究; Quimette，1997年）得出相同的结论。 结论，TS与更多的研究支持的疗法一样有效，实际上可能更优越于上级 当完全禁欲是治疗目标时。TS的一个主要目标是促进AA的联系和强大的 有证据表明，这一目标是解释TS有效性的主要因素（例如，Tonigan，2005）。 因此，高度优先的工作是调查机管局实际发生的情况， 专注于识别规定的AA行为和过程，预测饮酒减少。的 这些努力的指导假设是，改善TS的关键是首先更好地理解AA。为此目的， 这项研究将首次产生一个全面的、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EMA数据收集来实现， AA附属公司。使用实时的每日数据，目标1将确定AA研究人员确定的四个MOBC（收益） 在社会支持中，禁欲自我效能感、精神实践和消极紧迫感的增加）介导了 三种AA规定行为与饮酒结果之间的联系。值得注意的是，这些分析 包括卡兹丁（2007）的七个标准中的六个的第一次严格测试，以确认（或拒绝）这四个标准 统计媒介是MOBC。目的2将研究AA活性成分对 中介体（a路径）和中介体（B路径）的动作随时间恒定，或者，如果存在 影响的关键时期。最后，目标3将确定四个MOBC是否在不同的环境中以不同的方式运行。 亚群为了达到研究目的，我们提出了一个两组随机纵向研究（N = 190）。在 一组（n = 130），我们将收集6个月的连续EMA数据，使我们能够近实时检查 AA活性成分在三个领域，四个MOBC和饮酒之间的关联。同时，我们还将 在基线、3个月和6个月时进行面对面访谈。评估反应性是一个值得关注的问题， 因为这将是第一个在AA研究中使用EMA和面对面访谈的研究。我们将 因此，纳入了一个传统的固定评估组（n = 60），也在基线、3个月和6个月时进行了访谈， 识别我们的创新方法中引入的潜在测量偏差。学习目标的实现将 生成第一个经验验证的AA过程模型，该模型将向TS提供关键信息， 改善治疗效果。

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.