Expanding the science on recovery mutual aid for alcohol use disorder: An investigation of SMART Recovery

项目摘要 专业治疗在帮助酒精使用障碍(AUD)患者稳定和 开始恢复。然而，通常情况下，需要某种形式的持续支持来增加稳定的机会 减刑。因此，一种常见的临床策略是将患者与免费提供的互助联系起来 组织(MHO)，可以提供灵活的、持续的、基于社区的支持。MHO的有效性和 成本效益得到了经验的支持，因此，建议在#年转介到MHO 大多数实践指南。然而，由于缺乏数据，当前护理标准的局限性是 转介通常几乎完全是针对灵性导向的12步组织的事实，例如 戒酒互助会(AA)。12步研究的这种虚拟优势的一个重要结果是 MHO是唯一有经验支持的MHO持续护理转诊选择。考虑到精神上的 然而，12步组织的定位和美国一些州最高法院的裁决 从技术上讲，MHO是宗教，因此不能成为唯一的转介选择，提供世俗服务很重要 另类选择。一个主要的候选者是Smart Recovery，一个世俗的认知-行为MHO提供同行 在美国的1200次面对面会议中提供支持。然而，关于它在现实世界中的好处，人们知之甚少。一个 严谨的研究表明，智能恢复可以帮助降低复发风险，这将提供有价值的信息 可以增强临床对SMART作为低成本恢复资源的信心，从而从经验上成为一种长期的- 支持临床转诊选项。作为评估真实世界的临床和公共卫生效用的下一步 智能恢复，目前的研究将：1.描述和描述专业和非专业 使用组轨迹分析的恢复支持服务参与选择、迁移和路径 个人(N=348)开始新的澳元恢复尝试的两年期限。2.调查比较 通过比较AUD患者进行新恢复的结果来评估智能恢复的有效性 尝试(N=348)寻求智能恢复(n=174)或非智能恢复(n=174)路径。 由于大约一半聪明的参与者也选择参加AA，我们将使用分层设计来注册 AUD患者做出自然发生的持续护理选择与参与MHO在 平衡时尚，并在两年内前瞻性地遵循它们(即，智能AA与仅智能 与仅使用AA和两者都不使用相比)。因为之前的数据显示，聪明的参与者可能没有AA那么严重 参与者，我们将根据AUD的严重程度(轻度、中度和重度)对组进行分层。除了使用 倾向得分匹配，这种分层将使我们能够与更科学的严谨性结果进行比较 选择参与智能恢复与不参与智能恢复的人的比例，同时考虑同步选择 关于AA或不参加MHO的问题。3.探索行为改变的机制(如自我效能感、 冲动)，以及利益程度的主持人(例如，性别、精神困扰)，以帮助确定 聪明的复苏可能会如何帮助其附属公司。

Project Summary Professional treatment plays a vital role in helping individuals with alcohol use disorder (AUD) stabilize and begin recovery. Typically, however, some form of ongoing support is needed to increase the chances of stable remission. Consequently, a common clinical strategy is to link patients with freely available mutual-help organizations (MHOs), which can provide flexible ongoing community-based support. MHO effectiveness and cost-effectiveness have been supported empirically and, consequently, referral to MHOs is recommended in most practice guidelines. A limitation of the current standard of care, however, stemming from a lack of data, is the fact that referrals are typically made almost exclusively to spiritually-oriented 12-step organizations, such as Alcoholics Anonymous (AA). One important consequence of this virtual predominance of studies on 12-step MHOs is that they are the only empirically-supported MHO continuing care referral option. Given the spiritual orientation of 12-step organizations, however, and rulings by some US states’ supreme courts that 12-step MHOs are technically religions and thus cannot be the sole referral option, it is important to offer secular alternatives. One prime candidate is SMART Recovery, a secular cognitive-behavioral MHO providing peer support in 1,200 face-to-face meetings in the US. Little is known, however, regarding its real-world benefit. A rigorous study showing SMART Recovery can help reduce relapse risk would provide valuable information that could boost clinical confidence in SMART as a low-cost recovery resource and thus be a secular empirically- supported clinical referral option. As a next step in evaluating the real-world clinical and public health utility of SMART Recovery, the current study will: 1. Characterize and describe professional and non-professional recovery support service participation choices, migrations, and pathways using group trajectory analyses over a two-year period for individuals (N=348) starting a new AUD recovery attempt. 2. Investigate the comparative effectiveness of SMART Recovery by comparing outcomes of AUD individuals making the new recovery attempt (N=348) pursuing either a SMART Recovery (n=174), or a non-SMART recovery (n=174), pathway. Because roughly half of SMART participants also choose to attend AA, we will use a stratified design to enroll persons with AUD making naturally occurring continuing care choices vis-à-vis participation in MHOs in a balanced fashion, and follow them prospectively across a 2-year period (i.e., SMART + AA vs. SMART-Only vs. AA-Only vs. Neither). Because prior data shows SMART participants may be less severe than AA participants, we will stratify groups by AUD severity (mild, moderate, and severe). In addition to using propensity score matching, this stratification will allow us to compare with greater scientific rigor the outcomes of persons choosing to participate in SMART Recovery vs. not, while accounting for simultaneous choices regarding AA or no MHO participation. 3. Explore mechanisms of behavior change (e.g., self-efficacy, impulsivity), as well as moderators of the degree of benefit (e.g., gender, psychiatric distress) to help determine how SMART Recovery may help its affiliates.