Urban Native Americans and Alcoholics Anonymous

描述（由申请人提供）：从功利主义的角度来看，很难理解目前对美国原住民（NA）酒精行为干预的研究方向。今天，大约90%的NA生活在城市，但NIH赞助的研究不成比例地集中在发展文化适应的干预措施，旨在与基于保留地的医疗保健服务相结合。此外，大多数寻求治疗的城市NA将接受12步治疗，或者至少鼓励参加匿名酗酒者协会（AA）。然而，在最近对24项关于NA问题饮酒者干预的研究进行的综述中，没有一项研究调查了12步治疗或AA的有效性（格林菲尔德& Venner，2012）。拟议的研究解决了这些重大的差距进行了为期9个月的单组前瞻性调查酒精依赖的城市NA成人（N = 150）之间的早期AA联系。受试者将在接受门诊治疗时和直接从AA招募并签署知情同意书。然后将在基线、3个月、6个月和9个月时对参与者进行访谈。虽然重要，研究的目的远远超出了AA出席的轨迹和AA出席和后来饮酒之间的滞后关联的文件。具体而言，前瞻性的假设将测试文化适应和文化适应对城市化NA自我选择的综合调节作用，参与，以及与出席“主流”和“NA专门”AA会议相关的结果。相关的，有大量的证据表明，禁欲自我效能，社会支持和精神实践的收益，部分原因是AA的有益影响，至少在“主流”AA成员中。拟议的研究将调查这些变化过程是否被动员，并预测城市NA的参加AA之间的禁欲增加。研究目标的实现将对城市NA的“标准”护理产生广泛的影响，包括AA转诊。

DESCRIPTION (provided by applicant): From a utilitarian perspective, it is hard to understand the current direction of research on alcohol behavioral interventions for Native Americans (NA). Today, about 90% of NA's live in cities yet NIH sponsored research disproportionately focuses on the development of culturally-adapted interventions that are intended to be integrated with reservation-based health care services. Further, a majority of urban NA's seeking treatment will receive 12-step treatment or, at a minimum, will be encouraged to attend Alcoholics Anonymous (AA). In a recent review of 24 studies on interventions for NA problematic drinkers, however, not a single study investigated the effectiveness of 12-step treatment or AA (Greenfield & Venner, 2012). The proposed study addresses these significant gaps by conducting a nine-month single-group prospective investigation of early AA affiliation among alcohol dependent urban NA adults (N = 150). Participants will be recruited and consented as they present for outpatient treatment and directly from AA. Participants will then be interviewed at baseline, 3, 6, and 9-months. While important, study aims move well beyond the documentation of the trajectories of AA attendance and the lagged associations between AA attendance and later drinking. Specifically, prospective hypotheses will test the combined moderating effect of acculturation and enculturation on urbanized NA self-selection into, participation in, and outcomes associated with, attendance at "mainstream" and "NA specialized" AA meetings. Related, there is substantial evidence that gains in abstinence self-efficacy, social support, and spiritual practices account, in part, for th salutary effects of AA, at least among "mainstream" AA members. The proposed study will investigate whether these change processes are mobilized and also predict increased abstinence among urban NA's attending AA. The achievement of study aims will have a broad impact on "standard" care for urban NA's that includes AA referral.