Urban Native Americans and Alcoholics Anonymous

描述(申请人提供)：从功利主义的角度来看，很难理解目前对美洲原住民(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专注于开发适应文化的干预措施，旨在与基于保留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，或至少将被鼓励参加戒酒互助会(AA)。然而，在最近对24项针对NA问题饮酒者的干预研究的综述中，没有一项研究调查了12步治疗或AA的有效性(Greenfield&Venner，2012)。这项拟议的研究通过对依赖酒精的城市NA成年人(N=150)进行一项为期9个月的单一小组前瞻性调查，解决了这些重大差距。参与者将被招募并同意，因为他们在门诊接受治疗，并直接来自AA。然后，参与者将在基线、3个月、6个月和9个月时接受采访。虽然重要，但研究的目的远远超出了对AA出席人数的轨迹的记录，以及AA参加人数与后来饮酒之间的滞后关联。具体地说，前瞻性假设将检验文化适应和文化适应对城市化的NA自我选择、参加和参加“主流”和“NA专门化”AA会议的综合调节作用。与此相关的是，有大量证据表明，节欲自我效能感、社会支持和精神实践的进步在一定程度上解释了戒酒的有益效果，至少在“主流”戒酒协会成员中是如此。这项拟议的研究将调查这些变化过程是否被动员起来，并预测城市NA参加戒酒会的人禁欲增加。研究目标的实现将对包括AA转诊在内的城市NA的“标准”护理产生广泛的影响。

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.