Urban Native Americans and Alcoholics Anonymous

描述（由申请人提供）：从功利主义的角度来看，很难理解目前对美洲原住民（NA）酒精行为干预的研究方向。如今，约90%的北美原住民生活在城市，但美国国立卫生研究院赞助的研究不成比例地侧重于发展适应文化的干预措施，这些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匿名者将接受12步治疗，或者至少鼓励他们参加匿名戒酒会（AA）。然而，在最近对24项针对嗜酒成瘾者的干预研究的回顾中，没有一项研究调查了12步治疗或嗜酒成瘾者的有效性（Greenfield & Venner, 2012）。本研究通过对城市酒精依赖成人（N = 150）进行为期9个月的早期嗜酒者协会的单组前瞻性调查，解决了这些显著的差距。参与者将被招募和同意，因为他们出席门诊治疗和直接从AA。然后在基线、3、6和9个月时对参与者进行访谈。虽然重要，但研究的目的远远超出了记录参加嗜酒者互戒会的轨迹以及参加嗜酒者互戒会与后来饮酒之间的滞后关系。具体而言，前瞻性假设将检验文化适应和文化适应对都市化NA自我选择、参与以及出席“主流”和“NA专业”AA会议的相关结果的综合调节作用。与此相关的是，有大量证据表明，戒酒自我效能感、社会支持和精神实践的提高，在一定程度上解释了嗜酒者互戒会的有益效果，至少在嗜酒者互戒会的“主流”成员中如此。该研究将调查这些变化过程是否被调动起来，并预测在参加AA的城市NA中戒酒的增加。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.