A Transtheoretical Model of AA-Related Behavior Change

描述（由申请人提供）：在嗜酒成瘾者中，行为改变是如何被调动和维持的，我们所知甚少，而精神疾病的严重程度是如何介导这种改变的，我们所知更少。这是值得注意的，因为十二步疗法（TS）是美国流行的酒精治疗模式，而且大多数接受酒精治疗的人（TS和非TS）都会参加AA，即使只是在有限的时间内。在确定：(1)最有可能参加嗜酒者的特征和(2)了解嗜酒者接触的好处的性质和程度方面取得了重大进展。然而，在嗜酒成瘾中究竟发生了什么，以及这些特定的行为如何预测功能的改善，人们对这些行为的了解仍然很少，也很少进行研究。本研究的总体目的是测试AA行为改变的跨理论模型，并确定具体的AA相关行为，以调动这种变化。本申请提出了一项为期2年的AA暴露个体纵向研究（N = 300），参与者来自AA和门诊治疗。该研究有五个目标，即前瞻性地测试规定的aa相关行为如何调动aa特异性和非特异性的变化机制，以及这些机制如何被调动

DESCRIPTION (provided by applicant): Little is known about how behavior change is mobilized and sustained in AA, and even less is known about how co-occurring psychiatric severity may mediate such changes. This is remarkable given that Twelve-step (TS) therapy is the prevailing alcohol treatment model in the United States and a majority of persons receiving alcohol treatment (TS and non-TS) will attend AA, if only for a limited time. Significant gains have been made in identifying the: (1) characteristics of people most likely to attend AA, and (2) understanding the nature and magnitude of benefits associated with AA exposure. What actually occurs in AA, and how these specific behaviors may predict improved functioning, however, remains poorly understood and rarely investigated. The overall aim of this study is to test a transtheoretical model of behavior change in AA, and to identify the specific AA-related behaviors that mobilize such change. This application proposes a 2-year longitudinal study (N = 300) of AA-exposed individuals, with participants recruited from AA and out-patient treatment. The study has five aims that prospectively test how prescribed AA-related behaviors mobilize AA-specific and non-specific change mechanisms, and how such mechanisms once mobilized predict reductions in drinking and other drug use. A theme in this application is to argue for ecologically sound AA studies, but not at the expense of sacrificing rigorously designed and executed science. To this end, AA-related behaviors, behavior change mechanisms, and substance use are each defined multi-dimensionally, using assessments with strong psychometric properties. New knowledge of the general and mediational processes of behavior change in AA is critical for improvement of TS-based therapy. Study findings will provide TS oriented therapies with evidenced-based feedback that is instrumental for improving intervention strategies.