A Transtheoretical Model of AA-Related Behavior Change

描述（由申请人提供）：很少有人知道行为变化是如何动员和持续的AA，甚至更少的是知道如何共同发生的精神严重程度可能介导这种变化。这是值得注意的，因为跨步骤（TS）治疗是美国流行的酒精治疗模式，大多数接受酒精治疗的人（TS和非TS）将参加AA，如果只有有限的时间。在确定以下方面取得了重大进展：（1）最有可能参加AA的人的特征，以及（2）了解与AA暴露相关的益处的性质和程度。然而，AA中实际发生了什么，以及这些特定行为如何预测功能改善，仍然知之甚少，很少调查。本研究的总体目标是测试AA行为变化的跨理论模型，并确定具体的AA相关行为，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），参与者从AA和门诊治疗中招募。该研究有五个目的，前瞻性地测试规定的AA相关行为如何调动AA特异性和非特异性变化机制，以及这些机制一旦被调动， 预测饮酒和其他药物使用的减少。本申请的一个主题是主张生态上合理的AA研究，但不能以牺牲严格设计和执行的科学为代价。为此，AA相关的行为，行为改变机制，和物质使用每个定义多维度，使用具有强大的心理测量特性的评估。AA行为改变的一般和中介过程的新知识对于改善基于TS的治疗至关重要。研究结果将为TS导向的治疗提供基于证据的反馈，有助于改善干预策略。

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.