12-step Alternatives and Recovery Outcomes in a Large National Study

描述（由申请人提供）：现在人们普遍认为，嗜酒者互助协会和其他12步小组有助于改善那些对酒精和/或毒品上瘾并选择参加的人的物质使用结果。然而，大多数人并没有坚持定期参加12步疗法，即使12步疗法是治疗的重点。与此同时，参与12步替代疗法的人数相当多，而且似乎还在增长。最大的替代方案包括妇女戒酒（WFS），自我管理和恢复训练（SMART），生活和世俗戒酒组织（SOS）。然而，关于12步替代疗法有效性的研究几乎不存在，也没有已知的对小组成员的纵向研究。对各种替代方案的有效性进行研究，对于加强将正式治疗与适当替代方案相结合、改善转诊做法以及向法院和其他法律机构（例如，EAP计划）以及一般人群通报强制实施药物滥用治疗的情况非常重要。因此，目前的研究将利用最近一项非常大的全国性研究，对从酒精和/或药物问题中康复的个人进行跟踪调查，从12步小组（N=261）及其替代小组（N=390；总N=651）中招募的受访者，并测量互助小组的参与和康复结果。受访者将完成第一次随访调查，并在6个月和12个月时进行额外随访（第二次和第三次随访）。我们的主要目的是测试互助组参与与康复结果（如戒断和生活质量）之间的联系是否在互助组中有所不同（目的2）。我们还将比较将WFS、SMART、LifeRing和SOS作为主要互助组的受访者与12步成员在人口统计学、临床严重程度和参与性质方面的差异（目标1），并检查互助组中群体满意度和退出/减少参与的预测因素（目标3）。尽管有一些小的小组，我们希望在每个小组中都有足够的人数来比较个别的12步替代方案和AA。在短期内，当前的研究应该有助于建立关于特定互助小组的益处和局限性的知识库，并可能导致对一种或多种有前途的替代AA的更集中的研究，以及能够最好地解决有效性问题的研究设计，例如随机试验。最终，目前的研究可以支持有效互助团体的发展和许多愿意使用互助团体的个人的康复。该提案响应PA-13-161（酒精使用障碍：治疗、服务研究和康复，NIAAA），征求对酒精使用障碍的行为和药物治疗的研究。

DESCRIPTION (provided by applicant): It is now generally accepted that AA and other 12-step groups contribute to better substance use outcomes for those who are addicted to alcohol and/or drugs and choose to attend them. Nevertheless, most individuals do not sustain regular involvement in 12-step groups, even when 12-step participation is the focus of treatment. Meanwhile, involvement in 12-step alternatives is substantial and appears to be growing. The largest such alternatives include Women for Sobriety (WFS), Self-Management and Recovery Training (SMART), LifeRing, and Secular Organization for Sobriety (SOS). Yet, research relating to the effectiveness of 12-step alternatives is almost non-existent, and there are no known longitudinal studies on group members. Research on the effectiveness of the various alternatives is important to enhancing the integration of formal treatment with appropriate alternatives, improving referral practices, and informing courts and other legal bodies (e.g., EAP programs) involved in mandating substance abuse treatment, as well as the general population. The current study will thus capitalize on a very large, recent, national study of individuals in recovery from an alcohol and/or drug problem to follow respondents recruited from 12-step groups (N=261) and their alternatives (N=390; total N=651) and measure mutual help group involvement and recovery outcomes. Respondents will complete a First Follow-up survey and additional follow-ups at 6 and 12 months (Second and Third Follow-ups). Our primary aim is to test whether associations between mutual help group involvement and recovery outcomes (such as abstinence and quality of life) differ across mutual help groups (Aim 2). We will also compare respondents identifying WFS, SMART, LifeRing, and SOS as their primary mutual help group to 12-step members on demograpcharhics, clinical severity, and nature of involvement (Aim 1), and examine predictors of group satisfaction and drop-out/declining involvement across mutual help groups (Aim 3). Despite some small subgroups, we expect generally sufficient numbers within each group to facilitate comparisons between individual 12-step alternatives and AA. The current study should, in the short term, contribute to the knowledge base on the benefits and limits of specific mutual help groups, and may lead to more focused study of one or more promising alternative(s) to AA and to study designs that can best address questions of effectiveness, such as randomized trials. Ultimately, the current line of research could support both the growth of effective mutual help groups and the recovery of the many individuals who may be willing to use them. This proposal responds to PA-13-161 (Alcohol Use Disorders: Treatment, Services Research, and Recovery, NIAAA), soliciting research on behavioral and pharmacological treatment for alcohol use disorders.