Intensive Referral to Al-Anon: Benefits to Concerned Others and Their Drinkers

项目摘要：全世界至少有1亿成年人受到药物成瘾的不利影响。 近亲Al-Anon家庭团体，一个12步互助计划，为关心他人生活的人提供帮助。 饮用，广泛有效。然而，严重缺乏关于如何促进 在相关人士（CO）中，Al-Anon的参与程度以及Al-Anon对饮酒者的益处。 这项独特的研究将检查Al-Anon密集转诊（AIR）的有效性， 酒精使用障碍治疗中的个体（“饮酒者”）。AIR的目标是促进Al-Anon的参与 和积极的结果（例如，更好的生活质量，积极应对）。该项目还将审查 AIR与治疗参与、匿名戒酒会（AA）参与的相关程度，以及 饮酒者的积极结果。尽管有关酗酒是一种家庭疾病的文献经常指出， CO对饮酒者的结果有积极的影响，但方法学上强有力的研究数据非常缺乏。 本项目建立在本研究小组的两条主要研究路线上：（1）实施和展示 强化转介的有效性，一个12步的促进方法，以增加AA参与和改善 物质使用障碍治疗患者的结局及其CO;（2）最近的NIAAA 纵向R21研究，以确定Al-Anon参与对新来者的好处和机制， 成员和他们的饮酒者。 在AIR的随机对照试验中，这个为期4年的项目有三个具体目标。目标1：执行 在三个地点（阿肯色州小石城;内布拉斯加州奥马哈;加利福尼亚州帕洛阿尔托）进行AIR，以评估AIR对CO的有效性。COs 将在基线和3个月、6个月和1年随访时评估受试者（N = 534）及其饮酒者（N =534）。 假设是，与常规护理相比，AIR将（1A）加速寻求帮助并增加Al-Anon （1）提高参与度;（2）改善CO结果。目标2：评估AIR对饮酒者的有效性。假设 空气将与饮酒者（2A）获得更多治疗和AA参与以及（2B）更好相关 饮酒的结果。我们将使用广义混合效应回归模型来检验目标1和目标2 （GLMM）。目的3：检查AIR的作用机制（介质和调节剂）。此外，我们将 使用结构方程模型（SEM）检查CO和饮酒者功能的相互影响。 这个项目是建立在这样一个基础上的，即帮助CO是必不可少的，因为他们自己的痛苦。在 此外，必须帮助社区干事，以帮助饮酒者（饮酒者的更好运作反过来也有助于社区干事）。 与其他基于家庭的成瘾治疗方法相比，AIR在现实世界中是可行的 治疗方案，需要很少的资源。完成本RCT后，如果AIR被证明有效， 该研究计划的下一步将是进行实施研究（混合型2），以传播 并在治疗方案中维持空气，从而帮助CO和饮酒者。

Project Abstract: At least 100 million adults worldwide are adversely affected by the substance addiction of a close relative. Al-Anon Family Groups, a 12-step mutual-help program for people concerned about another’s drinking, is widely available and effective. However, there is a critical lack of knowledge about how to facilitate Al-Anon participation among concerned others (COs), and the extent to which Al-Anon also benefits drinkers. This unique study will examine the effectiveness of Al-Anon Intensive Referral (AIR) with COs of individuals in treatment for alcohol use disorders (“drinkers”). AIR’s goal is to facilitate Al-Anon participation and positive outcomes (e.g., better quality of life, active coping) among COs. The project will also examine the extent to which AIR is associated with treatment engagement, Alcoholics Anonymous (AA) participation, and positive outcomes among drinkers. Although literature on alcoholism as a family disorder frequently states that COs positively influence drinkers’ outcomes, data from methodologically strong studies are sorely lacking. This project builds on two main lines of research by this study team: (1) implementing and showing the effectiveness of Intensive Referral, a 12-step facilitation method, to increase AA participation and improve outcomes among patients in treatment for substance use disorders, and their COs; and (2) a recent NIAAA longitudinal R21 study to identify the benefits and mechanisms of Al-Anon participation to newcomers, members, and their drinkers. In a randomized controlled trial of AIR, this 4-year project has three Specific Aims. Aim 1: Implement AIR at three sites (Little Rock, AR; Omaha, NE; Palo Alto, CA) to evaluate AIR’s effectiveness for COs. COs (N=534) and their drinkers (N=534) will be assessed at baseline and 3-month, 6-month, and 1-year follow-ups. Hypotheses are that, compared to usual care, AIR will (1A) accelerate help-seeking and increase Al-Anon participation, and (1B) improve CO outcomes. Aim 2: Evaluate AIR’s effectiveness for drinkers. Hypotheses are that AIR will be associated with drinkers having (2A) more treatment and AA participation, and (2B) better drinking outcomes. We will examine Aims 1 and 2 using generalized mixed-effects regression models (GLMM). Aim 3: Examine AIR’s mechanisms of action (mediators and moderators). In addition, we will examine reciprocal effects of CO and drinker functioning using Structural Equation Modeling (SEM). This project is built on the foundation that it is essential to help COs because of their own suffering. In addition, it is essential to help COs in order to help drinkers (whose better functioning, in turn, also helps COs). In contrast to other family-based approaches to addiction treatment, AIR is feasible to deliver in real-world treatment programs, requiring few resources. After completing this RCT, if AIR is shown to be effective, the next step in this research program will be to conduct an implementation study (Hybrid Type 2) to disseminate and sustain AIR across treatment programs, thereby helping COs and drinkers.