Research and Mentoring in AA-related Mechanisms of Change (Tonigan, PI)

Alcoholics Anonymous (AA) is helpful to many, but not all, substance abusers. Eight studies have now reported that increased spiritual practices account, in part, for AA-related benefit. Our work indicates that increased prayer and meditation "drive" the salutary actions of spiritual practices although the underlying reasons for this effect have yet to be investigated. This revised application responds to PA-11-195, Mid-Career Award in Patient-Oriented Research (K24), and seeks 50% protected time for 5 years for Dr.Tonigan to initiate a new line of AA research that investigates whether self-reported increases in spiritual practices mobilize reductions in immediate reward bias (Boettiger et al., 2007), a cognitive-behavioral effect that would provide far-reaching protective benefit against relapse. The proposed research is highly significant because it represents one of the first theory-driven efforts to integrate self-report and behavioral data to understand underlying change processes in AA. The overall objective of the career development plan (25% FTE) is to provide Dr. Tonigan with the knowledge and skills that are necessary to initiate the investigation of the executive and impulsive-based decision-making systems underlying immediate reward bias (Bickel et al., 2011).To this end, coursework is proposed in the areas of neurocognitive measurement, impaired executive functioning and impulsivity, and brain-behavior neural linkages. Structured collaborations will consolidate and deepen these knowledge gains in addition to providing "hands-on" training in the administration and analysis of behavioral measures that are central to study immediate reward bias. Statistical workshops are also proposed to strengthen Dr. Tonigan's ability to use categorical outcomes in unbalanced longitudinal designs. A single-group longitudinal study of early AA members (N = 100) is proposed. Prospective hypotheses are guided by an empirically supported model of neurobehavioral decision-making processes (Bickel, et al., 2001), and will be tested using measures of self-reported prayer practices, stop-signal reaction time, impulsivity, and delay discounting rates collected five-times over 12-months. Protected time is also requested to mentor four outstanding prospective scientists focused on alcohol-related change mechanism research (25% FTE). The mentoring plan includes weekly meetings with mentees, clear mentoring objectives, and an annual conference for mentees to present their current work and future plans to local NIH investigators. The career development activities, pilot research, and mentoring aims are tightly integrated and mutually reinforcing. Achievement of the revised K24 aims will (1) add significant momentum to the career trajectories of four outstanding prospective investigators, and (2) will provide Dr. Tonigan with the necessary foundation and pilot data to launch a line of AA-based research that significantly advances how processes of change are studied in AA.