Therapeutic Mechanisms in AA (Tonigan, PI)

A basic premise of this application is that AA is a manual guided self-help program, a fact that is overlooked in nearly all investigations of AA. For example, AA literature provides clear prescriptions about desired AA behaviors, e.g., 12-steps, therapeutic mechanisms of change, and intended outcomes. This study aims to investigate how, if at all, prescribed AA practices mobilize three therapeutic mechanisms identified in the manual of AA, the Big Book: (1) selfish-narcissism, (2) social attachment, and (3) spirituality (religious behavior and spiritual coping). The four study aims are to: (1) determine the measurement structure and trajectory of these three AA-specific therapeutic mechanisms, (2) determine whether these three AA mechanisms mediate AA benefit, and identify the AA prescribed behaviors that kindle these mechanisms, (3) determine if AA therapeutic mechanisms are correlated with, or are consequences of, rival explanations for AA benefit (specifically, social support for abstinence); and (4) determine if alcohol problem severity moderates the processes under investigation. A single-group (N = 128) longitudinal design will be used and recruitment will occur in AA clubs and an outpatient treatment center. Little is known about how, if at all, history of prior alcohol quit efforts may influence processes of interest. Therefore, study inclusion-exclusion criteria are intended to recruit individuals in early stages of changing alcohol use who have had, at most, limited success in changing past alcohol use and who have had minimal exposure to AA and treatment. Constructs of interest will be defined in multidimensional terms, including substance use and consequences. Findings will shed light on the validity of long-held AA prescriptions, and will lead to an enlarging and/or sharpening of 12-step therapeutic practices to more effectively facilitate long-term AA participation.