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.

Public Health Relevance

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 recent work indicates that increased prayer and meditation are pivotal in this process although the underlying reasons for this effect have yet to be investigated. To address this question this revised K24 application seeks five years of protected time for Dr. Tonigan (FTE 50%) to acquire knowledge in the area of cognitive-behavioral neuropsychology and the behavioral measurement of rate of delay discounting and response inhibition. Building on these knowledge gains the proposed research study will investigate how self-reported changes in prayer influence reductions in immediate reward bias, an effect that would provide substantial protection against relapse (25% FTE). In tandem, Dr. Tonigan will provide intensive mentoring to four mentees with outstanding potential for becoming independent scientists in addiction research. The career, research, and mentoring plans are mutually reinforcing and will provide Dr. Tonigan with knowledge gains and pilot data that are necessary to prepare an R01 application in a new area of research on AA.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Health Services Research Review Subcommittee (AA)
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Chiapella, Page
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University of New Mexico
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United States
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Wilcox, Claire E; Tonigan, J Scott (2018) Changes in depression mediate the effects of AA attendance on alcohol use outcomes. Am J Drug Alcohol Abuse 44:103-112
Muñoz, Rosa E; Tonigan, J Scott (2017) Alcoholics Anonymous-Related Benefit for Urban Native Americans: Does Urban Native American Gender Moderate AA Engagement and Outcomes? Alcohol Treat Q 35:34-45
Montes, K S; Tonigan, J S (2017) Does Age Moderate the Effect of Spirituality/Religiousness in Accounting for Alcoholics Anonymous Benefit? Alcohol Treat Q 35:96-112
Tonigan, J Scott; McCallion, Elizabeth A; Frohe, Tessa et al. (2017) Lifetime Alcoholics Anonymous attendance as a predictor of spiritual gains in the Relapse Replication and Extension Project (RREP). Psychol Addict Behav 31:54-60
Bogenschutz, Michael P; Bhatt, Snehal; Bohan, Juliane et al. (2016) Coadministration of disulfiram and lorazepam in the treatment of alcohol dependence and co-occurring anxiety disorder: an open-label pilot study. Am J Drug Alcohol Abuse 42:490-499
Wilcox, Claire E; Pearson, Matthew R; Tonigan, J Scott (2015) Effects of long-term AA attendance and spirituality on the course of depressive symptoms in individuals with alcohol use disorder. Psychol Addict Behav 29:382-91
Tonigan, J Scott; Rynes, Kristina; Toscova, Radka et al. (2013) Do changes in selfishness explain 12-step benefit? A prospective lagged analysis. Subst Abus 34:13-9
Rynes, Kristina N; Tonigan, J Scott; Rice, Samara L (2013) Interpersonal Climate of 12-step Groups Predicts Reductions in Alcohol Use. Alcohol Treat Q 31:167-185