From a utilitarian perspective, it is hard to understand the current direction of research on alcohol behavioral interventions for Native Americans (NA). Today, about 90% of NA's live in cities yet NIH sponsored research disproportionately focuses on the development of culturally-adapted interventions that are intended to be integrated with reservation-based health care services. Further, a majority of urban NA's seeking treatment will receive 12-step treatment or, at a minimum, will be encouraged to attend Alcoholics Anonymous (AA). In a recent review of 24 studies on interventions for NA problematic drinkers, however, not a single study investigated the effectiveness of 12-step treatment or AA (Greenfield &Venner, 2012). The proposed study addresses these significant gaps by conducting a nine-month single-group prospective investigation of early AA affiliation among alcohol dependent urban NA adults (N = 150). Participants will be recruited and consented as they present for outpatient treatment and directly from AA. Participants will then be interviewed at baseline, 3, 6, and 9-months. While important, study aims move well beyond the documentation of the trajectories of AA attendance and the lagged associations between AA attendance and later drinking. Specifically, prospective hypotheses will test the combined moderating effect of acculturation and enculturation on urbanized NA self-selection into, participation in, and outcomes associated with, attendance at "mainstream" and "NA specialized" AA meetings. Related, there is substantial evidence that gains in abstinence self-efficacy, social support, and spiritual practices account, in part, for th salutary effects of AA, at least among "mainstream" AA members. The proposed study will investigate whether these change processes are mobilized and also predict increased abstinence among urban NA's attending AA. The achievement of study aims will have a broad impact on "standard" care for urban NA's that includes AA referral.
This application responds to PA-13-161. A majority of urban Native American (NA) problem drinkers are encouraged to attend Alcoholics Anonymous (AA) during and after treatment. To date, little is known about the efficacy of AA referral for urban NA and even less is known about how and why AA attendance may be beneficial for urban NA. This is extremely unfortunate given that a majority of NA's in the United States reside in urban areas and the rate of alcohol misuse among urban NA's is twice that of all other racial groups. The proposed study offers to investigate the extent that urban NA acculturation and enculturation moderates AA attendance in general and attendance at different types of AA meetings in particular. Lagged statistical tests will determine if during early AA affiliation gains in abstinece-based social support, spiritual practices, and abstinence self-efficacy account for AA- related benefit among urban NA problem drinkers.