The goal of this proposal is to prepare the candidate, Molly Magill, Ph.D., for a career as an independent clinical scientist specializing in the study of mechanisms of behavior change in psychosocial treatment for alcohol use disorders. Dr. Magill is a clinical social worker who has focused her career on substance use treatment at the level of science and practice. The candidate's experiences to date have led to a belief that research on change mechanisms can enhance the knowledge that is gained from clinical trials research. This is the case for findings of treatment outcome equivalence or difference. Such information can lead to greater treatment efficiency by identifying common treatment factors, treatment-specific ingredients, and thus, dissemination priorities. Dr. Magill has a beginning foundation in this area of research, but there are important gaps in her academic and research training. With advanced training in: (1) the design of change process research with an emphasis on observational measurement development and (2) the statistical analysis of change mechanisms with an emphasis on longitudinal methods, Dr. Magill will contribute to this area of study and to the improvement of psychosocial treatment for alcohol use disorders. The proposed Training Plan will occur at the Brown University Center for Alcohol and Addiction Studies under the mentorship of Dr. Robert Stout, with co-mentorship provided by Dr. Richard Longabaugh and Dr. Timothy Apodaca and consultation provided by Dr. Kathleen Carroll and Dr. Carlo DiClemente. The proposed Research Plan will directly apply skills that arise from training activities. Specifically, it will employ observational coding methods on longitudinal Project MATCH session data to inform knowledge of within-treatment mechanisms in aftercare for alcohol use disorders. The proposed Primary Aims will examine the construct of behavior change language (statements of commitment, ability, taking steps) with two novel sub-dimensions (regarding drinking, regarding coping) that are expected to be particularly useful for modeling common factor hypotheses about client post-session proximal and distal change behavior. The proposed Secondary Aims will draw from the general psychotherapy and addictions literature to examine two therapist common factor predictors (support of client self-efficacy, skills focus) of client mechanisms. The proposed Research Plan is well integrated with the proposed Training Goals, it has the potential to inform clinical practice, and it will ground subsequent research on common factors of client proximal and distal behavior change in treatment for alcohol use disorders.

Public Health Relevance

Alcohol use is a substantial public health issue that has resulted in countless societal and familial costs. Research on change process mechanisms can improve our understanding of how to best treat alcohol problems. Findings from the proposed research will not only inform future methods in this area of study, but will also provide data on predictors of client change that cut across three established treatments for alcohol abuse and dependence.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Health Services Research Review Subcommittee (AA)
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Falk, Daniel
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Brown University
Public Health & Prev Medicine
Schools of Public Health
United States
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Magill, Molly; R Apodaca, Timothy; Karno, Mitchell et al. (2016) Reliability and Validity of an Observational Measure of Client Decision-Making: The Client Language Assessment - Proximal/Distal (CLA-PD). J Subst Abuse Treat 63:10-7
Magill, M; Apodaca, Timothy R; Walthers, Justin et al. (2016) The Alcohol Intervention Mechanisms Scale (AIMS): Preliminary Reliability and Validity of a Common Factor Observational Rating Measure. J Subst Abuse Treat 70:28-34
Bourke, Emilie; Magill, Molly; Apodaca, Timothy R (2016) The In-Session and Long-Term Role of a Significant Other in Motivational Enhancement Therapy for Alcohol Use Disorders. J Subst Abuse Treat 64:35-43
Borsari, Brian; Magill, Molly; Mastroleo, Nadine R et al. (2016) Mandated college students' response to sequentially administered alcohol interventions in a randomized clinical trial using stepped care. J Consult Clin Psychol 84:103-12
Kahler, Christopher W; Caswell, Amy J; Laws, M Barton et al. (2016) Using topic coding to understand the nature of change language in a motivational intervention to reduce alcohol and sex risk behaviors in emergency department patients. Patient Educ Couns 99:1595-602
Magill, Molly; Walthers, Justin; Mastroleo, Nadine R et al. (2016) Therapist and client discussions of drinking and coping: a sequential analysis of therapy dialogues in three evidence-based alcohol use disorder treatments. Addiction 111:1011-20
Magill, Molly; Kiluk, Brian D; McCrady, Barbara S et al. (2015) Active Ingredients of Treatment and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later. Alcohol Clin Exp Res 39:1852-62
Yurasek, Ali M; Borsari, Brian; Magill, Molly et al. (2015) Descriptive norms and expectancies as mediators of a brief motivational intervention for mandated college students receiving stepped care for alcohol use. Psychol Addict Behav 29:1003-11
Mastroleo, Nadine R; Magill, Molly; Barnett, Nancy P et al. (2014) A pilot study of two supervision approaches for peer-led alcohol interventions with mandated college students. J Stud Alcohol Drugs 75:458-66
Magill, Molly; Gaume, Jacques; Apodaca, Timothy R et al. (2014) The technical hypothesis of motivational interviewing: a meta-analysis of MI's key causal model. J Consult Clin Psychol 82:973-83

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