This grant application responds to NIAAA PA 02-167 seeking collaborative treatment and services studies of high priority to providers, and emphasizing group therapies effective for managed care and minority populations. The application proposes a health services trial to test a manual-guided, group-oriented 12-step facilitation intervention called MAAEZ (Making Alcoholics Anonymous Easier). Based on evidence that AA can potentiate treatment effects, this intervention aims to help group-oriented treatment programs engage clients in AA. To this point, no group format manual for 12-step facilitation has been tested and made available to treatment programs. MAAEZ is grounded in Ajzen's Theory of Planned Behavior, and focuses on influencing patient attitudes, subjective norms, and sense of control regarding AA involvement. MAAEZ's 6 sessions help participants to appreciate the diversity of people, opinions and meetings that they encounter at AA; find convenient meetings that they like; and make connections at AA, walking participants through the process of talking to AA members at meetings, calling them on the telephone, and asking someone to be a temporary sponsor. The proposed trial (n=630) will be undertaken in three Kaiser outpatient clinics. For the first 10 weeks of recruitment, participants at Sites 1, 2 and 3 will receive usual treatment (OFF condition). During the next 10 weeks, a new cohort at Sites 1 and 2 will receive 6 weekly MAAEZ sessions in place of 6 usual care sessions (ON), while OFF continues for the new Site 3 cohort so that the study can rule out historical accounts of MAAEZ's effects. New Site 3 participants will receive MAAEZ during a third 10-week recruitment period. Participants will be interviewed at baseline, and at 6 weeks, 6 months, and 12 months post-baseline. Survey measures include AA involvement; attitudes, subjective norms, perceived control, and intentions regarding AA involvement; and drinking outcomes (primarily abstinence). Self-reported alcohol and drug use will be validated by urine testing. The study aims to test whether MAAEZ increases AA involvement and abstinence, to identify subgroups for whom MAAEZ is most effective, and to evaluate mechanisms of action associated with MAAEZ's influence on AA involvement and drinking outcomes. Analyses will include mixed-model ANCOVA's and linear regressions. Consistent with the PA goals, Kaiser program directors and clinicians have been involved in the research questions and will actively collaborate from implementation through dissemination. If effective, MAAEZ should be of wide interest to providers, as it can be rapidly incorporated into existing programs, offering a succinct manual for brief interventions in group-oriented treatment.
