# Development of a Comprehensive and Dynamic AA Process Model: One Day at a Time

> **NIH NIH R01** · UNIVERSITY OF NEW MEXICO · 2021 · $505,687

## Abstract

Alcoholics Anonymous (AA) is one of the most popular resources for dealing with alcohol-related problems,
and 12-step therapy (TS), based upon AA doctrine and practice, is one of the prevailing alcohol treatment
approaches in the United States. Two large multisite trials, one high in internal validity (PMRG, 1997) and the
second high in external validity (VA Substance Abuse Treatment Study; Quimette, 1997) came to the same
conclusion, TS was equally effective as more research supported therapies, and may actually be superior
when total abstinence is the treatment goal. A primary objective of TS is to facilitate AA affiliation and strong
evidence suggests that this aim is a major factor accounting for the effectiveness of TS (e.g., Tonigan, 2005).
High priority has therefore been assigned to the investigation of what actually occurs in AA, with a special
focus on identifying prescribed AA behaviors and processes that are predictive of drinking reduction. The
guiding assumption of these efforts is that the key to improve TS is to first understand AA better. To this end,
this study will generate, for the first time, a comprehensive and definitive process model of AA-related behavior
change. This objective will be realized through the highly innovative use of EMA data collection among early
AA affiliates. Using real-time daily data, aim 1 will determine if four MOBC identified by AA researchers (gains
in social support, increased abstinence self-efficacy, spiritual practices, and negative urgency) mediate the
linkage between three types of AA prescribed behaviors and drinking outcome. Noteworthy, these analyses will
include the first rigorous testing of six of seven of Kazdin's (2007) criteria to confirm (or reject) that these four
statistical mediators are MOBC. Aim 2 will investigate whether the actions of the AA active ingredients on
mediators (a path) and the actions of the mediators (b path) are constant over time or, alternatively, if there are
critical periods of influence. Last, aim 3 will determine if the four MOBC operate differently across distinct
subpopulations. To achieve study aims, we propose a two-group randomized longitudinal study (N = 190). In
one group (n = 130) we will collect 6-months of continuous EMA data, allowing us to examine near real-time
associations between AA active ingredients in three domains, four MOBC, and drinking. In tandem, we will also
conduct in-person interviews at baseline, 3, and 6-months. Assessment reactivity is a concern, especially so
because this will be the first study to use EMA in addition to in-person interviews in AA research. We will
therefore include a traditional fixed assessment group (n = 60) also interviewed at baseline, 3, and 6-months to
identify potential measurement biases introduced in our innovative approach. Achievement of study aims will
generate the first empirically validated AA process model that will inform TS with critical information for
improving treatment outcomes.

## Key facts

- **NIH application ID:** 10077808
- **Project number:** 5R01AA027508-02
- **Recipient organization:** UNIVERSITY OF NEW MEXICO
- **Principal Investigator:** J. SCOTT TONIGAN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $505,687
- **Award type:** 5
- **Project period:** 2020-01-01 → 2024-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10077808

## Citation

> US National Institutes of Health, RePORTER application 10077808, Development of a Comprehensive and Dynamic AA Process Model: One Day at a Time (5R01AA027508-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10077808. Licensed CC0.

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