Identifying Mechanisms of Behavior Change in Psychosocial Alcohol Treatment Trials: Improving the Quality of Evidence from Mediational Analyses

摘要

Objective:In recent years, a shift has occurred from identifying variables that mediate the effects of psychosocial interventions for problematic alcohol use to trying to identify effective mechanisms of behavior change (MOBCs) that lead to better drinking-related and other outcomes. Although implementing interventions targeting specific MOBCs has considerable conceptual and intuitive appeal, it is important that strong empirical evidence be available that supports such implementation. One aim of this article is to consider some prior mediational analyses of the effects of alcohol-focused psychosocial treatments to illustrate findings and the types of evidence that typically have been presented. A second aim is to consider methodological approaches, specifically certain statistical analyses of observational data and experimental designs, that could provide more rigorous evidence regarding the causal effects of mechanisms of change (mediators) in producing desired drinking-related outcomes.