The search for mechanisms of change in behavioral treatments for alcohol use disorders: a commentary.
BACKGROUND
Definitive results from efforts to identify mechanisms of change in behavioral treatments for alcohol use disorders have been elusive. The working hypothesis guiding this paper is that one of the reasons for this elusiveness is that the models we hypothesize to account for treatments effectiveness are unnecessarily restricted and too simple.


METHODS
This paper aims to accomplish 3 things. First, a typography for locating potential mediators of change will be presented. In the course of doing so, a nomenclature will be proposed with the hope that this will facilitate communications among alcohol treatment researchers studying mechanisms of change. Second, alternatives to the classic test of mediation of alcohol treatment effects will be considered and one such alternative described. Third, alternative ways of conceptualizing, constructing and analyzing variables to measure mediators will be suggested.


RESULTS
It is hoped that this commentary will facilitate research on mechanisms of change in behavioral treatments for alcohol use disorders.


CONCLUSIONS
Behavioral change is a complex process, and the models that we develop to account for this process need to reflect this complexity. Advances in statistical approaches for testing mediation, along with a better understanding as to how to use these tools should help in moving toward this goal.
Longabaugh
Richard
R
Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Providence, RI 02903, USA. Richard_Longabaugh@brown.edu
D000428:Alcohol Drinking; D000437:Alcoholism / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy; D002986:Clinical Trials as Topic; D004777:Environment; D019317:Evidence-Based Medicine; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D009626:Terminology as Topic; D013997:Time Factors