Novel Approaches to the Study of Mechanisms of Behavior Change in Alcohol and Other Drug Use Disorders.

159 Received: December 1, 2017. This research was supported by National Institute on Alcohol Abuse and Alcoholism Grant U13 AA024013 (Katie Witkiewitz and Mitchell Karno, multiple principal investigators). The content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health. Declaration of interests: None. *Members of the Mechanisms of Behavior Change Satellite Committee contributing to the manuscript are (in alphabetical order) Marsha E. Bates, AT THE TURN OF THE 21ST CENTURY, scientific gains in the pursuit of more effective treatments for alcohol and other drug use disorders had plateaued, and very little was known about the underlying processes that mobilize and sustain positive behavior change (Huebner & Tonigan, 2007; Longabaugh, 2007). In response to calls to better understand these underlying processes (Longabaugh & Wirtz, 2002), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) invested in research on the social, behavioral, psychological, and biological mechanisms that support reductions in alcohol use and other addictive behaviors. As a result, the first Mechanisms of Behavior Change (MOBC) meeting was held in 2004 as a satellite session to the annual meeting of the Research Society on Alcoholism. The MOBC satellite session has been held annually for the past 13 years, growing from 30 attendees in 2004 to more than 100 attendees in 2017. NIAAA formalized its commitment to MOBC research via several key initiatives: (a) the publication of a special issue monograph in Alcoholism: Clinical and Experimental Research (Huebner & Tonigan, 2007); (b) the development of an NIAAA (2009, 2017) MOBC statement within the Strategic Research Plan; (c) the formation of a transdisciplinary MOBC team within NIAAA leadership; (d) the inclusion of a call for MOBC research in the main program announcement for Treatment, Services, and Recovery Research; (e) the issuing of program announcements, requests for applications, and a research funding announcement with MOBC aims; and (f) the funding of two MOBC-focused conference grants (R13 AA023455; U13 AA024013). NIAAA was not alone in its efforts to improve behavior change interventions. Concurrently, the National Institutes of Health Institute directors identified research on crosscutting processes or mechanisms of change as a top scientific priority, and Science of Behavior Change became a program within the National Institutes of Health Common Fund, with its first funding opportunity announced in 2010. MOBC initiatives within NIAAA and the National Institutes of Health Common Fund represented a shift away from the then-prevailing efficacy paradigm (e.g., randomized clinical trials) as the exclusive means for building knowledge to improve alcohol and other drug treatment outcomes. The efficacy paradigm often resulted in evidence-based modalities producing near-equivalent reductions in alcohol and other drug use (see, e.g., Miller & Wilbourne, 2002; Wampold, 2001; Wampold et al., 1997). That distinct treatment programs with unique behavior targets were producing near-equivalent effects made it impossible for a test of treatment efficacy to determine exactly how change was occurring (Magill & Longabaugh, 2013). Although equivalent outcomes across different treatments could suggest uniform processes of behavior change, behavior change outcomes often vary by person and contextual factors. If we do not know how individuals change addictive behaviors or who is most likely to benefit from addictive behavior treatment, then we do not know how to improve treatment effectiveness. This recognition has resulted in an increased focus on MOBCs, a sixfold increase in citations using mediation models to assess MOBCs within alcohol research studies, and the dissemination of conceptual frameworks (Kazdin & Nock, 2003) and statistical tools (e.g., Hayes, 2013; MacKinnon, 2008) to promote research on MOBCs. The scientific imperative included a call for multidisciplinary research teams, multilevel change process considerations, and increasingly sophisticated analytic methodologies (NIAAA Strategic Plan, 2009). Combined, these efforts represent an attempt to “peel the onion” of human behavior change initiation, maintenance, and relapse. This Special Section in the Journal of Studies on Alcohol and Drugs is aimed at promoting the next phase in examining state-of-the-science approaches to studying MOBCs in addictive behaviors. We hope to highlight advances in this evolving literature and to guide researchers in developing new studies in MOBC science. Further, we offer a selec-