This article provides a narrative review of studies that examined mechanisms of behavior change in substance use disorder. Several mechanisms have some support, including self-efficacy, craving, protective behavioral strategies, and increasing substance-free rewards, whereas others have minimal support (e.g., motivation, identity). The review provides recommendations for expanding the research agenda for studying mechanisms of change, including designs to manipulate putative change mechanisms, measurement approaches that expand the temporal units of analysis during change efforts, more studies of change outside of treatment, and analytic approaches that move beyond mediation tests. The dominant causal inference approach that focuses on treatment and individuals as change agents could be expanded to include a molar behavioral approach that focuses on patterns of behavior in temporally extended environmental contexts. Molar behavioral approaches may advance understanding of how recovery from substance use disorder is influenced by broader contextual features, community-level variables, and social determinants of health.

中文翻译：

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经过和未经正规治疗的物质使用障碍行为改变的机制


本文对研究物质使用障碍行为改变机制的研究进行了叙述性回顾。几种机制有一定的支持，包括自我效能、渴望、保护性行为策略和增加无物质奖励，而其他机制则只有很少的支持（例如动机、身份）。该评论为扩大研究变革机制的研究议程提供了建议，包括操纵假定的变革机制的设计、在变革努力期间扩大分析时间单位的测量方法、对治疗之外的变化进行更多研究，以及超越治疗范围的分析方法。中介测试。侧重于治疗和个人作为变革推动者的占主导地位的因果推理方法可以扩展到包括摩尔行为方法，该方法侧重于时间扩展的环境背景下的行为模式。摩尔行为方法可以增进对物质使用障碍的恢复如何受到更广泛的背景特征、社区层面的变量和健康的社会决定因素的影响的理解。