Mechanisms, determinants and processes of change in the modification of drinking behavior.

BACKGROUND: This article explores the conceptual foundations of the search for mechanisms of change in psychotherapy and behavior change approaches.
METHOD: We examine historical and recent attempts to identify mechanisms and discuss results of research studies that examine the modification of drinking and other behaviors. Finally, we describe potential mechanisms of change and offer direction for the future of research.
RESULTS: A series of key questions is addressed. The first critical question is, Where are the appropriate places to look for mechanisms of change in the modification of drinking behavior: person, provider, intervention, or environment? The second questions what we know about change mechanisms from recent research. The third addresses the appropriate methods and designs to isolate and understand these mechanisms. The final question is, How should we proceed to advance our understanding of the critical mechanisms that drive the process of the modifying drinking and recovery from alcoholism?
CONCLUSIONS: We propose a dynamic, life course and an interactive, multidimensional perspective that focuses on personal mechanisms of change and how they interact with interventions, providers, policies, and other life context factors that facilitate or act as barriers to engaging these mechanisms of change.