Estimates suggest that nearly 1 in 20 adult women in the U.S. are married to or living with a partner with an alcohol use disorder (AUD). These women often experience significant psychological and physical distress, utilize substantially more health care services than spouses of those without an AUD, and incur overall higher healthcare costs. Improving their own physical and psychological health is important in its own right, but also may help facilitate partner drinking reduction, and buffer the negative effects of the partner's drinking on their children. Despite their prevalence, distress, importance, and cost, this population remains largely hidden and underserved. Institutional, psychological and socioeconomic barriers discourage these women from seeking help, and when they do seek help, the newer, empirically tested services are not within their reach. Novel, alternate delivery models are needed to overcome the barriers, and provide easy access to empirically evaluated services. To begin to meet this need, the investigators, in a prior Stage I effort, adapted an empirically tested face-to-face coping skills training program to a self-paced, Web version (StopSpinningMyWheels; SSMW). SSMW was well-received, had high participation, and, relative to no intervention, improved short-term coping skills and negative affect. The increase in skills partially mediated improvements in distress. This proposal builds on the pilot study by (a) updating and reprogramming SSMW to add responsive web-design, greater content personalization, and increased transportability; (b) adding a complementary mHealth app so women can use their smartphones to access SSMW content and interactivity; (c) developing a SSMW coach web portal to facilitate their tracking of participant engagement; and (d) developing a Usual Web Comparison (UWC) site that provides access to a compilation of free Web information. We then propose a large-scale RCT in which 450 women with an AUD partner will be randomized to one of three conditions: SSMW with coach support calls (SSMW+COACH), SSMW without coach support (SSMW ONLY), or the UWC. Assessments will occur at baseline, a 6-week interim, a 12-week post, and at subsequent 6 and 12-month followups. We hypothesize that, in reducing negative affect, both SSMW conditions will be more effective than UWC, and, in considering the role of coach support, SSMW+COACH will be more effective than SSMW ONLY in engaging participants, and reducing negative affect. We (a) test whether differential skill acquisition, behavioral activation, and negative thinking mediate these effects, (b) study the role of differential program engagement in this mediation model, and (c) explore the moderating role of baseline negative affect. The work expands our understanding of interventions for this underserved group, fills a major public health gap in how best to reach and improve their lives, and may, indirectly, facilitate a reduction in their partner's problem, and protect their children from its negative effects.
Nearly 1 in 20 adult women in the U.S. are married to or living with an alcoholic or problem drinking partner. As a result, these individuals experience significant psychological and physical distress, utilize health care services to a greater degree than spouses of nonalcoholics, and incur overall higher healthcare costs. While their physical and psychological health is important in its own right, their health and coping skills also can play a significant role in facilitating alcoholic partner drinking reduction and help-seeking, and in buffering their children from the negative effects of the other parent's alcohol problem. Yet, despite its size, distress, importance and cost, this population remains largely hidden and underserved, and significant barriers exist to prevent a large segment of this population form getting help. The ehealth intervention that we continue to build on and evaluate in the current application has the potential for eventually reaching large numbers of women who otherwise would not receive help. In so doing, it has the potential for having a much larger public health impact than conventional face-to-face delivery models, alone.
