This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04- AA-103: Novel Models of Service Delivery. 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, and importance, this population remains largely hidden and underserved. Relatively few of their partners seek treatment, and psychological and socioeconomic barriers limit the availability of and access to empirically- tested services for themselves. These barriers include: (a) inadequate third party coverage, (b) inability to pay, (c) fear of stigmatization, (d) fear of the partner's reaction, (e) competing job, childcare and other demands, (f) geographical and other isolation, and (g) the fear that they will be told to leave the partner, which they are not willing to do. The self-help group Al-Anon is available to this group, but not widely used, and its efficacy unclear. Stage II efficacy trials now show that clinic-based cognitive-behavioral, coping skill-based interventions, designed specifically for the spouse of the alcoholic can be effective in reducing psychological distress or facilitating alcoholic-partner help-seeking or drinking reduction, but the access barriers remain the same. Unless alternate service delivery models are developed, these treatments will reach relatively few individuals, and have little public health impact. The challenge is to develop novel, alternate service delivery models for these empirically-supported interventions that provide secure, engaging, low cost, easy access to a much larger population of women with alcoholic partners than the small population currently served. To begin to address this service delivery challenge, the current Stage I treatment development application proposes to build on the investigators'substantial research on face-to-face Coping Skills Training (CST) for women with alcoholic partners by adapting CST to a World Wide Web-accessible or deliverable database. An internet-delivered CST model has the potential to address several of the barriers noted above by providing services that (a) are relatively low cost, (b) readily accessible to a very broad population of women with alcoholic partners, (c) are accessible 24/7, and (d) with appropriate security precautions, offer a higher degree of privacy than clinic-based treatment, thereby helping to reduce stigma, embarrassment and other concerns. Development and preliminary evaluation of the internet-based CST (iCST) in the current proposal is accomplished in the two substages of Stage I treatment development work. In Stage Ia, we follow an iterative, user-centered Web site development process to adapt the content of the previously developed, face-to-face CST for interactive, on-line delivery. In Stage Ib, we pilot the feasibility of recruiting women for an iCST clinical trial, and randomly assign 84 women with a partner with an active alcohol use disorder to either 8 weeks of iCST or 8 weeks of a delayed treatment control (DTC) condition. The effect of treatment condition is then evaluated at posttreatment/postdelay to test (a) whether women engaging in iCST acquire a higher level of coping skills relative to DTC, (b) whether iCST, relative to DTC, participants reduce their level of depression, (c) whether, in exploratory analyses, skill acquisition mediates any iCST-DTC difference, and (d) whether treatment effects appear on secondary and ancillary outcomes, including participant anxiety and stress, partner drinking, drinking consequences, and relationship violence. Pilot clinical trial results will provide the foundation for a larger Stage II-level of research effort on this promising delivery model. In sum, the proposal represents a merging of the investigators'empirically-based research on CST, and a growing but nascent body of research on Web-based learning and internet-based interventions for behavioral health problems. The proposal is innovative in that it is the first internet adaptation of an empirically-supported intervention for the spouse/intimate of an alcoholic partner, and jumpstarts the first program of research studying novel delivery models for this underserved group. This innovative model for delivering empirically- supported treatments 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.
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, and importance, this population remains largely hidden and underserved, and significant barriers exist to prevent a large segment of this population from getting help. The internet-based intervention proposed for development 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.
| Rychtarik, Robert G; McGillicuddy, Neil B; Barrick, Christopher (2015) Web-based coping skills training for women whose partner has a drinking problem. Psychol Addict Behav 29:26-33 |
