An RCT of Brief Intervention for Problem Drinking and Partner Violence

描述（由申请人提供）：亲密伴侣暴力（IPV）仍然是美国发病率和死亡率的主要来源，妇女遭受大多数不利的长期后果。虽然男性和女性的IPV犯罪率相似，但这笔赠款将侧重于涉及IPV的女性饮酒者（受害者，肇事者或两者兼而有之）。IPV和大量饮酒（女性每天饮酒4杯或更多）通常被视为急诊科（艾德）环境中的并发症，无论是急性还是慢性，具有明显的双向因果关系;但这两种情况很少一起解决。有证据表明，在艾德环境中进行简短的机会性干预，可以有效减少随后的危险饮酒和酒精相关伤害，但在女性中的结果不太清楚。对IPV和药物滥用采取合作治疗方法的干预措施取得了更好的结果，但几乎完全集中在男性肇事者身上，尽管酗酒也与IPV受害和妇女的犯罪行为有关;事实上，妇女的IPV犯罪行为使她面临更大的暴力受害风险。由性别和酒精使用和动机增强治疗方面的国际专家提供咨询，多学科研究小组在IPV，急诊医学，简短的艾德干预，动机访谈，心理治疗疗效研究以及复杂心理社会数据的建模方面拥有丰富的经验，我建议进行一项随机对照试验，纳入600名女性艾德患者，发生问题饮酒和亲密伴侣暴力，以评估是否短暂的动机干预可以减少大量饮酒和IPV事件的主要结果，每周使用交互式语音应答系统进行评估，持续12周。在艾德访视后的12个月内，干预组和评估的对照组也将在第3、6和12个月时由对组分配不知情的访视者使用个性化的“安全”电话联系进行联系。为了确定单独评估的影响，我们将纳入一个仅在3个月时评估结局的无接触对照组。所有小组都将收到标准的书面推荐。次要结果包括IPV严重程度、酒精量/频率、自测健康、健康行为、生活质量和关系满意度。我们将探讨可能的调解人和调解人的干预。在艾德访视时，将由经过培训的社会工作者提供简短的25分钟手动指导动机干预（将监测其忠诚度），然后在第10天进行15分钟的电话助推器，因为这是一种可推广到其他急性医疗保健环境的模式。 公共卫生相关性：我们提出了一项随机对照试验，600名女性急诊科（艾德）患者，以评估是否一个简短的动机增强干预可以减少同时发生的大量饮酒和IPV（受害和犯罪），并鼓励后续与社区为基础的资源。在艾德来访时，经过动机访谈培训的社会工作者将进行25分钟的手动指导干预，并监测其忠诚度，然后在10天后进行电话助推器。将使用交互式语音应答系统每周评估重度饮酒事件和IPV事件的主要结局，持续12周。干预组和评估的对照组也将在第3、6和12个月时由对组分配不知情的访谈者使用个性化的“安全”电话联系进行联系。为了确定单独评估的影响，我们将纳入仅在3个月时评估的无接触对照组。所有小组都将收到标准的书面推荐。

DESCRIPTION (provided by applicant): Intimate partner violence (IPV) remains a major source of morbidity and mortality in the United States, with women suffering the majority of adverse long-term consequences. While both men and women perpetrate IPV at similar rates, this grant will focus on IPV-involved women drinkers (victims, perpetrators, or both). IPV and heavy drinking (4 or more drinks/day for women) are commonly seen in as co-occurring conditions in the emergency department (ED) setting, both acutely and chronically, with apparent bi-directional causation; but these two conditions are rarely addressed together. There is evidence that brief opportunistic interventions in the ED setting are effective in reducing subsequent hazardous drinking and alcohol-related injuries, but results have been less clear in women. Interventions that take a collaborative treatment approach to IPV and substance abuse have resulted in improved outcomes but have focused almost exclusively on male perpetrators, even though heavy drinking is also associated with IPV victimization and perpetration in women; indeed a woman's perpetration of IPV puts her at increased risk of violent victimization. Advised by international experts on gender and alcohol use and motivational enhancement therapy, the multidisciplinary group of investigators with experience in IPV, emergency medicine, brief ED interventions, motivational interviewing, psychotherapy efficacy research, and the modeling of complex psychosocial data, propose a randomized controlled trial with 600 women ED patients who self-disclose co-occurring problem drinking and intimate partner violence to assess whether a brief motivational intervention can decrease primary outcomes of episodes of heavy drinking and incidents of IPV, assessed weekly using an Interactive Voice Response System for 12 weeks. Both the intervention and the assessed control group will also be contacted every at 3, 6 and 12 months using individualized "safe" phone contact by interviewers blinded to group assignment for 12 months following the ED visit. To identify the impact of assessment alone, we will include a no-contact control group assessed for outcomes only at 3 months. All groups will receive standard written referrals. Secondary outcomes include IPV severity, alcohol quantity/frequency, self-rated health, health behaviors, quality of life, and relationship satisfaction. We will explore likely mediators and moderators of the intervention. The brief 25 minute manual-guided motivational intervention, which will be monitored for fidelity, will be delivered by trained social workers at the time of the ED visit, followed by a 15 minute phone booster at 10 days, as this is a model that could be generalizable to other acute health care settings. PUBLIC HEALTH RELEVANCE: We propose a randomized controlled trial with 600 women emergency department (ED) patients to assess whether a brief motivational enhancement intervention can decrease co-occurring heavy drinking and IPV (both victimization and perpetration) and encourage follow up with community-based resources. The 25 minute manual-guided intervention, monitored for fidelity, will be delivered at the time of the ED visit by social workers trained in motivational interviewing, followed by a phone booster at 10 days. Primary outcomes of episodes of heavy drinking and incidents of IPV will be assessed weekly using an Interactive Voice Response System for 12 weeks. The intervention and the assessed control group will also be contacted at 3, 6 and 12 months using individualized "safe" phone contact by interviewers blinded to group assignment. To identify the impact of assessment alone, we will include a no-contact control group assessed only at 3 months. All groups will receive standard written referrals.