An RCT of Brief Intervention for Problem Drinking and Partner Violence

针对酗酒问题和伴侣暴力问题的短期干预的随机对照试验

• 批准号: 8277419
• 负责人: KARIN V RHODES
• 金额: $ 50.93万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8277419
• 关键词: Accident and Emergency department; Acute; Address; Advisory Committees; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohols; Blinded; Clinical; Coercion; Communities; Complex; Control Groups; Counseling; Country; Couples; Data; Diagnosis; Effectiveness; Emergency Medicine; Ethnic Origin; Etiology; Evidence based intervention; Failure; Female; Frequencies; Gender; Goals; Grant; Health; Health behavior; Healthcare; Heavy Drinking; Illicit Drugs; Individual; Injury; International; Intervention; Intervention Studies; Interview; Interviewer; Length; Literature; Manuals; Measures; Mediator of activation protein; Medical; Mental Depression; Mental Health; Modeling; Monitor; Morbidity - disease rate; Outcome; Patients; Pattern; Persons; Post-Traumatic Stress Disorders; Preventive Intervention; Primary Health Care; Provider; Psychotherapy; Public Health; Quality of life; Randomized Controlled Trials; Recording of previous events; Reporting; Research Personnel; Resources; Risk; Role; Safety; Screening procedure; Self Efficacy; Services; Severities; Sexual abuse; Social Workers; Source; Substance abuse problem; Support Groups; Support System; System; Telephone; Time; Training; Translating; United States; Victimization; Violence; Visit; Voice; Woman; Writing; assault; base; brief intervention; brief motivational intervention; court; drinking; efficacy research; experience; falls; follow-up; hazardous drinking; improved; intervention effect; intimate partner violence; male; men; mortality; motivational enhancement therapy; motivational intervention; multidisciplinary; partner violence; perpetrators; physical abuse; physical conditioning; primary outcome; psychosocial; public health relevance; response; satisfaction; secondary outcome; treatment program

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.

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一个主要来源，其中大多数不利的长期后果由妇女承担。虽然男性和女性实施 IPV 的比例相似，但这笔赠款将重点关注涉及 IPV 的女性饮酒者（受害者、犯罪者或两者）。 IPV 和酗酒（女性每天 4 杯或更多饮酒）通常被视为急诊科 (ED) 环境中同时发生的病症，无论是急性还是慢性，具有明显的双向因果关系；但这两个条件很少同时得到解决。有证据表明，在急诊室进行短暂的机会性干预可有效减少随后的危险饮酒和与酒精相关的伤害，但对女性的结果尚不明确。对 IPV 和药物滥用采取协作治疗方法的干预措施已取得了改善的结果，但几乎完全集中于男性犯罪者，尽管大量饮酒也与女性 IPV 受害和犯罪有关；事实上，妇女实施 IPV 会使她遭受暴力侵害的风险增加。在性别、饮酒和动机增强治疗方面的国际专家的建议下，多学科研究小组在 IPV、急诊医学、简短的 ED 干预、动机访谈、心理治疗功效研究和复杂心理社会数据建模方面拥有丰富的经验，提出了一项随机对照试验，对象是 600 名自我披露同时存在的饮酒和亲密伴侣暴力问题的女性 ED 患者，以评估短暂的动机干预是否可以减少主要症状 酗酒事件和 IPV 事件的结果，每周使用交互式语音应答系统进行评估，持续 12 周。急诊室就诊后的 12 个月内，不知道分组情况的访调员将每隔 3、6 和 12 个月使用个性化的“安全”电话联系干预组和评估的对照组。为了单独确定评估的影响，我们将纳入一个非接触对照组，仅在 3 个月时评估结果。所有团体都将收到标准的书面推荐。次要结果包括 IPV 严重程度、饮酒量/频率、自我评价健康状况、健康行为、生活质量和关系满意度。我们将探讨干预措施的可能调解者和调节者。简短的 25 分钟手动引导激励干预将由训练有素的社会工作者在急诊室就诊时进行，并对其准确性进行监控，随后在 10 天后进行 15 分钟的电话强化干预，因为这是一个可以推广到其他急性医疗保健环境的模型。 公共健康相关性：我们建议对 600 名急诊科 (ED) 女性患者进行一项随机对照试验，以评估短暂的动机增强干预是否可以减少同时发生的酗酒和 IPV（受害和犯罪），并鼓励利用社区资源进行跟进。接受过动机性访谈培训的社会工作者将在急诊室就诊时提供 25 分钟的人工指导干预，并监测其保真度，随后在 10 天后进行电话辅助干预。将使用交互式语音应答系统每周评估酗酒事件和 IPV 事件的主要结果，持续 12 周。干预组和评估的对照组也将在 3、6 和 12 个月时由不知道小组分配的采访者通过个性化的“安全”电话联系进行联系。为了单独确定评估的影响，我们将纳入一个仅在 3 个月时进行评估的非接触对照组。所有团体都将收到标准的书面推荐。