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，妇女遭受的不良长期后果居多。虽然男性和女性的IPV发生率相似，但这笔赠款将重点关注涉及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4杯或更多）通常被视为急诊科（ED）环境中的共同发生的情况，包括急性和慢性，具有明显的双向因果关系；但这两种情况很少同时得到解决。有证据表明，在急诊科环境中，短暂的机会性干预对减少随后的危险饮酒和酒精相关伤害是有效的，但对女性的结果不太清楚。对IPV和药物滥用采取合作治疗方法的干预措施改善了结果，但几乎只关注男性犯罪者，尽管大量饮酒也与妇女IPV受害和犯罪有关；事实上，妇女实施IPV使她面临更大的暴力受害风险。由具有IPV、急诊医学、简短ED干预、动机性访谈、心理治疗疗效研究和复杂心理社会数据建模经验的多学科调查小组提供关于性别和酒精使用以及动机增强疗法的国际专家的建议，提出一项随机对照试验，对600名自我披露饮酒和亲密伴侣暴力共同发生的女性ED患者进行随机对照试验，以评估简短的动机干预是否可以降低重度饮酒和IPV事件的主要结局，每周使用交互式语音应答系统进行评估，持续12周。干预组和被评估的对照组也将在每3、6和12个月通过个性化的“安全”电话联系，在急诊科访问后的12个月里，由对小组分配不知情的采访者进行联系。为了确定单独评估的影响，我们将纳入一个仅在3个月时评估结果的无接触对照组。所有小组都将收到标准的书面推荐。次要结局包括IPV严重程度、酒精量/频率、自评健康、健康行为、生活质量和关系满意度。我们将探讨干预可能的中介和调节者。简短的25分钟手动引导的动机干预将由训练有素的社会工作者在急诊科就诊时提供，并将对其保真度进行监测，随后在第10天进行15分钟的电话助推器，因为这是一个可以推广到其他急性卫生保健环境的模式。

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.