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，妇女遭受大部分不利的长期后果。虽然男性和女性实施IPV的比率相似，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)在急诊科(ED)环境中通常被视为急性和慢性并存的情况，具有明显的双向因果关系；但这两种情况很少同时处理。有证据表明，在ED环境中进行短暂的机会性干预在减少随后的危险饮酒和与酒精相关的伤害方面是有效的，但对女性的结果不太清楚。对IPV和药物滥用采取合作治疗办法的干预措施取得了改善的结果，但几乎完全集中在男性犯罪者身上，尽管酗酒也与妇女的IPV受害和实施有关；的确，妇女实施IPV使其面临更大的暴力受害风险。在性别和酒精使用以及激励增强疗法的国际专家的建议下，具有IPV、急救医学、简要ED干预、激励访谈、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研究人员小组提出了一项随机对照试验，有600名女性ED患者自我披露共同发生的问题饮酒和亲密伴侣暴力，以评估短暂的激励干预是否可以减少酗酒和IPV事件的主要结果，使用交互式语音反应系统进行每周评估，为期12周。干预组和被评估的控制组也将在ED访问后12个月内，由盲目分配小组的面试者使用个性化的“安全”电话联系，每隔3、6和12个月联系一次。为了单独确定评估的影响，我们将包括一个仅在3个月时评估结果的非接触性对照组。所有小组都将收到标准的书面推荐。次要结果包括IPV严重性、饮酒量/频率、自我评估的健康状况、健康行为、生活质量和关系满意度。我们将探索干预的可能调解人和主持人。这一简短的25分钟人工指导的动机干预将在急诊科就诊时由训练有素的社会工作者提供，随后在10天内提供15分钟的电话助听器，因为这是一种可推广到其他急性医疗机构的模式。

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.