Testing the Efficacy of a Technology-Supported Lifestyle Physical Activity Intervention Among Women with Depression in Alcohol Treatment

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ABSTRACT Alcohol use disorder (AUD) is a significant and costly public health problem. Women develop AUD more quickly and suffer a broader range of adverse alcohol-related health consequences than men. Yet, due to stigma, shame, and child care issues, women are less likely to receive specialty addiction treatment. Moreover, mounting evidence indicates factors that precipitate relapse differ between men and women. Men are more likely to relapse in response to positive emotional states and social pressure while negative emotional states are important precipitators of relapse in women. Indeed, women often report drinking to cope with negative emotions and express a lack of alternate coping strategies. Given the robust evidence for physical activity (PA) in decreasing depression, negative affect, and alcohol craving, PA interventions may play an important role as an alternate coping strategy for women with AUD and a means to decrease relapse. Our team was the first group to develop and test a lifestyle physical activity (LPA) approach with women with AUD (R34 AA024038). LPA is a new PA paradigm that emerged as an alternative to the gym-based fitness training interventions that struggle with high dropout and lack transportability to varied settings. LPA interventions represent simple, low- cost, and flexible approaches that are supported by brief counseling and activity monitors (e.g., Fitbit) to facilitate goal-setting and self-monitoring. In our Stage 1a and 1b studies, we developed and demonstrated initial support for an LPA+Fitbit intervention for women with AUD and depression. The intervention consisted of 6 brief, phone-based PA counseling sessions focused on increasing PA and strategically using bouts of PA to cope with affect and alcohol cravings and use of the Fitbit fitness tracker and mobile app. Our preliminary work established the acceptability and feasibility of this intervention. In addition, results of an initial randomized controlled trial (RCT; N = 50) showed that, relative to a health education contact (HEC) control, women in the LPA+Fitbit intervention had higher rates of alcohol abstinence, greater reductions in depression and negative affect, and increased PA at the 3-month follow-up. We propose to build on our promising preparatory work and take the next step by conducting a fully powered (N=214), Stage 2 RCT to test the efficacy of the LPA+Fitbit intervention, compared to a Fitbit Only condition, for women with AUD and depression in alcohol treatment. In addition, to elucidate mechanisms of treatment effects, we will employ two, 10-day bouts of ecological momentary assessment (EMA) to obtain multiple daily measures of affect, cravings, drinking, and PA engagement during early recovery (i.e., first 90 days) coupled with objective assessment of PA (i.e., Fitbit data). This project will contribute much-needed knowledge on the role of PA in reducing alcohol use, depressive symptoms and negative mood in women with AUD. If the efficacy of the LPA+Fitbit intervention can be established, depressed women with AUD will have a valuable adjunct to traditional alcohol treatment that can server as an alternate coping strategy during early recovery, when relapse risk is highest.