A SMART evaluation of an adaptive web-based AUD treatment for service members and their partners

项目摘要 与重度饮酒服务成员合作伙伴关系的军人配偶报告了高水平的抑郁症 症状，饮酒和社会障碍，与配偶相比，家庭暴力的风险更高 他们没有与酗酒的伴侣建立关系，这些后果会变得更加复杂， 两人都喝得很厉害。然而，配偶往往不寻求照顾自己或他们的伴侣的问题， 阻碍寻求护理的多重障碍。军人配偶和伴侣-称为“有关伴侣” （CP）-可能是激励服务成员寻求护理的重要途径。然而，CP可以首先 需要减少自己的饮酒，改善沟通，以有效地支持和鼓励 改变他们的服务伙伴。拟议的研究建立在我们与合作伙伴连接的试点工作基础上， 为军事CP提供的4次网络干预（WBI）。在目标1中，我们提出了一个顺序多重 评估适应性CP干预对CP疗效的分配随机试验（SMART）设计 酗酒和寻求SM帮助在目标2中，我们将研究适应性干预如何以及对谁最重要。 有效的通过看主持人和调解员的服务成员寻求帮助，并补充这些 定量分析与定性CP和服务成员访谈的原因和驱动力的服务 成员求助。我们将进行两阶段的SMART设计。在第一阶段，我们将CP随机化， 合作伙伴连接或来自Gottman Institute网站的通信资源。CP将 如果他们的服务成员完成了他们的个性化规范， 反馈（PNF）会话。第一阶段无应答者的CP（服务人员未完成PNF） 将被重新随机分组，在第二阶段接受额外的沟通干预。舞台的目的 二次随机化是为了测试什么能帮助第一阶段的无应答者。我们希望通过进一步治疗 我们可以改善CP沟通和饮酒， 最终帮助服务成员获得一个简短的，有效的PNF干预他们的饮酒。我们的目标是 减少军队中的健康差距，首先与服务成员的配偶进行干预， 他们的成果，以更好地装备他们从事服务的成员。在此过程中，我们开发了一个 这种模式增加了治疗的可及性，并在可能不寻求护理的群体中具有吸引力。的 对CP来说，最佳的包装是改善CP的饮酒，心理健康和沟通， 最终让服役人员参与PNF由此可见，Partners Connect是一款新颖的“二合一” 为CP和服务成员填补服务空白的干预措施。

PROJECT ABSTRACT Military spouses in relationships with a heavy drinking service member partner report high levels of depression symptoms, drinking, and social impairment, and a heightened risk for domestic violence compared to spouses who are not in a relationship with a heavy drinking partner, and these consequences are compounded when both partners drink heavily. Yet, spouses often do not seek care for their own or their partner’s problems due to multiple barriers preventing pursuit of care. Military spouses and partners —termed “concerned partners” (CPs)—may be an important gateway for motivating service members to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. The proposed study builds off our pilot work with Partners Connect, a 4-session web-based intervention (WBI) for military CPs. In Aim 1, we propose a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate the efficacy of an adaptive CP intervention on CP drinking and SM help-seeking. In Aim 2, we will examine how and for whom the adaptive intervention is most efficacious by looking at moderators and mediators of service-member help-seeking and supplementing these quantitative analyses with qualitative CP and service member interviews on the reasons and drivers of service member help-seeking. We will conduct a two-stage SMART design. In stage one, we will randomize CPs to either Partners Connect or communication resources from the Gottman Institute website. CPs will be considered a ‘”responder” at stage one if their service member completes their personalized normative feedback (PNF) session. CPs who are non-responders to stage one (service member has not completed PNF) will be re-randomized to receive additional communication interventions in stage two. The purpose of the stage two randomization is to test what helps stage one non-responders. We expect that by further treating those that do not respond initially to Partners Connect, we can improve CP communication and drinking, and ultimately help service members access a brief, effective PNF intervention for their drinking. Our goal is to reduce health disparities in the military by first intervening with the service member’s spouse and improving their outcomes to better equip them to engage their service member in services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care. The optimal package for CPs is the one that improves the CP’s drinking, mental health, and communication and that ultimately engages the service member in PNF. Thus, Partners Connect is a novel “two-in-one” intervention that fills service gaps for CPs and service members.