An RCT of Brief Intervention for Problem Drinking and Partner Violence

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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.