Family-focused vs. Drinker-focused Smartphone Interventions to Reduce Drinking-related Consequences of COVID-19

项目总结/摘要 COVID-19和酒精/物质使用障碍的结合加剧了现有的各种疾病， 问题，包括感染COVID的可能性和后果的严重性，与流行病有关的 引发酒精和物质使用的压力，失业和医疗保健，增加人际关系 暴力和总体的系统性不平等。需要采取干预措施来解决这些严重问题， 即使在COVID疫苗广泛可用之后，这种情况也可能持续下去。 作为对PAR 20-243的响应，该R 01项目是一项混合II RCT/实施研究，修改并测试了两个 我们的酒精智能手机干预措施，以应对COVID的影响。我们提出了一个3臂RCT 比较对照组、饮酒者干预组和家庭干预组。以饮酒者为中心 干预（ACHESS-C）是我们的循证成瘾综合健康的延伸 增强支持系统（ACHESS），增加了COVID资源。以家庭为中心的干预 （FamCHESS-C）将ACHESS-C服务与循证酒精行为夫妇治疗相结合 服务，以帮助双方饮酒者和合作伙伴的行为改变，关系问题，和一般的福祉。 在拟议的8个月试验加4个月随访中，将随机抽取198对夫妇（饮酒者+家庭成员）， 分配给：1）智能手机控制：都收到一个标准的支持和危机号码的智能手机; 2） ACHESS-C：饮酒者收到ACHESS-C电话，合作伙伴收到支持和危机电话 3）Fam-CHESS-C：两者都接收具有FamCHESS-C的电话。该项目的目标如下： 目标1：对FamCHESS-C应用程序进行全面改进。 目的2：进行一项平衡的随机对照试验，以检验以下结果：主要：1）饮酒者%重度饮酒日，2） 二分体生活质量。次要因素：3）二人关系满意度，4）二人心理/身体冲突，5） 饮酒者无大量饮酒天数，6）饮酒者酒精/药物使用天数%，7）二元COVID疫苗接种率，8） 饮酒者酒精和毒品相关的问题。探索性：9）伴侣酒精/药物使用天数%，10）二元危机 医疗保健使用，11）二元技术满意度。我们假设，结果将更有利， FamCHESS-C相对于ACHESS-C，两者相对于智能手机控制都更有利。 目的3：检验二元个体的能力、相关性和动机的中介效应;饮酒者的临时变化 酒精和药物使用的天数百分比，以及用于比较ACHESS-C和FamCHESS-C的应用程序使用程度。 通过饮酒者性别、饮酒者基线饮酒的严重程度、饮酒者 参与AUD/SUD治疗，以及二人基线关系满意度。 目标4：使用实施科学模型进行小规模（20对）形成性评价， 收集关于使用ACHESS-C和FamCHESS-C的困难和益处的定性数据。

PROJECT SUMMARY / ABSTRACT The combination of COVID-19 and alcohol/substance use disorders exacerbates a wide range of existing problems, including the likelihood of contracting COVID and severity of consequences, pandemic-related stresses that trigger alcohol and substance use, loss of jobs and healthcare access, increased interpersonal violence, and overarching systemic inequities. Interventions are needed to address these serious problems, which are likely to persist even after widespread availability of COVID vaccines. In response to PAR 20-243, this R01 project is a Hybrid II RCT/implementation study modifying and testing two of our alcohol smartphone interventions to address the fallout from COVID. We propose a 3-arm RCT comparing a control vs. a drinker-focused intervention vs. a family-focused intervention. The drinker-focused intervention (ACHESS-C) is an extension of our evidence-based Addiction–Comprehensive Health Enhancement Support system (ACHESS), augmented with COVID resources. The family-focused intervention (FamCHESS-C) combines ACHESS-C services with evidence-based Alcohol Behavioral Couple Therapy services to help both drinker and partner with behavior change, relationship problems, and general well-being. In the proposed 8-month trial plus 4-month follow-up, 198 dyads (drinker + family member) will be randomly assigned to: 1) Smartphone control: both receive a smartphone with standard support and crisis numbers; 2) ACHESS-C: drinker receives a phone with ACHESS-C, partner receives a phone with support and crisis numbers; 3) Fam-CHESS-C: both receive phone with FamCHESS-C. The project has the following aims: Aim 1: Complete refinements to the FamCHESS-C app. Aim 2: Conduct a balanced RCT to test the following outcomes: Primary: 1) drinker % heavy drinking days, 2) dyad quality of life. Secondary: 3) dyad relationship satisfaction, 4) dyad psychological/physical conflict, 5) drinker no heavy drinking days, 6) drinker % days alcohol/drug use, 7) dyad COVID vaccination rates, 8) drinker alcohol- and drug-related problems. Exploratory: 9) partner % days alcohol/drug use, 10) dyad crisis healthcare use, 11) dyad technology satisfaction. We hypothesize that outcomes will be more favorable in FamCHESS-C relative to ACHESS-C, and both will be more favorable relative to smartphone control. Aim 3: Examine mediation effects of dyad's competence, relatedness, and motivation; drinker's interim change in % days of alcohol and drug use, and extent of app use for comparisons of ACHESS-C and FamCHESS-C. Examine moderation of effects of condition by drinker sex, severity of drinker’s baseline alcohol use, drinker engagement in treatment for AUD/SUD, and dyad’s baseline relationship satisfaction. Aim 4: Conduct a small-scale (20 dyads) formative evaluation using an implementation science model to collect qualitative data on perceptions of difficulties and benefits of ACHESS-C and FamCHESS-C use.