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

项目摘要/摘要 新冠肺炎和酒精/物质使用障碍的结合加剧了一系列现有的 与大流行有关的问题，包括感染COVID的可能性和后果的严重性 压力会引发酒精和药物使用，失去工作和医疗保健机会，增加人际关系 暴力，以及总体上的系统性不平等。需要采取干预措施来解决这些严重问题， 即使在广泛获得COVID疫苗后，这种情况也可能持续下去。 为响应PAR 20-243，该R01项目是一项混合II RCT/实施研究，修改和测试两个 我们的酒精智能手机干预措施，以应对COVID的影响。我们建议一种三臂RCT 将对照组与以饮酒者为中心的干预与以家庭为中心的干预进行比较。专注于饮酒的人 干预(ACHESS-C)是我们循证成瘾-全面健康的延伸 增强支持系统(ACHESS)，增加了COVID资源。以家庭为重点的干预 (FamCHESS-C)将ACHESS-C服务与循证酒精行为夫妇治疗相结合 帮助饮酒者和伴侣改变行为、关系问题和总体健康的服务。 在拟议的为期8个月的试验和4个月的随访中，198个二元组(饮酒者+家庭成员)将随机 分配给：1)智能手机控制：两人都收到一部带有标准支持和危机号码的智能手机；2) ACHESS-C：饮酒者收到带有ACHESS-C的电话，合作伙伴收到带有支持和危机的电话 号码；3)Fam-Chess-C：两个人都收到FamchESS-C的电话。该项目的目标如下： 目标1：完成对FamCHESS-C应用程序的改进。 目标2：进行平衡随机对照试验，以测试以下结果：1)饮酒者酗酒天数，2) 二重生活质量。其次：3)二人关系满意度，4)二人心理/身体冲突，5) 饮酒者不酗酒天数，6)饮酒者饮酒/吸毒天数百分比，7)二联冠状病毒疫苗接种率，8) 饮酒者酗酒和毒品相关问题。探索性：伴侣酗酒/吸毒天数百分比，二重人格危机 医疗保健使用，二分体技术满意度。我们假设结果会更有利。 FamCHESS-C相对于ACHESS-C，两者都将比智能手机控制更有利。 目标3：检验二元能力、关联性和动机的中介效应；饮酒者的临时变化 在酒精和药物使用天数百分比和APP使用范围方面比较ACHESS-C和FamCHESS-C。 检查饮酒者性别、饮酒者基线饮酒严重程度、饮酒者对病情影响的适度性 AUD/SUD的治疗参与度和DYAD的基线关系满意度。 目标4：使用实施科学模型进行小规模(20个二元)形成性评估 收集有关使用ACHESS-C和FamCHESS-C的困难和益处认知的定性数据。

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.