Developing Web Delivered Coping Skills Training for Women with Alcoholic Partners

开发网络为女性与酗酒伴侣提供应对技巧培训

• 批准号: 7817925
• 负责人: ROBERT G RYCHTARIK
• 金额: $ 50万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7817925
• 关键词: Address; Adult; Alcohol abuse; Anger; Anxiety; Area; Behavioral; Buffers; Characteristics; Child; Clinic; Clinical Research; Clinical Trials; Cognitive; Coping Skills; Data Analyses; Databases; Development; Distress; Ensure; Ethnic Origin; Evaluation; Family; Foundations; Fright; Health; Health Care Costs; Health Services; Healthcare Systems; Individual; Internet; Intervention; Intervention Trial; Learning; Left; Life; Literature; Manuals; Mediating; Mental Health; Modeling; Occupations; Online Systems; Outcome; Parents; Participant; Play; Population; Privacy; Process; Public Health; Randomized; Reaction; Recruitment Activity; Relative (related person); Research; Research Personnel; Role; Schedule; Secure; Security; Services; Spouses; Staging; Stigmata; Stigmatization; Stress; Structure; Sum; Support Groups; Testing; Training; Training Programs; Underserved Population; Woman; Work; alcohol use disorder; base; behavioral health; care seeking; coping; cost; depression; depressive symptoms; digital; drinking; efficacy evaluation; efficacy trial; evidence base; experience; help-seeking behavior; improved; innovation; non-alcoholic; novel; prevent; problem drinker; programs; psychologic; psychological distress; public health relevance; relationship violence; research study; response; satisfaction; skill acquisition; skills training; social stigma; socioeconomics; theories; therapy design; therapy development; treatment effect; usability; web site; web-accessible

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04- AA-103: Novel Models of Service Delivery. Nearly 1 in 20 adult women in the U.S. are married to or living with an alcoholic or problem drinking partner. As a result, these individuals experience significant psychological and physical distress, utilize health care services to a greater degree than spouses of nonalcoholics, and incur overall higher healthcare costs. While their physical and psychological health is important in its own right, their health and coping skills also can play a significant role in facilitating alcoholic partner drinking reduction and help-seeking, and in buffering their children from the negative effects of the other parent's alcohol problem. Yet, despite its size, distress, and importance, this population remains largely hidden and underserved. Relatively few of their partners seek treatment, and psychological and socioeconomic barriers limit the availability of and access to empirically- tested services for themselves. These barriers include: (a) inadequate third party coverage, (b) inability to pay, (c) fear of stigmatization, (d) fear of the partner's reaction, (e) competing job, childcare and other demands, (f) geographical and other isolation, and (g) the fear that they will be told to leave the partner, which they are not willing to do. The self-help group Al-Anon is available to this group, but not widely used, and its efficacy unclear. Stage II efficacy trials now show that clinic-based cognitive-behavioral, coping skill-based interventions, designed specifically for the spouse of the alcoholic can be effective in reducing psychological distress or facilitating alcoholic-partner help-seeking or drinking reduction, but the access barriers remain the same. Unless alternate service delivery models are developed, these treatments will reach relatively few individuals, and have little public health impact. The challenge is to develop novel, alternate service delivery models for these empirically-supported interventions that provide secure, engaging, low cost, easy access to a much larger population of women with alcoholic partners than the small population currently served. To begin to address this service delivery challenge, the current Stage I treatment development application proposes to build on the investigators' substantial research on face-to-face Coping Skills Training (CST) for women with alcoholic partners by adapting CST to a World Wide Web-accessible or deliverable database. An internet-delivered CST model has the potential to address several of the barriers noted above by providing services that (a) are relatively low cost, (b) readily accessible to a very broad population of women with alcoholic partners, (c) are accessible 24/7, and (d) with appropriate security precautions, offer a higher degree of privacy than clinic-based treatment, thereby helping to reduce stigma, embarrassment and other concerns. Development and preliminary evaluation of the internet-based CST (iCST) in the current proposal is accomplished in the two substages of Stage I treatment development work. In Stage Ia, we follow an iterative, user-centered Web site development process to adapt the content of the previously developed, face-to-face CST for interactive, on-line delivery. In Stage Ib, we pilot the feasibility of recruiting women for an iCST clinical trial, and randomly assign 84 women with a partner with an active alcohol use disorder to either 8 weeks of iCST or 8 weeks of a delayed treatment control (DTC) condition. The effect of treatment condition is then evaluated at posttreatment/postdelay to test (a) whether women engaging in iCST acquire a higher level of coping skills relative to DTC, (b) whether iCST, relative to DTC, participants reduce their level of depression, (c) whether, in exploratory analyses, skill acquisition mediates any iCST-DTC difference, and (d) whether treatment effects appear on secondary and ancillary outcomes, including participant anxiety and stress, partner drinking, drinking consequences, and relationship violence. Pilot clinical trial results will provide the foundation for a larger Stage II-level of research effort on this promising delivery model. In sum, the proposal represents a merging of the investigators' empirically-based research on CST, and a growing but nascent body of research on Web-based learning and internet-based interventions for behavioral health problems. The proposal is innovative in that it is the first internet adaptation of an empirically-supported intervention for the spouse/intimate of an alcoholic partner, and jumpstarts the first program of research studying novel delivery models for this underserved group. This innovative model for delivering empirically- supported treatments has the potential for eventually reaching large numbers of women who otherwise would not receive help. In so doing, it has the potential for having a much larger public health impact than conventional face-to-face delivery models, alone. PUBLIC HEALTH RELEVANCE: Nearly 1 in 20 adult women in the U.S. are married to or living with an alcoholic or problem drinking partner. As a result, these individuals experience significant psychological and physical distress, utilize health care services to a greater degree than spouses of nonalcoholics, and incur overall higher healthcare costs. While their physical and psychological health is important in its own right, their health and coping skills also can play a significant role in facilitating alcoholic partner drinking reduction and help-seeking, and in buffering their children from the negative effects of the other parent's alcohol problem. Yet, despite its size, distress, and importance, this population remains largely hidden and underserved, and significant barriers exist to prevent a large segment of this population from getting help. The internet-based intervention proposed for development in the current application has the potential for eventually reaching large numbers of women who otherwise would not receive help. In so doing, it has the potential for having a much larger public health impact than conventional face-to-face delivery models, alone.

描述（由申请人提供）：本申请涉及广泛的挑战领域（04）临床研究和特定的挑战主题，04- AA-103：服务提供的新模式。在美国，每20名成年女性中就有1人与酗酒者或有酗酒问题的伴侣结婚或同居。因此，这些人经历了严重的心理和身体上的痛苦，比非酗酒者的配偶更大程度地利用医疗保健服务，并承担更高的医疗保健费用。虽然他们的身体和心理健康本身就很重要，但他们的健康和应对技能也可以在促进酗酒伴侣减少饮酒和寻求帮助方面发挥重要作用，并在缓冲他们的孩子免受另一方父母酗酒问题的负面影响方面发挥重要作用。然而，尽管这一群体规模庞大，处境艰难，地位重要，但他们在很大程度上仍然被隐藏起来，得不到充分的服务。她们的伴侣中寻求治疗的相对较少，心理和社会经济障碍限制了她们自己获得和获得经经验检验的服务。这些障碍包括：(a)第三方保险不足；(b)无力支付；(c)害怕被污名化；(d)害怕伴侣的反应；(e)工作、托儿和其他要求相互竞争；(f)地理和其他隔离；(g)害怕被告知离开伴侣，而她们不愿意这样做。这个群体可以参加自助团体“匿名者协会”（Al-Anon），但没有得到广泛应用，其效果也不清楚。II期疗效试验现在表明，专门为酗酒者配偶设计的以临床为基础的认知行为和应对技能干预措施，可以有效地减少心理困扰，或促进酗酒者伴侣寻求帮助或减少饮酒，但获取障碍仍然是一样的。除非开发出替代的服务提供模式，否则这些治疗只能惠及相对较少的个人，对公共卫生的影响也很小。面临的挑战是为这些经经验支持的干预措施开发新的替代服务提供模式，这些干预措施可以为更多有酗酒伴侣的妇女提供安全、吸引人、低成本和方便的服务，而不是目前服务的少数人群。为了开始解决这一服务提供方面的挑战，目前的第一阶段治疗开发应用程序建议在调查人员对有酗酒伴侣的妇女进行面对面应对技能培训（CST）的大量研究的基础上，通过将CST改编为万维网可访问或可交付的数据库。互联网提供的CST模式有可能解决上述几个障碍，因为它提供的服务(a)成本相对较低，(b)有酗酒伴侣的广大妇女群体随时可以获得，(c)全天候可获得，以及(d)有适当的安全预防措施，比诊所治疗提供更高程度的隐私，从而有助于减少耻辱、尴尬和其他问题。在目前的建议中，基于互联网的CST （iCST）的发展和初步评估是在第一阶段治疗发展工作的两个子阶段完成的。在阶段a中，我们遵循一个迭代的、以用户为中心的网站开发过程，将先前开发的面对面CST的内容改编为交互式的、在线的交付。在Ib阶段，我们对招募女性进行iCST临床试验的可行性进行了试点，并随机分配了84名患有活动性酒精使用障碍的女性，分别接受8周的iCST治疗或8周的延迟治疗控制（DTC）治疗。然后在治疗后/后延迟评估治疗条件的效果，以测试(a)参与iCST的女性是否获得了相对于DTC更高水平的应对技能，(b)相对于DTC， iCST是否降低了参与者的抑郁水平，(c)在探索性分析中，技能习得是否介导了iCST-DTC的任何差异，以及(d)治疗效果是否出现在次要和辅助结果上，包括参与者焦虑和压力，伴侣饮酒，饮酒后果，以及关系暴力。试点临床试验结果将为这一有前景的交付模式的更大规模的ii期研究工作提供基础。总而言之，该提案代表了研究者基于经验的CST研究与基于网络的学习和基于网络的行为健康问题干预研究的结合。这项提议的创新之处在于，它是第一个在互联网上改编的针对酗酒伴侣的配偶/亲密者的经验支持干预措施，并启动了第一个研究项目，研究为这一服务不足的群体提供新的服务模式。这种提供经验支持治疗的创新模式有可能最终惠及大量本来得不到帮助的妇女。这样做，它有可能比传统的面对面交付模式产生更大的公共卫生影响。