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: 7936061
• 负责人: ROBERT G RYCHTARIK
• 金额: $ 49.48万
• 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 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7936061
• 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 Depression; 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; 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) 临床研究和特定挑战主题，04-AA-103：服务交付的新颖模型。在美国，近二十分之一的成年女性与酗酒或酗酒的伴侣结婚或同居。因此，这些人会经历严重的心理和身体痛苦，比非酗酒者的配偶更多地利用医疗保健服务，并且总体上承担更高的医疗费用。虽然他们的身心健康本身很重要，但他们的健康和应对技巧也可以在促进酗酒伴侣减少饮酒和寻求帮助以及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，尽管其规模庞大、处境艰难且重要，但这一群体在很大程度上仍然处于隐蔽状态且得不到充分服务。他们的伴侣寻求治疗的人相对较少，而心理和社会经济障碍限制了他们自己获得和获得经过经验检验的服务的机会。这些障碍包括：(a) 第三方覆盖不足，(b) 无力支付，(c) 担心受到污名化，(d) 担心伴侣的反应，(e) 竞争性工作、儿童保育和其他要求，(f) 地理和其他隔离，以及 (g) 担心他们会被告知离开伴侣，但他们不愿意这样做。自助小组Al-Anon可供该群体使用，但并未广泛使用，其功效尚不清楚。第二阶段疗效试验现在表明，专为酗酒者配偶设计的基于临床的认知行为、应对技能的干预措施可以有效减少心理困扰或促进酗酒者伴侣寻求帮助或减少饮酒，但获取障碍仍然相同。除非开发出替代的服务提供模式，否则这些治疗将覆盖到相对较少的人，并且对公共健康的影响很小。面临的挑战是为这些经验支持的干预措施开发新颖的替代服务提供模式，为比目前服务的小群体更多的有酗酒伴侣的女性群体提供安全、有吸引力、低成本、便捷的服务。为了开始应对这一服务提供挑战，目前的第一阶段治疗开发应用建议以研究人员对酗酒伴侣的女性面对面应对技能培训 (CST) 的大量研究为基础，将 CST 适应万维网可访问或可交付的数据库。互联网提供的 CST 模式有可能通过提供以下服务来解决上述几个障碍：(a) 成本相对较低，(b) 很容易为广大有酗酒伴侣的女性群体提供服务，(c) 24/7 随时可用，(d) 采取适当的安全预防措施，提供比诊所治疗更高程度的隐私，从而有助于减少耻辱、尴尬和其他担忧。当前提案中基于互联网的 CST (iCST) 的开发和初步评估是在第一阶段治疗开发工作的两个子阶段完成的。在第一阶段，我们遵循以用户为中心的迭代网站开发流程，以适应先前开发的面对面 CST 的内容，以实现交互式在线交付。在 Ib 阶段，我们试验了招募女性参加 iCST 临床试验的可行性，并将 84 名其伴侣患有活动性酒精使用障碍的女性随机分配到 8 周的 iCST 或 8 周的延迟治疗控制 (DTC) 条件。然后在治疗后/延迟后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 参与者是否降低了抑郁水平，（c）在探索性分析中，技能获取是否介导了任何 iCST-DTC 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 以及压力、伴侣饮酒、饮酒后果和关系暴力。试点临床试验结果将为这一有前途的交付模式进行更大规模的第二阶段研究工作奠定基础。总而言之，该提案代表了研究人员对 CST 的实证研究与基于网络学习和行为健康问题干预的新兴研究的融合。该提案具有创新性，因为它是第一个针对酗酒伴侣的配偶/亲密者的基于经验支持的干预措施的互联网改编，并启动了第一个针对这一服务不足群体的新颖交付模式的研究计划。这种提供经验支持治疗的创新模式有可能最终惠及大量原本无法获得帮助的女性。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。 公共卫生相关性：在美国，近二十分之一的成年女性与酗酒或酗酒的伴侣结婚或同居。因此，这些人会经历严重的心理和身体痛苦，比非酗酒者的配偶更多地利用医疗保健服务，并且总体上承担更高的医疗费用。虽然他们的身心健康本身很重要，但他们的健康和应对技巧也可以在促进酗酒伴侣减少饮酒和寻求帮助以及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，尽管其规模、困境和重要性，这一人群在很大程度上仍然是隐藏的和得不到充分服务的，并且存在重大障碍来阻止这一人群中的很大一部分获得帮助。当前申请中提议开发的基于互联网的干预措施有可能最终惠及大量否则无法获得帮助的妇女。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。