Building and pilot testing a couples-based smartphone systems to address alcohol use disorder

项目总结 酒精使用障碍(AUD)是最常见的物质使用障碍。然而，只有一小部分人 那些需要治疗的人得到了治疗，他们中的大多数人只得到了短期的支持，尽管持续的护理已经 已经被证明是更有效的。更加一致和可用的持续护理可以极大地改善 病人正在康复。合作伙伴的支持对恢复也很关键，但许多合作伙伴不知道如何 支持他们的合作伙伴的恢复或管理他们自己的应对措施。临床医生也缺乏证据表明 患者正在为康复而努力。治疗其中一人正从澳元病中恢复的夫妇 已经被证明是有效的；特别是酒精行为夫妻疗法(ABCT)已经表明 结果是积极的。尽管如此，ABCT仍未被广泛采用，部分原因是实际问题。甲级国际象棋 是一种基于智能手机的系统，已被证明可以大幅减少复发，但A-Chess只为患者服务。 可以将针对患者和伴侣的复发预防和康复支持内置于智能手机中， 可以使这些服务几乎随时随地可用。大多数成年人拥有智能手机， 不分种族、教育程度和经济状况。该项目将开发和试运行一种新的 基于智能手机的AUD患者、他们的伴侣和临床医生系统，称为PartnerCHESS。 PartnerCHESS将整合ABCT和A-Chess的关键功能。这笔R34规划拨款将试行测试 PartnerCHESS并准备进行一项大型随机试验来测试新系统。PartnerCHESS还将 包括临床医生报告，该报告将自动提醒临床医生有复发风险患者，以及其他 有关恢复工作进展情况的信息。该项目有三个具体目标： 1.将A-Chess与ABCT的关键功能相结合，创建PartnerCHESS，服务于患者、伴侣和 临床医生。 2.进行PartnerCHESS的试点试验(小型随机临床试验)，以估计效应大小并改进 我们将在大型随机对照试验中使用的方案、程序、招募策略、测量和操作。 3A.决定是否继续申请R01。3B.可能会为R01做计划。 该项目将与6对招募的夫妇一起开发PartnerCHESS，他们测试该系统并提供反馈。 一旦准备好，该系统将由34对随机接受PartnerCHESS+的夫妇进行测试 按常规治疗(TAU)或A-象棋+TAU进行为期6个月的试验。数据将在基线和2，4， 和6个月，并进行分析，以确定大型临床试验是否有希望，如果是，则导致申请 根据在这一试点试验中制定的要素和取得的结果，支持进行全面试验。 这项研究对公众健康很重要，因为酒精滥用的范围和潜在的 改善患者和伴侣生活的技术。如果成功，这种技术将极大地 扩大AUD治疗的范围和影响，特别是夫妻治疗。

PROJECT SUMMARY Alcohol use disorder (AUD) is the most common substance use disorder. Yet only a small fraction of people who need treatment receive it, and most of them get only short-term support even though continuing care has been shown to be much more effective. More consistent and available continuing care could greatly improve patient recovery. Partner support can also be critical to recovery, but many partners do not know how to support their partners' recovery or manage their own responses to it. Clinicians also lack evidence of the efforts patients are making toward recovery. Treating couples in which one member is recovering from AUD has been shown to be efficacious; in particular, Alcohol Behavioral Couples Therapy (ABCT) has shown positive outcomes. Still, ABCT has not been widely adopted, in part because of practical problems. A-CHESS is a smartphone-based system proven to substantially reduce relapse, but A-CHESS serves only the patient. Relapse prevention and recovery support for both patient and partner could be built into smartphones, which could make these services available almost anywhere and anytime. A majority of adults own a smartphone, regardless of race, education, and financial status. This project would develop and pilot test a new smartphone-based system for AUD patients, their partners, and clinicians called PartnerCHESS. PartnerCHESS would integrate key features of ABCT and A-CHESS. This R34 planning grant would pilot test PartnerCHESS and prepare for a large randomized trial to test the new system. PartnerCHESS will also include a Clinician Report that will automatically alert clinicians of patients at risk of relapse, along with other information on how recovery is proceeding. The project has three specific aims: 1. Integrate A-CHESS with key features of ABCT to create PartnerCHESS to serve patients, partners, and clinicians. 2. Conduct a pilot test (a small randomized clinical trial) of PartnerCHESS to estimate effect size and refine the protocol, procedures, recruitment strategy, measurements, and operations we would use in a large RCT. 3a. Decide whether to pursue an R01 application. 3b. Possibly plan for the R01. The project would develop PartnerCHESS with 6 recruited couples who test the system and give feedback. Once ready, the system would be tested by 34 other couples randomized to receive either PartnerCHESS + treatment as usual (TAU) or A-CHESS + TAU for a 6-month trial. Data will be collected at baseline and 2, 4, and 6 months and analyzed to see if a large clinical trial holds promise and, if so, lead to an application for support of a full-scale trial based on the elements developed and results obtained in this pilot test. The study is important to public health because of the scope of the alcohol abuse and the potential of technology to improve the lives of both patients and partners. If successful, such technology could greatly broaden the reach and impact of AUD treatment in general and couples therapy in particular.