A SMART evaluation of an adaptive web-based AUD treatment for service members and their partners

项目摘要 与酗酒军人伴侣有关系的军人配偶报告抑郁程度较高 症状、饮酒和社交障碍，与配偶相比，家庭暴力的风险增加 与酗酒的伴侣没有关系，这些后果在以下情况下会加剧 夫妻双方都酗酒。然而，配偶通常不会为自己或伴侣的问题寻求照顾，因为 阻碍寻求护理的多重障碍。军人配偶和伴侣--被称为“关心的伴侣” (CPS)-可能是激励服役人员寻求护理的重要途径。然而，CPS可能会首先 需要减少自己的饮酒和改善自己的沟通，以有效地支持和鼓励 针对其服务成员合作伙伴的更改。拟议的研究建立在我们与合作伙伴连接的试点工作的基础上， 针对军事CP的4次基于网络的干预(WBI)。在目标1中，我们提出了顺序倍数 评估适应性CP干预对CP疗效的分配随机试验(SMART)设计 酗酒和短信求助。在目标2中，我们将研究适应性干预是如何以及对谁是最重要的 通过查看服务人员的主持人和调解人-寻求帮助和补充这些内容-有效 通过定性CP和服务成员访谈对服务的原因和驱动因素进行量化分析 会员求助。我们将进行两个阶段的智能设计。在第一阶段，我们将把CP随机化到 合作伙伴连接或Gottman Institute网站上的通信资源。CPS将是 如果他们的服务人员完成了他们的个性化规范，则在第一阶段被视为“响应者” 反馈(PnF)会议。第一阶段无应答者的CP(服役人员尚未完成PNF) 将被重新随机化，以便在第二阶段接受额外的沟通干预。这一阶段的目的 两个随机化是为了测试什么有助于第一阶段无应答者。我们希望通过进一步治疗这些 最初对合作伙伴连接没有响应，我们可以改善CP通信和饮酒，以及 最终帮助服务人员为他们的饮酒提供简短、有效的PNF干预。我们的目标是 减少军队中的健康差距，首先与军人的配偶进行干预并改善 他们的成果是使他们更好地装备他们的服务人员参与服务。在此过程中，我们开发了一种 在可能不寻求治疗的群体中增加治疗可及性和吸引力的模式。这个 CPS的最佳包装是改善CP的饮酒、心理健康和沟通，以及 这最终会让PNF的服务人员参与进来。因此，合作伙伴互联是一种新颖的“二合一” 为CP和服务成员填补服务空白的干预。

PROJECT ABSTRACT Military spouses in relationships with a heavy drinking service member partner report high levels of depression symptoms, drinking, and social impairment, and a heightened risk for domestic violence compared to spouses who are not in a relationship with a heavy drinking partner, and these consequences are compounded when both partners drink heavily. Yet, spouses often do not seek care for their own or their partner’s problems due to multiple barriers preventing pursuit of care. Military spouses and partners —termed “concerned partners” (CPs)—may be an important gateway for motivating service members to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. The proposed study builds off our pilot work with Partners Connect, a 4-session web-based intervention (WBI) for military CPs. In Aim 1, we propose a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate the efficacy of an adaptive CP intervention on CP drinking and SM help-seeking. In Aim 2, we will examine how and for whom the adaptive intervention is most efficacious by looking at moderators and mediators of service-member help-seeking and supplementing these quantitative analyses with qualitative CP and service member interviews on the reasons and drivers of service member help-seeking. We will conduct a two-stage SMART design. In stage one, we will randomize CPs to either Partners Connect or communication resources from the Gottman Institute website. CPs will be considered a ‘”responder” at stage one if their service member completes their personalized normative feedback (PNF) session. CPs who are non-responders to stage one (service member has not completed PNF) will be re-randomized to receive additional communication interventions in stage two. The purpose of the stage two randomization is to test what helps stage one non-responders. We expect that by further treating those that do not respond initially to Partners Connect, we can improve CP communication and drinking, and ultimately help service members access a brief, effective PNF intervention for their drinking. Our goal is to reduce health disparities in the military by first intervening with the service member’s spouse and improving their outcomes to better equip them to engage their service member in services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care. The optimal package for CPs is the one that improves the CP’s drinking, mental health, and communication and that ultimately engages the service member in PNF. Thus, Partners Connect is a novel “two-in-one” intervention that fills service gaps for CPs and service members.