Aim 1. Couples (N=50 dyads) with a Concerned Partner (CP) and a Drinking Partner (DP) will independently complete baseline and follow-up surveys and a 21-day EMA with three daily reports on their communication and DP's drinking. Aim 2. Iteratively develop a four-session web based intervention and evaluate the WBI's feasibility and acceptability with 15 CPs. Aim 3. Perform a pilot randomized controlled trial (RCT) comparing WBI to psychoeducation control in 110 couples.
Alcohol misuse negatively affects relationships and is significantly correlated with higher rates of relationship conflict, distress, and dissolution as well as other serious negative interpersonal consequences (e.g., domestic violence, sexual assaults). Encouragement from concerned partners (CPs) is a common motivator for those who misuse alcohol to pursue care and often the most helpful mechanism in supporting change. The goals of this proposal are to: Identify how specific CP behaviors influence their partner's alcohol craving, motives, drinking, and problems on a daily basis using dyadic ecological momentary assessment techniques (Aim 1); use the knowledge from EMA analysis to iteratively develop a CP-focused web-based intervention (WBI) that provides psychoeducation about communication patterns that influence DP drinking and by integrating personalized feedback about CPs' own communication behaviors that may be working against their goals (Aim 2); and pilot the WBI's efficacy on CP outcomes (depression, anxiety, social support), their partner's drinking behavior (alcohol consumption, motives, related consequences), and both partners' relationship distress and conflict (Aim 3). The investigators expect the WBI will yield significant improvements in all outcomes. This project is significant because intervening with CPs has strong potential to change relationship dynamics that may reduce problems and prevent future problems associated with alcohol misuse. It also develops a new prevention model that does not rely on the drinking partner attending a clinical facility to access care. The proposed study is innovative because it uses dyadic and ecological momentary assessment designs to test dynamic questions about interdependence in relationship interactions and alcohol use between partners and employs the generated knowledge to inform intervention adaptation. Teaching CPs to effectively communicate their concerns may be a necessary catalyst for decreasing their partner's alcohol use and preventing alcohol use disorders. The potential reach of this intervention is large such that it can be easily implemented over the web to those who may need help but would not otherwise seek care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
160
The web-based intervention will comprise sessions focusing on community reinforcement and family therapy principles including: (1) self-care, (2) positive communication including ways to increase responsiveness to their partner (PPR; i.e., actively listening, showing understanding, expressing interest in what their partner is thinking and feeling, and trying to see where their partner is coming from), (3) understanding their partner's drinking reinforcers, and (4) supporting their partner if they want help and engaging in positive, healthy activities with their partner.
This is a psychoeducation control condition.
CP Depression Symptoms Questionnaire
Patient Health Questionnaire. 8 items. Scores range from 0-32. Higher scores indicate more depressive symptoms.
Time frame: 1 month post-intervention.
CP Anxiety Symptoms Questionnaire
Generalized Anxiety Disorder scale. 7 items. Higher scores indicate more anxiety symptoms.
Time frame: 1 month post-intervention.
CP Anger expression questionnaire
Dimensions of Anger Reactions - 5 item (DAR-5). Scores range 1-5 with higher scores indicating greater anger.
Time frame: 1 month post-intervention.
CP Loneliness Questionnaire
Measure: UCLA 3-item Loneliness Scale (Hughes, M. E., Waite, L. J., Hawkley, L. C., \& Cacioppo, J. T. (2004). A Short Scale for Measuring Loneliness in Large Surveys. Research on Aging, 26(6), 655-672. https://doi.org/10.1177/0164027504268574) Scores are 1-9. Higher scores indicate more loneliness.
Time frame: 1 month post-intervention.
CP Partner Social Support Questionnaire
Marital Perceived Social Support (Cohen et al., 1985). Scored 0-3. Higher scores mean more social support.
Time frame: 1 month post-intervention.
CP-DP Relationship Functioning Questionnaire
Quality of Marriage Index (Norton, 1983). Higher scores indicate greater relationship satisfaction.
Time frame: 1 month post-intervention.
DP AUDIT Questionnaire
Drinking Partner's AUDIT score. 10 items. Items are summed. Greater scores indicate greater alcohol use.
Time frame: 1 month post-intervention.
CP General Social Support Questionnaire
MOS Social Support Survey (Sherbourne \& Stewart, 1991). Scored 1-5. Higher scores indicate more social support. Sherbourne, C. D., \& Stewart, A. L. (1991). The MOS social support survey. Social science \& medicine, 32(6), 705-714.
Time frame: 1 month post-intervention.
DP Alcohol Use Questionnaire
Drinking Partner's: Alcohol consumption via the Quantity/Frequency/Peak Alcohol Use Index (Dimeff et al., 1991). Six items measure the drinking partner's alcohol consumption. The items are not scored together but evaluated individually (e.g., frequency, typical quantity, peak quantity, etc.). Higher scores denote greater consumption.
Time frame: 1 month post-intervention.
DP Drinking Motives Questionnaire
Drinking Partner's Drinking Motives using the Drinking Motives Questionnaire (Cooper et al., 1992). Subscales for coping, enhancement, social, and conformity. Items are averaged. Higher scores indicate greater endorsement of that motive.
Time frame: 1 month post-intervention.
DP Alcohol-related Consequences Questionnaire
Drinking Partner's Alcohol-related Consequences assess via the Brief Young Adult Alcohol Related Consequences measure. 24 items. Scores are created by summing the items. Higher scores denote greater consequences endorsed.
Time frame: 1 month post-intervention.
CP-DP Communication Questionnaire
Family Environment via the Brief Family Relationship Scale. Fok, C. C., Allen, J., Henry, D., \& People Awakening Team (2014). The brief family relationship scale: a brief measure of the relationship dimension in family functioning. Assessment, 21(1), 67-72. https://doi.org/10.1177/1073191111425856. Cohesion, expressiveness, and conflict subscales. Items are averaged. For each subscale, greater scores reflect greater cohesion, expressiveness, and constructive ways of handling conflict.
Time frame: 1 month post-intervention.
CP-DP Perceived Partner Responsiveness Questionnaire
Measures perceived partner responsiveness. Scores range from 1-5. Greater scores mean greater responsiveness perceived about the partner. Source articles: Laurenceau, J. P., Barrett, L. F., \& Pietromonaco, P. R. (1998). Intimacy as an interpersonal process: The importance of self-disclosure, partner disclosure, and perceived partner responsiveness in interpersonal exchanges. Journal of Personality and Social Psychology, 74(5), 1238-1251. https://doi.org/10.1037//0022-3514.74.5.1238 O'Neill, A.S., Mohr, C.D., Bodner, T., \& Hammer, L. (2020). Perceived Partner Responsiveness, Sleep and Pain: A Dyadic Study of Military-Connected Couples. Health Psychology, 39(12), 1089-1099. https://doi.org/10.1037/hea0001035
Time frame: 1 month post-intervention.
CP Communication about Drinking Questionnaire
We have created a measure adapted from the Spouse Behavior Questionnaire (Love et al., 1991) and the Partner Management Strategies Questionnaire (Rodriguez et al., 2013) that will assess different behaviors CPs use to attempt to change their partner's drinking. Subscales include punishing drinking, rewarding sobriety, withdrawing, and supporting drinking. Items are averaged. Higher scores mean greater endorsement of these subscales.
Time frame: 1 month post-intervention.
CP-DP Communication: Number of conflicts
We will ask participants the number of disagreements they have had with their partner. Higher numbers denote more disagreements.
Time frame: 1 month post-intervention.
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