Using EMA Data to Inform a Web-intervention for Couples Concerned About Drinking

Stanford University

Status: Not yet enrolling

Conditions: Alcohol; Use, Problem

Treatments: Behavioral: WBI

Study type: Interventional

Funder types: Other

Identifiers

NCT06501677

71858

Details and patient eligibility

About

Alcohol misuse is a prevalent and serious problem with significant harms to society, individuals, and their relationships. Romantic partners have a strong influence on their partner's behavior, uniquely positioning them as a motivator and supportive factor in changing their partner's alcohol use, but little evidence exists on the specific ways they can influence their partner. The impact this has on the quality of their relationship, communication, and overall well-being has yet to be explored. Thus, this study utilizes qualitative, quantitative, and ecological momentary assessment (EMA) data from both partners to develop a web-based intervention that applies communication-based personalized feedback to support the concerned partner (CP) in motivating their drinking partner (DP) to reduce drinking and other adverse relationship outcomes.

Full description

Previous research by our team and others has shown that certain CP responses to their DP's drinking (e.g., using punishment such as expressing anger or sarcasm, or threatening to leave) lead to increased DP drinking and poorer relationship functioning. Effective CP communication may affect fluctuations in DP drinking, but its mechanism is poorly understood. Limitations of prior research include long intervals between data collection points and lack of real-time dyadic data.The proposed project will use EMA and dyadic data to identify specific CP behaviors that elicit and/or inhibit DP drinking which will directly inform a CP-focused intervention. CP-focused interventions, such as Community Reinforcement and Family Therapy (CRAFT), encourage CP positive communication and reinforcement as important tools in promoting the DP's treatment entry. The DPs of CPs receiving CRAFT are 2-3 times more likely to enter alcohol treatment compared with Al-Anon or Johnson interventions and CRAFT is also effective in improving CP mental health and relationship functioning. However, CRAFT is time- and resource-intensive (i.e., 12 in-person sessions), limiting access for CPs who lack time or are hesitant to seek help. The proposed study aims to adapt CRAFT as a new WBI developed for a community sample of CPs. In contrast to the goals of CRAFT that focus on DP treatment entry, our WBI goals focus on outcomes that may be more proximal to treatment initiation and more attainable with a WBI including improved DP drinking, CP mental health and relationship functioning. In doing so, we also target DPs with a continuum of drinking severity including those who may not need treatment. Using EMA findings that elucidate communication strategies that influence DP drinking, the WBI will include psychoeducation on interaction patterns commonly associated with DP drinking and personalized feedback based on CP baseline data to support changes in CP communication strategies. This research addresses an important problem of mitigating the adverse impact of alcohol misuse on individuals and their families. The expected outcome of this research is to leverage CP influence into an accessible, theoretically-informed intervention that will help CPs more effectively communicate with their DP for improvements to their DP's drinking behavior, their own well-being, and their relationship functioning.

Enrollment: 275 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Concerned Partners:

Inclusion Criteria:

• be at least 18 years of age
• be in a romantic relationship
• live with their partner
• have a computer, tablet, or phone with internet access
• have no plans to separate from partner in next 60 days
• feel safe from partner violence

Exclusion Criteria:

• report 4/5+ on the AUDIT-C

Drinking Partners:

Inclusion Criteria:

• be at least 18 years of age
• report 4/5+ on the AUDIT-C
• have a computer, tablet, or phone with internet access
• feel safe from partner violence

Exclusion Criteria:

• in current treatment for alcohol
• concern about their CPs drinking

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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275 participants in 3 patient groups

Identify CP communication behaviors that elicit or inhibit DP drinking using EMA

No Intervention group

Description:

Couples (N=50 dyads) with one CP and one DP will be recruited from social media. Both partners will independently complete baseline and follow-up surveys. Both the CP and DP will independently complete a 21-day EMA with three daily reports on their communication and DP's drinking (craving, motives, consumption, problems). We will identify specific CP communication behaviors as proximal and long-term predictors of the DP's drinking and non-drinking. Hyp1: CP punishing drinking (e.g., yelling) will relate to increases in DP drinking. Hyp2: CP rewarding drinking (e.g., bringing alcohol home) will relate to increases in DP drinking. Hyp3: CP rewarding sobriety (e.g., planning non-drinking activities) will relate to decreases in DP drinking.

Develop and evaluate the feasibility and acceptability of a WBI providing personalized feedback

Experimental group

Description:

We will use the Behavioral Intervention Technology Model framework to iteratively develop a four-session WBI that includes CRAFT principles and education about communication patterns learned in Aim 1. During the WBI, CPs will receive personalized feedback based on their baseline data on how their communication may influence their DP's drinking. We will evaluate the WBI's feasibility and acceptability with 15 CPs to iteratively improve the WBI.

Treatment:

Behavioral: WBI

Perform a pilot randomized controlled trial (RCT) comparing WBI to psychoeducation control

Active Comparator group

Description:

Outcomes include DP drinking (primary), CP well-being (e.g., depression, anxiety, social support), and relationship functioning (e.g., relationship distress). Although the WBI will target CPs, we will collect data from both partners (N=80 couples) at baseline and 1-month follow-up to evaluate effects. Hyp4: DP, CP, and relationship outcomes will show greater improvement in the WBI compared to control.

Treatment:

Behavioral: WBI