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Osilla KC, Gore KL, Pedersen ER, Hummer JF, DeYoreo M, Manuel JK, McKay JR, Kim JP, Nameth K. Study protocol for a sequential multiple assignment randomized trial to reduce risky drinking among service members and their partners. Contemp Clin Trials 2023; 133:107324. [PMID: 37652360 PMCID: PMC10591961 DOI: 10.1016/j.cct.2023.107324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Military spouses and partners in relationships with a heavy drinking service member report high levels of mental health concerns and consequences, which are compounded when both partners drink heavily. Military spouses and partners -termed "concerned partners" (CPs)-may be an important gateway for motivating service members (SMs) 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. Partners Connect is a web-based intervention aimed at improving communication and relationship quality and increasing SM help-seeking. METHODS The current study design is a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to develop an adaptive CP intervention to decrease CP drinking and increase SM help-seeking. CPs aged 18 and older (n = 408) will be recruited via social media and followed for six months. In stage one, we will randomize CPs to either a 4-session web-based intervention (Partners Connect) or to receive communication resources from the Gottman Institute website. The goal is to have CPs invite their SM to complete an online personalized normative feedback (PNF) session. If their SM completes the PNF at stage one, CPs will be considered "responders," if the SM does not complete, CPs who are "non-responders" will be re-randomized during stage two to receive either (1) a CRAFT workbook or (2) phone-based CRAFT if in Partners Connect; or (1) Partners Connect or (2) a CRAFT workbook if in Gottman. DISCUSSION By first intervening with the service member's CP, we aim to better equip them to engage their service member partner in treatment services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care. CLINICALTRIALS gov Identifier: NCT05619185.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Kristie L Gore
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA
| | - Eric R Pedersen
- University of Southern California Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA
| | - Justin F Hummer
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Maria DeYoreo
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Jennifer K Manuel
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - James R McKay
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Crescenz VAMC, Philadelphia, PA, USA
| | - Jane P Kim
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Katherine Nameth
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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Flanagan JC, Leone RM, Melkonian AJ, Jarnecke AM, Hogan JN, Massa AA. Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence. FAMILY PROCESS 2023. [PMID: 37148131 DOI: 10.1111/famp.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Alexander J Melkonian
- Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amber M Jarnecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jasara N Hogan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea A Massa
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Leone RM, Jarnecke AM, Gilmore AK, Flanagan JC. Alcohol use problems and conflict among couples: A preliminary investigation of the moderating effects of maladaptive cognitive emotion regulation strategies. COUPLE & FAMILY PSYCHOLOGY 2022; 11:290-299. [PMID: 36438780 PMCID: PMC9697959 DOI: 10.1037/cfp0000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Alcohol use can operate as a chronic relationship stressor with adverse influences on individual and relationship functioning, including negative conflict behaviors; however, it remains unclear what modifiable individual-level factors may moderate this association. The current study examined the effects of maladaptive cognitive emotion regulation strategies on the relation between alcohol use problems and negative relationship conflict behaviors. Participants were 30 couples (N=60) wherein at least one partner engaged in recent hazardous drinking or illicit drug use. Participants completed a measure of maladaptive cognitive emotion regulation strategies (i.e., catastrophizing, self-blame, blaming others, rumination) and engaged in a 10-minute dyadic conflict task in the laboratory. Couple conflict behaviors were video-recorded and assessed using a validated coding system. Actor partner interdependence models indicated that (1) men with more maladaptive cognitive emotion regulation strategies displayed more negative relationship conflict behaviors and (2) among women who use fewer maladaptive cognitive emotion regulation strategies, those who report alcohol use problems display more negative relationship behaviors than women who report fewer alcohol use problems. These findings suggest that the tendency to engage in fewer maladaptive cognitive emotion regulation strategies buffers the effect of conflict among women without alcohol use problems. Results also suggest that women with alcohol use problems engaged in more negative conflict behaviors regardless of their tendency to use maladaptive cognitive emotion regulation strategies. This research has important implications for integrating emotion regulation skills into alcohol use treatment for women, particularly later in the course of treatment.
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Affiliation(s)
- Ruschelle M. Leone
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
- Center for Interpersonal Violence, Georgia State University
| | - Amber M. Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Amanda K. Gilmore
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
- Center for Interpersonal Violence, Georgia State University
| | - Julianne C. Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
- Ralph H. Johnson VA Medical Center
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Osilla KC, Becker K, Ecola L, Hurley B, Manuel JK, Ober A, Paddock SM, Watkins KE. Study design to evaluate a group-based therapy for support persons of adults on buprenorphine/naloxone. Addict Sci Clin Pract 2020; 15:25. [PMID: 32653029 PMCID: PMC7353769 DOI: 10.1186/s13722-020-00199-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Opioid use disorders (OUDs) have devastating effects on individuals, families, and communities. While medication treatments for OUD save lives and are increasingly utilized, rates of treatment dropout are very high. In addition, most existing medication treatments for OUD may often neglect the impact of untreated OUD on relationships and ignore the potential role support persons (SPs) could have on encouraging long-term recovery, which can also impact patient treatment retention. Methods/design The current study adapts Community Reinforcement and Family Training (CRAFT) for use with SPs (family member, spouse or friend) of patients using buprenorphine/naloxone (buprenorphine) in an outpatient community clinic setting. The study will evaluate whether the adapted intervention, also known as integrating support persons into recovery (INSPIRE), is effective in increasing patient retention on buprenorphine when compared to usual care. We will utilize a two-group randomized design where patients starting or restarting buprenorphine will be screened for support person status and recruited with their support person if eligible. Support persons will be randomly assigned to the INSPIRE intervention, which will consist of 10 rolling group sessions led by two facilitators. Patients and SPs will each be assessed at baseline, 3 months post-baseline, and 12 months post-baseline. Patient electronic medical record data will be collected at six and 12 months post-baseline. We will examine mechanisms of intervention effectiveness and also conduct pre/post-implementation surveys with clinic staff to assess issues that would affect sustainability. Discussion Incorporating the patient’s support system may be an important way to improve treatment retention in medication treatments for OUD. If SPs can serve to support patient retention, this study would significantly advance work to help support the delivery of effective treatments that prevent the devastating consequences associated with OUD. Trial registration This study was registered with ClinicalTrials.gov, NCT04239235. Registered 27 January 2020, https://clinicaltrials.gov/ct2/show/NCT04239235.
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Affiliation(s)
- Karen Chan Osilla
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Kirsten Becker
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Liisa Ecola
- RAND Corporation, 1100 South Hayes Street, VA, 22202, Arlington, USA
| | - Brian Hurley
- LA County Department of Health Services, UCLA Department of Family Medicine, 10780 Santa Monica Blvd., Suite 105, Los Angeles, CA, 90025, USA
| | - Jennifer K Manuel
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.,San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA
| | - Allison Ober
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Susan M Paddock
- NORC at the University of Chicago, 55 East Monroe St, 31st Floor, Chicago, IL, 60603, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
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Rodriguez LM, Webster GD. The Three-Item Thinking about Your Partner's Drinking Scale (TPD-3): Item Response Theory, Reliability, and Validity. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:471-488. [PMID: 31355961 DOI: 10.1111/jmft.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Interdependence is a defining feature of close relationships, and alcohol use is one domain where one person's motivations and behaviors can affect a partner's well-being. Concern about partner drinking is a gauge that determines whether a partner's alcohol use has the potential to be problematic to the relationship, and brief and efficient measurement of this construct can be used to serve clinicians, scientists, and practitioners. Across four studies (N = 1,807), we use item response theory analysis to present a 3-item brief screening tool assessing concern about partner drinking: Thinking about your Partner's Drinking-3 (TPD-3). The TPD-3 revealed strong test-retest reliability and expected patterns of convergent, concurrent, and incremental validity with perceived partner drinking and alcohol-related consequences, behavioral responses to partner drinking, and relationship well-being. We present the TPD-3 as a useful screening tool and for measurement of concern about partner drinking when efficient assessment is desired.
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Derrick JL, Wittkower LD, Pierce JD. Committed relationships and substance use: recent findings and future directions. Curr Opin Psychol 2019; 30:74-79. [PMID: 30986616 DOI: 10.1016/j.copsyc.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 11/25/2022]
Abstract
Recent research on substance use in committed relationships covers three general areas. First, partners tend to be concordant for substance use, and concordance is at least partially the result of partner influence (or convergence). Second, substance use (particularly discrepant use) predicts relationship outcomes such as lower relationship quality and greater conflict, intimate partner aggression, and risky sex. Concordant use, however, can be protective. Finally, relationship variables, such as conflict, intimate partner aggression, and support for cessation, predict substance use. Recent advances in methodological innovation, such as the use of longitudinal designs and dyadic data, are noted. Although the field has moved in some new directions conceptually, the research in this area is still relatively atheoretical. Suggestions for future research directions are discussed.
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Affiliation(s)
- Jaye L Derrick
- Department of Psychology, University of Houston, 3695 Cullen Blvd. Room 126, Houston, TX 77204-5022, United States.
| | - L David Wittkower
- Department of Psychology, University of Houston, 3695 Cullen Blvd. Room 126, Houston, TX 77204-5022, United States
| | - Jace D Pierce
- Department of Psychology, University of Houston, 3695 Cullen Blvd. Room 126, Houston, TX 77204-5022, United States
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