Family-focused vs. Drinker-focused Smartphone Interventions to Reduce Drinking-related Consequences of COVID-19

PROJECT SUMMARY / ABSTRACT The combination of COVID-19 and alcohol/substance use disorders exacerbates a wide range of existing problems, including the likelihood of contracting COVID and severity of consequences, pandemic-related stresses that trigger alcohol and substance use, loss of jobs and healthcare access, increased interpersonal violence, and overarching systemic inequities. Interventions are needed to address these serious problems, which are likely to persist even after widespread availability of COVID vaccines. In response to PAR 20-243, this R01 project is a Hybrid II RCT/implementation study modifying and testing two of our alcohol smartphone interventions to address the fallout from COVID. We propose a 3-arm RCT comparing a control vs. a drinker-focused intervention vs. a family-focused intervention. The drinker-focused intervention (ACHESS-C) is an extension of our evidence-based Addiction-Comprehensive Health Enhancement Support system (ACHESS), augmented with COVID resources. The family-focused intervention (FamCHESS-C) combines ACHESS-C services with evidence-based Alcohol Behavioral Couple Therapy services to help both drinker and partner with behavior change, relationship problems, and general well-being. In the proposed 8-month trial plus 4-month follow-up, 198 dyads (drinker + family member) will be randomly assigned to: 1) Smartphone control: both receive a smartphone with standard support and crisis numbers; 2) ACHESS-C: drinker receives a phone with ACHESS-C, partner receives a phone with support and crisis numbers; 3) Fam-CHESS-C: both receive phone with FamCHESS-C. The project has the following aims: Aim 1: Complete refinements to the FamCHESS-C app. Aim 2: Conduct a balanced RCT to test the following outcomes: Primary: 1) drinker % heavy drinking days, 2) dyad quality of life. Secondary: 3) dyad relationship satisfaction, 4) dyad psychological/physical conflict, 5) drinker no heavy drinking days, 6) drinker % days alcohol/drug use, 7) dyad COVID vaccination rates, 8) drinker alcohol- and drug-related problems. Exploratory: 9) partner % days alcohol/drug use, 10) dyad crisis healthcare use, 11) dyad technology satisfaction. We hypothesize that outcomes will be more favorable in FamCHESS-C relative to ACHESS-C, and both will be more favorable relative to smartphone control. Aim 3: Examine mediation effects of dyad's competence, relatedness, and motivation; drinker's interim change in % days of alcohol and drug use, and extent of app use for comparisons of ACHESS-C and FamCHESS-C. Examine moderation of effects of condition by drinker sex, severity of drinker's baseline alcohol use, drinker engagement in treatment for AUD/SUD, and dyad's baseline relationship satisfaction. Aim 4: Conduct a small-scale (20 dyads) formative evaluation using an implementation science model to collect qualitative data on perceptions of difficulties and benefits of ACHESS-C and FamCHESS-C use.