JMIR Publications

ABSTRACT

Background:

Individuals living with a partner with an alcohol use disorder (AUD) can experience significant psychological distress and use healthcare services more than those without an AUD-affected partner. Yet, the availability of treatment for these individuals is limited by the prevailing treatment system's focus on treating their partner and personal barriers to seeking face-to-face help for themselves. Preliminary work on a self-directed web-based coping skills training program, Stop Spinning My Wheels (SSMW), shows promise in broadening the availability of treatment modalities and overcoming barriers for this underserved population. This study conducts a robust evaluation of SSMW effects on primary outcomes.

Objective:

To test whether women with a partner with an AUD assigned to SSMW experienced a greater reduction in negative affect (depression, anger) (a) when compared to an active Usual Web Care (UWC) control, and (b) with brief phone coach support (SSMW+Coach) than without (SSMW-Only). And to test whether baseline negative affect moderated treatment effects.

Methods:

Women (mean age=45.7, SD 10.8 years; 89% [408/456] White, 4% [17/456] Black) were randomized to SSMW-Only, SSMW+Coach, or UWC. Depression (BDI; Beck Depression Inventory II) and anger (STAXI-2; State-Trait Anger Expression Inventory 2-State Anger) were assessed at baseline, 12-week posttest, and 6- and 12-month follow-ups.

Results:

All conditions decreased in depression from baseline to posttest and baseline to follow-up; SSMW-Only and SSMW+Coach decreased in anger, UWC did not. Compared to UWC participants, SSMW-Only participants experienced a greater decrease in anger (P=.0294), and SSMW+Coach participants experienced a greater decrease in depression (P=.0008) from baseline to posttest. From baseline to follow-up, however, only a greater SSMW+Coach change in anger compared to UWC approached significance. Although SSMW conditions did not differ from each other in negative affect anytime (Ps=.0634-.5698), SSMW+Coach had higher program engagement and satisfaction (Ps < .0037). Baseline negative affect did not moderate effects, though remission from baseline clinically-relevant depressive symptoms (BDI≥14) was higher in SSMW-Only (49% [33/67]; OR 2.13, 95% CI 1.05-4.30, P=.0346) and SSMW+Coach (62% [46/74]; OR 3.60, 95% CI 1.79-7.23, P=.0003) than UWC (31% [21/67]); SSMW conditions did not differ on remission rates (P=.1230).

Conclusions:

Results partially supported hypotheses. SSMW conditions appeared to have earlier effects than UWC, but positive change in UWC, particularly in depressive symptoms, mitigated, in part, hypothesized long-term SSMW-UWC differences. The results highlight the importance of incorporating active controls in web-based RCTs. Though SSMW+Coach showed benefits relative to SSMW-Only on ancillary engagement and satisfaction measures, and in the number needed to treat (NNT for SSMW-Only=5.6; NNT for SSMW+Coach=3.2), SSMW conditions were comparable to one another and superior to UWC on depressive symptom remission levels. Overall, SSMW, with or without a coach, can reduce clinically meaningful distress and add to available treatment options for this large and underserved group. Clinical Trial: Clinicaltrials.gov NCT02984241