Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 20, 2024
Date Accepted: Jul 14, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Couple-Focused Smartphone Intervention to Reduce Problem Drinking: A Randomized Pilot Trial
ABSTRACT
Background:
Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples via smartphone may serve as an effective adjunct to alcohol use disorder treatment.
Objective:
This pilot sought to (1) evaluate the feasibility of comparing a patient-only (A-CHESS) versus a couple-focused (Partner-CHESS) intervention for alcohol misuse delivered by smartphone apps, (2) assess perceptions about and use of the two apps, and (3) examine initial indications of differences in primary clinical outcomes between the two apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial.
Methods:
33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental), with outcome measure surveys at 0, 2, 4, and 6 months. Couples comprised one partner with current alcohol use disorder (76% male) and a romantic partner (79% female). Primary outcomes were percentage of days with heavy drinking and percentage of drinking days, measured by Timeline Followback. Secondary outcomes included app use and perceptions, and multiple psychosocial variables.
Results:
At 6 months, 77.8% of Partner-CHESS patients and 73.3% of A-CHESS patients were still using the intervention; apps were rated helpful on a 5-point scale by 88.9% of both Partner-CHESS patients (M 3.7, SD 1.0) and partners (M 3.6, SD 0.9) and by 86.7% of A-CHESS patients (M 3.1, SD 0.9; 1=not at all helpful, 5=extremely helpful). At 6 months, Partner-CHESS patients had nonsignificantly fewer percentage of days with heavy drinking compared to A-CHESS (b= -17.4, 95% CI -36.1 to 1.4, P=.068, Hedges g= -0.53), while percentage of drinking days was relatively equal between patient groups (b= -2.1, 95% CI -24.8 to 20.7, P=.85, Hedges g= -0.12).
Conclusions:
Initial results support the feasibility of evaluating patient-only and couple-focused smartphone interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate sustained engagement of most participants for 6 months. A future, fully-powered trial is warranted to evaluate the relative effectiveness of both interventions. Clinical Trial: ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549
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