Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States.
Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States.
JMIR Form Res. 2024 Nov 1;8:e58622. doi: 10.2196/58622.
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 through smartphones may serve as an effective adjunct to alcohol use disorder treatment.
This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial.
A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients' percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables.
At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=-17.4, 95% CI -36.1 to 1.4; P=.07; Hedges g=-0.53), while the percentage of drinking days was relatively equal between patient groups (β=-2.1, 95% CI -24.8 to 20.7; P=.85; Hedges g=-0.12).
Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions.
ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549.
在美国，酒精使用障碍是最普遍的物质使用障碍之一，终身患病率为 30%。推荐的治疗选择包括基于证据的行为干预；基于智能手机的干预具有便携性、持续访问和避免污名等诸多好处；研究表明，涉及夫妻双方的干预可能比仅针对患者的干预效果更好。在这种情况下，通过智能手机向夫妻双方提供的行为干预可能是治疗酒精使用障碍的有效辅助手段。
本试点研究旨在：(1) 评估通过智能手机比较针对患者的（Addiction 版综合健康增强支持系统；A-CHESS）与针对夫妻双方的（Partner 版综合健康增强支持系统；Partner-CHESS）电子健康应用程序治疗酒精滥用的可行性，(2) 评估对这两种应用程序的看法和使用情况，以及 (3) 检验使用这两种应用程序的患者组在主要临床结果方面的差异的初步迹象。总体而言，这些目标旨在评估更大规模随机对照试验的研究方案的可行性。
共有 33 对浪漫伴侣被随机分配接受 6 个月的 A-CHESS 应用程序使用（主动治疗对照）或 Partner-CHESS 应用程序使用（实验）。夫妻双方均包括一名当前患有酒精使用障碍的患者（33 例中的 25 例，76%为男性）和一名浪漫伴侣（33 例中的 26 例，79%为女性）。在 0、2、4 和 6 个月时，患者和伴侣双方均完成了结局测量问卷调查。主要结局是通过时间线回溯法测量患者的重度饮酒天数和任何饮酒天数的百分比。次要结局包括应用程序的使用和看法以及多个心理社会变量。
在 6 个月时，78%（14/18）的 Partner-CHESS 患者和 73%（11/15）的 A-CHESS 患者仍在使用干预措施。应用程序的有用性评分在 1 到 5 之间（1=一点也不有用，5=非常有用），33 对夫妻中的 89%（29/33）的 Partner-CHESS 患者（平均 3.7，SD 1）和伴侣（平均 3.6，SD 0.9）以及 87%（13/15）的 A-CHESS 患者（平均 3.1，SD 0.9）都给予了评分。在 6 个月时，与 A-CHESS 患者相比，Partner-CHESS 患者的重度饮酒天数百分比较低，但差异无统计学意义（β=-17.4，95%置信区间-36.1 至 1.4；P=.07；Hedges g=-0.53），而患者组的饮酒天数百分比相对相等（β=-2.1，95%置信区间-24.8 至 20.7；P=.85；Hedges g=-0.12）。
初步结果支持评估针对患者和夫妻双方的基于智能手机的干预措施治疗酒精滥用的可行性。结果表明，这两种干预措施都被认为是有用的，并表明大多数参与者在 6 个月内保持了参与。需要进行一项未来的、充分 powered 的试验来评估这两种干预措施的相对有效性。
ClinicalTrials.gov NCT04059549；https://clinicaltrials.gov/ct2/show/NCT04059549。
