Zinzow Heidi M, Pericot-Valverde Irene, Smalls Lauren, Brancato Madelyn G, Chapman Greyson, Smith Allison, Thompson Ava, Greco Caroline, Shank Meghan, Eichelberger Kacey Y, Smith Kimbley, Litwin Alain H
Clemson University, Clemson, SC, United States.
Prisma Health, Greenville, SC, United States.
JMIR Res Protoc. 2025 Aug 8;14:e68673. doi: 10.2196/68673.
Women in substance use treatment are disproportionately affected by violence. Both a history of violence and substance use place women at risk for cumulative exposure to violence and adverse outcomes, including mental and physical health problems. Interventions are urgently needed to reduce these health disparities by preventing initial and repeated exposure to sexual and intimate partner violence among women with substance use disorders (SUDs). The Healthy Relationships and Interpersonal Violence Education (THRIVE) program adapts evidence-based strategies for this population and is informed by the information, motivation, behavioral skills theoretical model. Topics include the intersection of substance use and violence, consent, risk detection, protective behavioral strategies, and help seeking. THRIVE uses a novel approach by delivering the program via peer support specialists (PSSs), trained advocates in recovery from SUDs who can help overcome barriers to care, including stigma and accessibility.
The first objective is to determine program acceptability and feasibility. The second objective is to determine the preliminary effectiveness of THRIVE, including its effect on violence-related knowledge and attitudes, protective behaviors, exposure to sexual and intimate partner violence, substance use, and mental health.
The study entailed a single-arm trial of THRIVE with 71 women in behavioral and medication-assisted substance use treatment, recruited from 3 outpatient and residential treatment sites. Interview data assessing intervention acceptability and feasibility were collected from participants and PSSs. Participants completed assessments at 4 time points over 3 months (baseline, after the intervention, and 1- and 3-month follow-ups). Self-report questionnaires assessed (1) violence prevention knowledge, attitudes, and behaviors; (2) exposure to sexual and intimate partner violence; and (3) substance use and mental health. To determine acceptability and feasibility, both quantitative and qualitative data were collected on feasibility (recruitment and retention), adherence, and acceptability (engagement, perceived usefulness, barriers and facilitators to participation and adoption, and working alliance with PSSs).
Of the 92 women recruited and enrolled, 71 (77%) completed the intervention, 58 (63%) completed the 1-month follow-up, and 44 (48%) completed the 3-month follow-up between June 2024 and March 2025. The mean age of enrolled participants was 35 (SD 9.87) years, and the majority were White (n=79, 86%), followed by Black (n=4, 4%) and other racial and ethnic identities (n=7, 8%).
THRIVE will address critical gaps in the field by (1) expanding violence prevention strategies to SUD treatment settings, (2) integrating sexual and intimate partner violence prevention, (3) incorporating a focus on illicit substance use, and (4) engaging PSSs to overcome barriers to care. The long-term objective of this project is to develop an accessible, scalable, and efficacious prevention program that reduces the incidence of exposure to sexual and intimate partner violence, substance use, and violence-related mental health disorders for women in substance use treatment.
ClinicalTrials.gov NCT06608979; https://clinicaltrials.gov/study/NCT06608979.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/68673.
接受物质使用治疗的女性受暴力影响的比例过高。暴力史和物质使用都会使女性面临累积暴露于暴力及不良后果的风险，包括身心健康问题。迫切需要采取干预措施，通过预防患有物质使用障碍（SUD）的女性初次及反复遭受性暴力和亲密伴侣暴力，来减少这些健康差距。健康关系与人际暴力教育（THRIVE）项目针对这一人群采用了循证策略，并以信息、动机、行为技能理论模型为依据。主题包括物质使用与暴力的交叉、同意、风险检测、保护性行为策略以及寻求帮助。THRIVE采用了一种新颖的方法，通过同伴支持专家（PSS）来实施该项目，这些专家是从SUD康复中接受过培训的倡导者，能够帮助克服护理障碍，包括耻辱感和可及性问题。
第一个目标是确定项目的可接受性和可行性。第二个目标是确定THRIVE的初步效果，包括其对与暴力相关的知识和态度、保护行为、遭受性暴力和亲密伴侣暴力、物质使用以及心理健康的影响。
该研究对THRIVE进行了单臂试验，从3个门诊和住院治疗场所招募了71名接受行为和药物辅助物质使用治疗的女性。从参与者和PSS收集了评估干预可接受性和可行性的访谈数据。参与者在3个月内的4个时间点（基线、干预后、1个月和3个月随访）完成评估。自我报告问卷评估了（1）暴力预防知识、态度和行为；（2）遭受性暴力和亲密伴侣暴力的情况；（3）物质使用和心理健康状况。为了确定可接受性和可行性，收集了关于可行性（招募和留存）、依从性和可接受性（参与度、感知有用性、参与和采用的障碍与促进因素以及与PSS的工作联盟）的定量和定性数据。
在2024年6月至2025年3月期间，招募并登记的92名女性中，71名（77%）完成了干预，58名（63%）完成了1个月随访，44名（48%）完成了3个月随访。登记参与者的平均年龄为35（标准差9.87）岁，大多数是白人（n = 79，86%），其次是黑人（n = 4，4%）和其他种族和族裔身份（n = 7，8%）。
THRIVE将通过以下方式填补该领域的关键空白：（1）将暴力预防策略扩展到SUD治疗环境；（2）整合性暴力和亲密伴侣暴力预防；（3）纳入对非法物质使用的关注；（4）让PSS参与以克服护理障碍。该项目的长期目标是开发一个可及、可扩展且有效的预防项目，以降低接受物质使用治疗的女性遭受性暴力和亲密伴侣暴力、物质使用以及与暴力相关的心理健康障碍的发生率。
ClinicalTrials.gov NCT06608979；https://clinicaltrials.gov/study/NCT06608979。
国际注册报告识别码（IRRID）：DERR1-10.2196/68673。
