Adapting Alcohol Behavioral Couple Therapy for Service Members in Post-Deployment

This R34 proposal, "Adapting Alcohol Behavioral Couple Therapy for Service Members in Post-Deployment," in response to PA-13-078, "Behavioral & Integrative Treatment Development Program," seeks to adapt and test a well-established civilian Alcohol Behavioral Couple Therapy (ABCT) approach (McCrady & Epstein, 2009) to meet the unique needs and challenges facing returning service members from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Among the two million personnel who have served in OIF/OEF/OND, up to 38% report alcohol problems, 50% report marital violence, 25% suffer from depression and/or thoughts of suicide, 31% have Post Traumatic Stress Disorder (PTSD), and 19-22% have Traumatic Brain Injury (TBI). For the 65% of solders re-integrating into marital relationships, these alcohol and related problems are associated with significant discord. Our proposed manual-guided treatment protocol, ABCT_Military, will deliver our existing core sets of (a) abstinence-based, alcohol-related interventions, and (b) couple interventions, but with adaptations in content, illustration, and delivery, to make the treatment palatable and relevant to post-deployment service members. Four new optional modules will be developed to address issues exacerbated by and aggravating problem drinking among soldiers and their families following return from theater; the modules are designed to help couples cope with symptoms of: 1. Intimate Partner Violence; 2. Depression; 3. PTSD, and 4.TBI. Specific Aims in the current proposal are: (1)To modify our existing, ABCT_civilian model to treat soldiers in post deployment, and develop optional content modules to address relevant co-morbid challenges in this population in a 15 session outpatient format; (2) To test feasibility and preliminary efficacy of the treatment protocol using a Stage 1a successive cohort design, and (3) To complete a Stage 1b small Randomized Controlled Trial (RCT) comparing Treatment as Usual (TAU) to TAU+ABCT_Military. To achieve these aims, male and female OIF/OEF/OND service members who are in post-deployment or separated from active service, are drinking excessively, and are married or in a committed relationship with a partner willing to participate in the treatment, will be recruited through the Massachusetts Statewide Advocacy for Veterans' Empowerment (SAVE) program, which provides referrals to over 700 service men and women annually across all branches of the military. After manual development and iterative testing on two cohorts of 6 couples each (Stage 1a), 44 couples in the small RCT (stage 1b) will be randomly assigned to either TAU (n=22 couples) or TAU + ABCT_Military (n=22 couples), then will complete a follow up interview post treatment.