Clinical Trial of Interventions with Significant Others (Miller, PI)
Treatment and referral centers commonly receive pleas for help from concerned spouses and significant others (CSOs) living with problem drinkers. Although a variety of strategies for counseling CSOs are widely used in practice, their outcomes are largely unknown because of a paucity of evaluation. Further, currently practice approaches suggests divergent, even diametrically opposed strategies for counseling CSOs. Effective intervention through CSOs is likely to have important health impact, because (a) it may benefit both CSOs and problem drinkers, as well as their relationship and families; (b) it may facilitate earlier treatment or behavior change in problem drinkers, and (c) CSOs are likely to exert ongoing influence in the drinkers' lives following any intervention or treatment. The proposed Phase I randomized clinical trial (N=150) would yield new knowledge regarding the relative efficacy and cost-effectiveness of three commonly employed strategies for helping CSOs, based on: (1) Al-Anon, (2) the Johnson Institute intervention, and (3) unilateral CSO skill training based on Azrin's community reinforcement approach. Evaluation will focus on the impact of interventions on the CSO's general functioning, the drinker's alcohol use and related problems, treatment-seeking for alcohol problems, and family happiness and adjustment including health-care utilization. A second randomized trial is embedded in this design, which also serves the important function of standardizing immediate access to services when the Phase I intervention results in referral of the drinker for treatment. This Phase II trial will extend prior outcome research contrasting 12- step and community reinforcement approaches in treating alcohol abuse and dependence. Analyses will be assess main effects within these two trials, as well as hypothesized clients markers of differential response ("matching"), and the interaction of intervention and treatment styles. Secondary analyses will also be pursued to clarify processes underlying response to Phase I and Phase II modalities.