Testing a couple-based program for alcohol risk reduction in the National Guard
Rates of binge drinking in the military currently hover at 47% and constitute a "public health crisis" (IOM, 2012), with few evidence-based prevention programs in place to stem the tide. Hazardous drinking among service members is directly detrimental to psychological fitness and military readiness, and is also a risk factor for several overlapping problems, including alcohol use disorder (AUD), use of other drugs, depression, suicide, and relationship conflict. This R34, "Testing A Couple-based Program for Alcohol Risk Reduction in the National Guard," in line with PAR-12-279, aims to develop and test an indicated, secondary prevention intervention to harness marital support and health promoting endeavors such as relationship enhancement and problem solving to replace use of alcohol to cope with reintegration challenges. Up to 81% of military members are married or in a committed relationship and the integration of couple-based prevention programs into military service settings has been identified as a promising but underutilized health promotion strategy. National Guard (NG) members and their families are a special needs population due to high rates of heavy drinking, mental health, and family problems, paired with geographic challenges that limit access to military heath care support systems. The proposed "indicated secondary prevention" project targets hazardous drinking NG members who have not yet developed AUD. Aim 1 is to modify our efficacious Alcohol Behavioral Couple Therapy (ABCT) manual into a brief indicated secondary prevention protocol called Alcohol Behavioral Couple Prevention (ABCP), available for in-person or telehealth delivery by professionals or paraprofessionals in military settings. The goal of the new ABCP is for couples to learn to work together to minimize hazardous drinking in order to then begin to effectively address other problems often present among returning service members. Aim 2 is to field test an in-person delivery platform of the protocol (ABCP_P) with 6 couples, refine, and then field test a telehealth delivery platform (ABCP_T) for the refined protocol with 6 new couples. Aim 3 is to conduct a small randomized controlled trial with 22 couples in each condition: (1) "Prevention as usual" (PAU) which includes annual briefings and a limited monitoring system currently in place in the NG; (2) PAU plus ABCP_P, and (3) PAU plus ABCP_T. Primary outcome variables include alcohol use, marital functioning and coping skills. Candidate mediators of health promotion behavior change, including attitudes and beliefs about drinking will be tracked. This project is in accord with IOM (2013) recommendations; it aims to fill a gap in prevention strategies for hazardous drinking and associated risks among service members, with an evidence-based risk reduction protocol to support overall force readiness while strengthening the family unit. Further, it includes a teleheath delivery platform to address geographic challenges and lower barriers to accessible services for the armed forces.