Reducing Alcohol Consumption for Health Together: Pilot testing a brief couples intervention via telehealth

About This Grant

Sexual and gender minority persons face substantial health inequities, including high rates of unhealthy alcohol use (UAU). High rates of UAU are a consequence of a lack of social safety and social stressors due to systemic oppression that are oftentimes supportive of greater UAU. Despite the important influence of primary partners on UAU and demonstrated efficacy of couples-based treatment for alcohol use disorder in heterosexual couples, the vast majority of alcohol interventions with sexual and gender minority populations have been individually focused. Based on our conceptual and empirical understanding of UAU, we recently completed a rigorous iterative development and pilot testing process for a 3-session couples-based alcohol intervention (called “ReACH2Gether) for cisgender male couples in which at least one partner was receiving care for HIV. In a one-arm pilot trial, the intervention, which was delivered entirely by videoconferencing and allowed for a range of alcohol reduction goals for both members of the couple, was feasible and highly acceptable. Participants showed meaningful and significant changes in alcohol use and key couples-related mechanisms of change. Based on our successful findings, we propose to adapt ReACH2Gether to meet the diverse needs of sexual and gender minority couples and to provide additional content suggested by our pilot work. Guided by a community advisory board (CAB) that represents the diversity of sexual and gender identities who will participate in the project, we will use a two-step sequence of treatment development and evaluation. Stage 1a includes: (1) working with our CAB to adapt our existing couples-based intervention to be inclusive of diverse sexual and gender identities and to incorporate additional content guided by interdependence and social safety theories, (2) conducting a one-arm pilot trial with 12 couples to refine the manual and study procedures, and (3) analyzing exit interviews to finalize refinements to the intervention. Stage 1b consists of a pilot randomized controlled trial with 30 sexual and gender minority adults with UAU and their partners (total N = 60) to test feasibility, acceptability, and potential promise of the intervention. Couples will be randomized to ReACH2Gether or brief advice on alcohol and couples communication (with ReACH2Gether offered after 12 weeks). Alcohol use and mechanisms of behavior change will be assessed at 6-, 12-, and 18-week follow-ups. We will share study results with our CAB and conduct a focus group with key informants, who are involved in delivering behavioral healthcare to sexual gender minority populations, in order to assess the appropriateness and feasibility of deploying ReACH2Gether in their practice contexts. The proposed research plan is well aligned with the prioritization of sexual and gender minority communities for health disparities research and NIH’s strategic plan to advance research on the health of sexual and gender minorities. Findings will provide the necessary groundwork to examine intervention efficacy and implementation processes in a future, large-scale, randomized hybrid effectiveness-implementation trial.