Academic journal article Journal of Marital and Family Therapy

Efficacy of a Web-Based Intervention for Concerned Spouses of Service Members and Veterans with Alcohol Misuse

Academic journal article Journal of Marital and Family Therapy

Efficacy of a Web-Based Intervention for Concerned Spouses of Service Members and Veterans with Alcohol Misuse

Article excerpt

Alcohol misuse is a problem in the military and is associated with numerous problems including fitness for duty, absenteeism, depression, anxiety (LeardMann et al., 2013; Mattiko, Olmsted, Brown, & Bray, 2011), suicide (LeardMann et al., 2013), and sexual violence (Morral et al., 2016). Alcohol misuse, or drinking that is quantified as at-risk or heavy drinking, precedes more severe alcohol use disorders (National Institute on Alcohol Abuse and Alcoholism, 2007). Misuse of alcohol is most common among younger service members (Institute of Medicine, 2012) with over a quarter of 18 to 35-year-olds reporting binge drinking in the past month (Ramchand et al., 2011). Over half of service members are married (Karney & Crown, 2007), and some research suggests that married service members report alcohol misuse at a higher rate (40%; Paul, Grubaugh, Frueh, Ellis, & Egede, 2011) than married civilians (13%; Bray et al., 2009, & Karney & Crown, 2007).

The mental health of spouses is a growing concern among the military, specifically during the deployment cycle (Booth et al., 2007; De Burgh, White, Fear, & Iversen, 2011; Eaton et al., 2008; Verdeli et al., 2011). Military spouses are an at-risk population for mental health problems because they face the stressors of military life, including frequent moves to new military bases, frequent spousal separations for military training, assignments, and combat deployments (Drummet, Coleman, & Cable, 2003). Furthermore, these stressors can erode the social support available to military spouses due to loss of social networks through changes in residence (Drummet et al., 2003), and loss of support from partners with combat-related mental health issues (e.g., PTSD) (Karney & Trail, 2017).

Spouses in relationships with a heavy drinking service member partner often report high levels of depression, anxiety, and social impairment (Erbes, Meis, Polusny, & Arbisi, 2012; Rodriguez, Osilla, Trail, Gore, & Pedersen, 2017). Depressive and anxiety symptoms in spouses affect the mental health of children and increase rates of marital conflict (Verdeli et al., 2011), and may interfere with healthy partnerships involving mutual support. Interventions for military spouses are important because if the mental health needs of spouses are met and they are able to receive more social support for their stress, these improvements may improve the overall health of the family.

COMMUNITY REINFORCEMENT AND FAMILY TRAINING FOR MILITARY CONCERNED PARTNERS

Preventive interventions have been shown to address the needs of spouses-concerned partners (CPs)-in relationships with partners who misuse alcohol, but have not been tested in military samples. The Community Reinforcement and Family Training (CRAFT) intervention targets the CP and is typically composed of 12 individual in-person sessions that focus on positive communication and other behavioral reinforcement and punishment strategies to help the CP influence their partner's drinking and change their negative interactions (Meyers & Wolfe, 2004; Smith & Meyers, 2007). CRAFT was developed to engage treatment-resistant partners into alcohol treatment by teaching the CP supportive and non-confrontational skills to cope with their partner's drinking (e.g., positive communication, social skills, pleasant activity planning), and ways to interact with their partner through positive reinforcement (e.g., rewards for sobriety) and punishment (e.g., letting natural consequences happen from drinking). CRAFT utilizes functional analysis so that CPs learn about the context around their partner's drinking (e.g., triggers, rewards) and offers support for how CPs can help reduce their partner's drinking and encourage help-seeking. CRAFT is an ideal intervention for CPs with behavioral health concerns because it focuses on CP self-care and CP interactions with their partner. Moreover, the research supports the efficacy of CRAFT. …

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