PLOS ONE · 8 authors, 8 centres
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This pilot randomized trial tested a brief computerized intervention to reduce alcohol and drug use among 50 women recruited from domestic violence shelters. The intervention was feasible and acceptable, with 80% completion rates and high satisfaction scores, but there were no significant differences between groups in substance use outcomes or IPV severity. A fully powered trial is needed to determine efficacy.
**Background:** Intimate partner violence (IPV) affects over 48 million women in the U.S., and substance use disorders (SUDs) are twice as prevalent among women with IPV compared to the general population. Women in domestic violence shelters have high rates of substance use (estimated 42%), and comorbid substance use increases risk of new IPV episodes. Digital interventions offer a scalable, low-cost approach that can be delivered without substantial staff burden. This pilot study examined the feasibility, acceptability, and preliminary effectiveness of a brief computerized intervention for shelter residents with IPV and substance use risk.
**Methods:** Fifty women (mean age 35.2 years; 42% Black, 38% White, 18% Latina) with recent IPV and at-risk alcohol/drug use were recruited from domestic violence shelters in Rhode Island (n=21), Ohio (n=22), and Massachusetts (n=7). Participants were randomized 1:1 by the computer program to either the experimental computerized intervention (n=25) or an attention- and time-matched control condition (n=25). The intervention consisted of a 50-minute session plus a 15-minute booster session two weeks later, delivered via the Computerized Intervention Authoring Software (CIAS) on a Tablet PC in a private shelter setting. It used motivational strategies, personalized feedback, psychoeducation on the bidirectional relationship between substance use and IPV, and tailored content based on current substance use status (relapse prevention, goal setting, or pros/cons). The control condition involved viewing popular entertainer/show videos for the same duration. The primary outcome was percent heavy drinking (4+ drinks) or drug using days over 3-month increments across 6 months post-shelter, assessed via the Timeline Follow-Back (TLFB). Secondary outcomes included receipt of substance use services (Treatment Services Review, TSR) and IPV severity (Composite Abuse Scale [CAS], Safety Behavior Checklist [SBC], cyberstalking scale). Feasibility was assessed via recruitment, refusal, and completion rates; acceptability via the Satisfaction with CIAS Software Scale (SSS) and Client Satisfaction Questionnaire-Revised (CSQ-8-R). Analyses used generalized estimating equations with negative binomial or normal distributions, adjusted for baseline values.
**Key Results:** The intervention was feasible and acceptable: 20 of 25 participants (80%) completed both sessions. Mean CSQ-8-R score was 29.9 (SD=0.62) out of 32, exceeding the scale average of 27. Mean CIAS satisfaction score was 4.78 (SD=0.28) out of 5. There were no significant differences between conditions in the primary outcome of percent heavy drinking/drug using days at 3 or 6 months (adjusted longitudinal analysis: ratio of exponentiated means 0.28, 95% CI 0.46–1.62, p=0.64, Cohen's d=0.15). Wide individual variation was observed: from baseline to 3 months, percent drinking days decreased by a mean of 20% (range −70% to +34%) in the control condition and by a mean of 23% (range −87% to +66%) in the intervention condition. For substance use services, receipt decreased by a mean of 0.05 times/day in the control condition (range −1.00 to +0.55) and increased by a mean of 0.06 times/day in the intervention condition (range −0.13 to +0.89) from baseline to 6 months (p=0.26). IPV severity decreased substantially over time in both conditions (e.g., median baseline CAS Victimization scores >50 in both conditions fell to <10 at follow-ups). However, adjusted analyses showed significantly worse CAS Victimization scores in the intervention versus control condition (ratio 0.41, 95% CI 0.18–0.90, p=0.03, d=0.71), and a trend toward worse CAS Perpetration scores (ratio 0.46, 95% CI 0.20–1.05, p=0.06, d=0.59). No differences were found for Safety Behavior Checklist (p=0.16) or cyberstalking (p=0.26). Theorized mediators (readiness and self-efficacy) showed no significant between-group differences.
**Clinical Implications:** A computerized intervention to reduce substance use risk among women with IPV in domestic violence shelters is feasible and acceptable, with high completion rates and satisfaction. The wide individual variability in outcomes and lack of significant between-group differences on substance use are consistent with the pilot nature of the trial. The unexpected finding of worse IPV severity scores in the intervention condition may reflect measurement issues, shelter-related protection, or insufficient intervention dose relative to other shelter services. These results underscore the need for a fully powered trial to conclusively evaluate efficacy. The intervention's low cost, scalability, and fidelity across sites make it a promising approach if effectiveness is confirmed.