ADVANCE integrated group intervention to address both substance use and intimate partner abuse perpetration by men in substance use treatment: a feasibility randomised controlled trial.

BACKGROUND: Substance use is a risk factor for intimate partner abuse (IPA) perpetration. Delivering perpetrator interventions concurrently with substance use treatment shows promise. METHODS: The feasibility of conducting an efficacy and cost-effectiveness trial of the ADVANCE 16-week intervention to reduce IPA by men in substance use treatment was explored. A multicentre, parallel group individually randomised controlled feasibility trial and formative evaluation was conducted. Over three temporal cycles, 104 men who had perpetrated IPA towards a female (ex) partner in the past year were randomly allocated to receive the ADVANCE intervention + substance use treatment as usual (TAU) (n = 54) or TAU only (n = 50) and assessed 16-weeks post-randomisation. Participants' (ex) partners were offered support and 27 provided outcome data. Thirty-one staff and 12 men who attended the intervention participated in focus groups or interviews that were analysed using the framework approach. Pre-specified criteria assessed the feasibility of progression to a definitive trial: 1) ≥ 60% of eligible male participants recruited; 2) intervention acceptable to staff and male participants; 3) ≥ 70% of participants followed-up and 4) levels of substance use and 5) IPA perpetrated by men in the intervention arm did not increase from average baseline level at 16-weeks post-randomisation. RESULTS: 70.7% (104/147) of eligible men were recruited. The formative evaluation confirmed the intervention's acceptability. Therapeutic alliance and session satisfaction were rated highly. The overall median rate of intervention session attendance (of 14 compulsory sessions) was 28.6% (range 14.3-64.3% by the third cycle). 49.0% (51/104) of men and 63.0% (17/27) of their (ex) partners were followed-up 16-weeks post-randomisation. This increased to 100% of men and women by cycle three. At follow-up, neither substance use nor IPA perpetration had worsened for men in the intervention arm. CONCLUSIONS: It was feasible to deliver the ADVANCE intervention in substance use treatment services, although it proved difficult to collect data from female (ex)partners. While some progression criteria were met, others were not, although improvements were demonstrated by the third cycle. Lessons learned will be implemented into the study design for a definitive trial of the ADVANCE intervention. TRIAL REGISTRATION: ISRCTN79435190 prospectively registered 22nd May 2018.

Provocation and target gender as moderators of the relationship between acute alcohol use and female perpetrated aggression.

Acute alcohol use appears to exert a small but significant effect on female perpetrated aggression in the laboratory but there has been no effort to evaluate comprehensively the situational moderators of this relationship. This preliminary review was intended to explore the moderating effects of provocation and target gender on alcohol-related aggression among females in this understudied area of research. Moderator analyses were conducted on 14 studies. Despite limitations imposed by the sparsity of laboratory based research on alcohol-related aggression among females, initial results suggest that alcohol may exert stronger effects over female aggression following high (d = 0.25, k = 8, p < .01, 95% CI = 0.10-0.40) rather than low (d = -0.07, k = 6, p = .52, 95% CI = -0.29-0.15) provocation and when targets of aggression are female (d = 0.19, k = 9, p = .01, 95% CI = 0.04-0.34) rather than male (d = -0.06, k = 4, p = .61, 95% CI = -0.30-0.18). Results offer initial insight into situational risk factors pertinent to research and treatment of alcohol-related aggression among females while serving as an impetus for future research in this critical, neglected area of study.

Problematic alcohol use as a risk factor for cyber aggression within romantic relationships.

BACKGROUND AND OBJECTIVES: Cyber aggression has emerged as a modern form of intimate partner violence which has yet to undergo sufficient research necessary to identify risk factors that may increase the likelihood or severity of cyber aggressive behavior toward a relationship partner. Prior research offers contradictory findings pertaining to the relationship between problematic alcohol use and cyber aggression. METHODS: We recruited 100 (40 female) adult participants through online crowdsourcing to complete a series of questionnaires assessing traditional partner violence, cyber aggression, and problematic alcohol use. RESULTS: Forty-two percent of the sample reported perpetrating cyber relational aggression and 35% reported perpetrating cyber privacy invasion during the year prior to study participation. Traditional partner violence was associated with both forms of cyber aggression. Problematic alcohol use was only associated with privacy invasion after accounting for demographic factors and traditional partner violence. DISCUSSION AND CONCLUSIONS: Cyber aggression was prevalent among the current adult sample. Results suggest that problematic alcohol use is a risk factor for cyber privacy invasion but not cyber relational aggression. SCIENTIFIC SIGNIFICANCE: Findings add to and clarify the nascent, conflicting results that have emerged from prior research on alcohol-related cyber aggression. (Am J Addict 2018;XX:1-7).

Interventions to reduce intimate partner violence perpetration among people with substance use disorders.

The social and economic cost of intimate partner violence (IPV) is exorbitant and highlights the need for policy reform as it pertains to IPV interventions at a global level. There are multiple variables associated with the aetiology of IPV and, hence, multiple treatment needs must be considered. Substance use is one of several factors likely to influence the occurrence of IPV, but often goes unaddressed in standard treatment approaches. This review will discuss several treatment models for substance using offenders of IPV, including Psycho-educational Models, Cognitive Behavioural Therapy, Couples' Treatments, Parenting Programmes, Integration of Care Models, and Pharmacotherapies. Clinical recommendations will be discussed. Treatment outcomes among substance using offenders of IPV may be improved by implementing changes in protocol that increase diagnostic evaluations, integrate care with evidence-based models, require limits to the number of offenders in a group, and require qualifications for clinicians who treat offenders (licensed and trained psychologists, social workers, and/or psychiatrists).

Axis I psychopathology and the perpetration of intimate partner violence.

OBJECTIVES: Initial evidence suggests that individuals with specific psychiatric conditions may perpetrate intimate partner violence (IPV) at greater frequency than nondiagnosed comparison samples. The present investigation examined the relationship between IPV and specific clinical diagnoses. METHOD: The current investigation utilized data provided by 190 (34% female) adult offenders during court-mandated substance use evaluations to investigate the incidence of past-year IPV among samples of dually diagnosed (bipolar, posttraumatic stress disorder [PTSD], and attention deficit-hyperactivity disorder [ADHD]) clients relative to 3 comparison samples matched on substance use and sociodemographic variables. RESULTS: Bipolar and PTSD diagnosed participants were more likely to perpetrate IPV than matched comparison and ADHD participants. Bipolar and PTSD diagnosed participants were equally likely to perpetrate IPV, as were ADHD and matched comparison samples. CONCLUSIONS: The frequency of IPV perpetration among bipolar and PTSD diagnosed clients may complicate interpersonal and relationship functioning. The development of integrated treatments for IPV and underlying psychopathology is recommended.

The occurrence of female-to-male partner violence among male intimate partner violence offenders mandated to treatment: a brief research report.

Little is known about the perceived perpetration of female-to-male intimate partner violence by victims of male offenders mandated to treatment. Sixty-eight male perpetrators of partner violence completed measures of dyadic violent and aggressive responding at intake and at a 12-week follow-up. Approximately 20% of male offenders reported partner violence perpetration and 30% reported victimization with bidirectional violence as the most common configuration of couple violence. Maladaptive responses to conflict were prevalent across partners. Significant and highly correlated reductions in aversive behaviors were detected across the assessment period for both males and their female partners. Results are interpreted within the context of motivational models of female-to-male partner violence and current treatment approaches.

Risk factors of violence during a 4-week period in a psychiatric outpatient population.

The clinical impact of structured risk assessment instruments has been limited by a lack of information regarding a) their short-term accuracy and b) the relationship between change as measured by the instrument and a change in the risk for harm. Data were collected every 4 weeks on a) variables designed to resemble the items of a structured risk assessment instrument, b) substance use, c) social circumstances and mental state, and d) violent behavior. Scores on the variables designed to resemble the items of a risk assessment instrument were associated with violence during the ensuing 4 weeks. However, an increase in a subject's score on these variables was not associated with violence. Instead, increasing cocaine use and increasing social conflict as described by the subject at interview were associated with violence during those weeks.

Adapting the ADVANCE group program for digitally-supported delivery to reduce intimate partner violence by men in substance use treatment: a feasibility study.

Introduction: COVID-19 restrictions created barriers to "business as usual" in healthcare but also opened the door to innovation driven by necessity. This manuscript (1) describes how ADVANCE, an in-person group perpetrator program to reduce intimate partner violence (IPV) against female (ex)partners by men in substance use treatment, was adapted for digitally-supported delivery (ADVANCE-D), and (2) explores the feasibility and acceptability of delivering ADVANCE-D to men receiving substance use treatment. Methods: Firstly, the person-based approach and mHealth development framework were used to iteratively adapt ADVANCE for digitally-supported delivery including conceptualization, formative research, and pre-testing. Then, a non-randomized feasibility study was conducted to assess male participants' eligibility, recruitment, and attendance rates and uptake of support offered to their (ex)partners. Exploratory analyses on reductions in IPV perpetration (assessed using the Abusive Behavior Inventory; ABI) and victimization (using the revised ABI; ABI-R) at the end of the program were performed. Longitudinal qualitative interviews with participants, their (ex)partners, and staff provided an understanding of the program's implementation, acceptability, and outcomes. Results: The adapted ADVANCE-D program includes one goal-setting session, seven online groups, 12 self-directed website sessions, and 12 coaching calls. ADVANCE-D includes enhanced risk management and support for (ex)partners. Forty-five participants who had perpetrated IPV in the past 12 months were recruited, forty of whom were offered ADVANCE-D, attending 11.4 (SD 9.1) sessions on average. Twenty-one (ex)partners were recruited, 13 of whom accepted specialist support. Reductions in some IPV perpetration and victimization outcome measures were reported by the 25 participants and 11 (ex)partners interviewed pre and post-program, respectively. Twenty-two participants, 11 (ex)partners, 12 facilitators, and 7 integrated support service workers were interviewed at least once about their experiences of participation. Overall, the program content was well-received. Some participants and facilitators believed digital sessions offered increased accessibility. Conclusion: The digitally-supported delivery of ADVANCE-D was feasible and acceptable. Remote delivery has applicability post-pandemic, providing greater flexibility and access. Given the small sample size and study design, we do not know if reductions in IPV were due to ADVANCE-D, time, participant factors, or chance. More research is needed before conclusions can be made about the efficacy of ADVANCE-D.

Depression as a mediator of the association between substance abuse and negative parenting of fathers.

OBJECTIVE: The role of substance abuse (SA) and depression on paternal parenting has recently gained attention in the research literature. Both SA and depression have been associated with negative parenting in fathers, but studies to date have not examined the mediating role that depression may play in the association of SA and fathering. METHODS: SA, depression, and parenting data were reported by 87 fathers presenting for SA evaluation. Bootstrap mediation modeling was conducted to determine the role of depression on the association between SA and negative parenting. RESULTS: Depression is a significant mediator of the relationship between the severity of fathers' drug use and hostile-aggressive parenting behaviors. Fathers who had concerns about parenting or wanted help to improve the parent-child relationship had significantly higher symptoms of depression. CONCLUSIONS: Depressive symptoms in fathers entering SA treatment have implications for both the severity of drug abuse and negative parenting behaviors.

Differences in treatment outcome among marijuana-dependent young adults with and without antisocial personality disorder.

BACKGROUND: Few studies have addressed comorbid antisocial personality disorder (ASPD) and marijuana dependence in young adults, and results from previous studies are inconsistent. OBJECTIVES: This study evaluated differences in pretreatment characteristics and treatment outcomes between marijuana-dependent young adults with and without ASPD. METHODS: Data for this study were derived from a randomized trial, in which marijuana-dependent young adults (n = 136) between 18 and 25 years of age were randomized to four behavioral conditions: (1) MET/CBT with CM, (2) MET/CBT without CM, (3) DC with CM, and (4) DC without CM. RESULTS: Forty-four percent of the participants met DSM-IV-TR criteria for ASPD. ASPD clients had significantly more lifetime alcohol dependence disorders, marijuana use in the 28 days pretreatment, arrests, and assault and weapon charges compared to those without ASPD. ASPD clients did not differ in retention or substance use outcomes at 8 weeks posttreatment or the 6-month follow-up. In general, both groups had more attendance in the voucher condition, but there were no significant ASPD by treatment interactions. CONCLUSIONS: These data suggest that marijuana-dependent young adults with comorbid ASPD do not necessarily have poorer retention or substance use outcomes compared with marijuana-dependent young adults who do not have ASPD when treated in a well-defined behavioral therapy protocol. SCIENTIFIC SIGNIFICANCE: Previous research has shown increased risks for clients with comorbid ASPD and marijuana dependence; however, our findings suggest that specialized programs for clients with ASPD may not be necessary if they are provided with empirically supported, structured treatments.

Mindfulness and modification therapy for behavioral dysregulation: results from a pilot study targeting alcohol use and aggression in women.

OBJECTIVES: Increasing evidence suggests that deficits in mindfulness (awareness, attentiveness, and acceptance of the present moment) play a role in a range of disorders involving behavioral dysregulation. This paper adds to that literature by describing a transdiagnostic psychotherapy (Mindfulness & Modification Therapy; MMT) developed to target behavioral dysregulation. DESIGN: An open-treatment pilot-trial investigated the feasibility, acceptability, and pre-post effects of MMT targeting women (N = 14) court-referred for alcohol abuse/dependence and aggression. RESULTS: Pre-post comparisons revealed significant decreases in alcohol use, drug use, and aggression. In addition, the retention rate was 93%. CONCLUSION: Preliminary evidence suggests that MMT is a feasible and acceptable treatment that decreases dysregulated behaviors such as substance use and aggression, while also potentially increasing retention.

Online Crowdsourcing as a Quasi-Experimental Method for Collecting Data on the Perpetration of Alcohol-Related Partner Aggression.

Cross-sectional survey, prospective, and experimental data have been evaluated to better understand the role of alcohol as a contributing cause of intimate partner aggression. Laboratory-based alcohol administration studies provide controlled data regarding causality, but the use of this methodology lacks ecological validity and has been hampered by rigorous procedural and financial demands. Online crowdsourcing is an emerging pseudoexperimental methodology with low costs, rapid data collection, access to diverse populations, greater ecological validity, and the potential to facilitate prolific research to supplement the chronic scarcity of experimental data. The current rapid review first summarizes prior methodological approaches to investigating the proximal influence of alcohol on partner aggression, then reviews prior crowdsourcing research in the disparate areas of alcohol and partner aggression, then describes aggression paradigms that may be readily adapted to online administration. We conclude by introducing recommendations for future quasi-experimental research investigating alcohol-related partner aggression research using the online crowdsourcing methodology. Initial evidence suggests that online crowdsourcing may yield appropriate samples and that existing paradigms may be adapted to rapidly, efficiently, and ethically supplement experimental alcohol-related partner aggression research.

The feasibility of delivering the ADVANCE digital intervention to reduce intimate partner abuse by men receiving substance use treatment: protocol for a non-randomised multi-centre feasibility study and embedded process evaluation.

BACKGROUND: Compared to men in the general population, men in substance use treatment are more likely to perpetrate intimate partner abuse (IPA). The ADVANCE group intervention for men in substance use treatment is tailored to address substance use and IPA in an integrated way. In a feasibility trial pre-COVID, men who received the ADVANCE intervention via face-to-face group delivery showed reductions in IPA perpetration. Due to COVID-19, ADVANCE was adapted for remote digital delivery. METHODS/DESIGN: This mixed-methods non-randomised feasibility study, with a nested process evaluation, will explore the feasibility and acceptability of delivering the ADVANCE digital intervention to men in substance use treatment who have perpetrated IPA towards a female partner in the past year. Sixty men will be recruited from seven substance use treatment services in Great Britain. The ADVANCE digital intervention comprises a preparatory one-to-one session with a facilitator to set goals, develop a personal safety plan, and increase motivation and a preparatory online group to prepare men for taking part in the intervention. The core intervention comprises six fortnightly online group sessions and 12 weekly self-directed website sessions to recap and practise skills learned in the online group sessions. Each website session is followed by a one-to-one video/phone coaching session with a facilitator. Men will also receive their usual substance use treatment. Men's female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Outcome measures for men and women will be sought post intervention (approximately 4 months post male baseline interview). Feasibility parameters to be estimated include eligibility, suitability, consent, recruitment, attendance, retention and follow-up rates. In-depth interviews or focus groups will explore the intervention's acceptability to participants, facilitators and ISS workers. A secondary focus of the study will estimate pre-post-differences in outcome measures covering substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts and quality of life. DISCUSSION: Findings will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE digital intervention for reducing IPA. TRIAL REGISTRATION: The feasibility study was prospectively registered: ISRCTN66619273 .

The impact of fatherhood on treatment response for men with co-occurring alcohol dependence and intimate partner violence.

OBJECTIVE: The role of fathers in the lives of children has gained increasing attention over the last several decades, however, studies that specifically examine the parenting role among men who are alcohol dependent and have co-occurring intimate partner violence (IPV) have been limited. This brief report is intended to highlight the need to develop and focus interventions for men with co-occurring substance abuse and IPV with an emphasis on their roles as fathers. METHOD: Sixty-nine men who participated in a randomized comparison study of a coordinated substance abuse and domestic violence treatment program (SADV) and Twelve Step Facilitation (TSF) provided information about whether they were fathers. Analysis of covariance was used to assess the impact of fatherhood on the outcomes of intimate partner violence and alcohol use during the 12 weeks of treatment. RESULTS: There was a significant interaction between type of treatment (SADV vs. TSF) and fatherhood. SADV resulted in significantly less IPV and use of alcohol over the 12 weeks of treatment than TSF for men without children. There were no significant differences between SADV and TSF for men who were fathers. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Results indicate a need to further explore the role of fatherhood for men with co-occurring substance abuse and IPV and development of specialized treatments that may improve treatment outcomes for fathers.

The Impact of Depressive Symptoms on Response to Integrated Cognitive Behavioral Therapy for Substance Use Disorders and Intimate Partner Violence.

PURPOSE: Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. We hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response. DESIGN/METHODOLOGY/APPROACH: A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n=29) to those in DC (n=34). FINDINGS: Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (e.g., family, strangers) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up. ORIGINALITY: Although integrated CBT's efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated. PRACTICAL IMPLICATIONS: Integrated CBT buffered depressive symptoms' impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms. RESEARCH LIMITATIONS/IMPLICATIONS: This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples.

Using the Behaviour Change Wheel to design an intervention for partner abusive men in drug and alcohol treatment.

BACKGROUND: We aimed to establish what core elements were required in a group therapy programme for men who disclose perpetrating intimate partner abuse in a substance use setting and develop, and test the feasibility of delivering an intervention in this setting. METHODS: We describe the theoretical development and feasibility testing of an integrated substance use and intimate partner abuse intervention ('ADVANCE') for delivery in substance use services. We employed a comprehensive eight-stage process to guide this development applying the 'COM-B' ('capability', 'opportunity', 'motivation' and 'behaviour') model for intervention design which specifies the following: (1) define the problem, (2) select the target behaviour, (3) specify the target behaviour, (4) identify what needs to change, (5) identify intervention functions, (6) identify policy categories, (7) select behaviour change techniques, and (8) design a mode of delivery. The development was informed by primary research conducted by the authors, consulting with organisation steering groups and by those with personal experiences. The identified targets for intervention and mode and method of delivery were then refined over 4 intervention development meetings, using the nominal group technique with the ADVANCE experts, then further refined following consultation with service user groups and wider expert groups via a learning alliance meetings. RESULTS: Our final intervention, the ADVANCE intervention consisted of a group intervention comprising of up to four pre-group individual interviews, followed by 12 × 2-h group sessions supported by integrated safety work for victim/survivors, and risk and safety support and integrity support for the professionals. The main targets for change were personal goal planning, self-regulation, and attitudes and beliefs supporting intimate partner abuse. The intervention was regarded as very acceptable to both staff and clients in substance use services, with group attendees reported positive behaviour changes and development of new skills. CONCLUSION: We have demonstrated the ability to employ a structured eight-step process to develop an integrated intervention to address substance use-related intimate partner abuse that is acceptable to staff and clients in substance use services. This led to a feasibility study (ISRCTN 79435190) involving 104 men and 30 staff at three different locations across the UK was conducted to assess the feasibility and acceptability of the intervention and to refine the content and approach to delivery (BMC Public Health, 21: 980, 2021).

A meta-analytic review of the relationship between cyber aggression and substance use.

BACKGROUND: Prior research has demonstrated that various substances of abuse play a contributing role to acts of physical and verbal aggression. It is less clear if and to what extent substance use is associated with an increased risk in perpetrating cyber aggression, an emerging form of aggressive behavior that occurs through digital communication. METHODS: A comprehensive review of the literature resulted in 15 studies and 18 unique samples from which effect size estimates were calculated. RESULTS: Analyses resulted in a moderate, significant mean observed correlation indicating that individuals who engaged in substance use were more likely than those who did not to perpetrate cyber aggression (r = 0.24, k = 18, 95% CI = 0.20, 0.28). Comparing data across types of substances revealed that alcohol use represents a stronger risk factor for cyber aggression than nicotine, cannabis, or other illicit drugs. Results also suggest a stronger relationship between substance use and cyber aggression among older than younger samples and in the context of intimate partner rather than peer aggression. Comparable estimates of substance-related cyber aggression emerged across types of cyber aggression and perpetrator gender. CONCLUSIONS: Further research is required to increase confidence in estimates used in moderation analyses. As with traditional aggression, alcohol use appears to represent a risk factor for cyber aggression, though it is unclear if the disinhibitory properties of alcohol are the mechanism of action for substance-related cyber aggression.

Racial differences in treatment effect among men in a substance abuse and domestic violence program.

BACKGROUND: It is unclear whether racial differences in treatment effect exist for individuals in substance abuse and domestic violence programs. OBJECTIVES: This study examined racial differences in treatment effect among substance dependent Caucasian and African-American male intimate partner violence (IPV) offenders court mandated to an integrated substance abuse and domestic violence treatment. METHODS: From baseline to completion of treatment (week 12), 75 participants (39 Caucasian; 36 African-American) were assessed on demographics, substance use, legal characteristics, and use of violence (physical, verbal, and psychological). RESULTS: African-American men served more months incarcerated in their life than Caucasian men. Both groups showed decreases in their use of physical violence and alcohol abuse over treatment. Caucasian men also showed a decrease in their use of verbal abuse. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: At treatment completion, both groups showed a reduction in physical abuse and alcohol abuse. Caucasian men showed a reduction in their use of verbal abuse, but African-American men did not. Substance dependent African-American male IPV offenders may benefit from interventions that thoroughly target communication skills in addition to issues of substance abuse and IPV to reduce use of verbal abuse and improve treatment outcomes among African American men.

Can we prevent smoking in children with ADHD: a review of the literature.

UNLABELLED: Cigarette smokers pose public health challenges and are over-represented among individuals with attention deficit hyperactivity disorder (ADHD). This article reviews the link between ADHD and smoking across various developmental stages with an emphasis on factors that interact with ADHD (e.g., comorbidity with conduct disorder) to modify risk for nicotine dependence from childhood through adulthood. METHOD: A literature review was conducted for 2000-2009 using key words ADHD, smoking, adolescents, adulthood. RESULTS: Childhood, adolescent and adult ADHD all increase risk for smoking. Childhood ADHD increases risk for early smoking during adolescence, particularly if untreated and in combination with conduct disorder (CD). Attention deficit hyperactivity disorder in adolescence increases the risk of daily smoking in adulthood. These findings underscore the importance of smoking prevention for children and adolescents with ADHD and other risk factors (e.g., CD). Pharmacotherapy for ADHD offers promise to lower the risk of smoking during adolescence. Preventing the development of conduct disorder (CD) or controlling the symptoms of CD is also possible and may reduce smoking and associated outcomes.

A study protocol to assess the feasibility of conducting an evaluation trial of the ADVANCE integrated intervention to address both substance use and intimate partner abuse perpetration to men in substance use treatment.

BACKGROUND: Strong evidence exists that substance use is a contributory risk factor for intimate partner abuse (IPA) perpetration. Men in substance use treatment are more likely to perpetrate IPA than men from the general population. Despite this, referral pathways are lacking for this group. This trial will assess the feasibility of conducting an evaluation trial of a tailored integrated intervention to address substance use and IPA perpetration to men in substance use treatment. METHODS/DESIGN: ADVANCE is a multicentre, parallel-group individually randomised controlled feasibility trial, with a nested formative evaluation, comparing an integrated intervention to reduce IPA + substance use treatment as usual (TAU) to TAU only. One hundred and eight men who have perpetrated IPA in the past 12 months from community substance use treatment in London, the West Midlands, and the South West will be recruited. ADVANCE is a manualised intervention comprising 2-4 individual sessions (2 compulsory) with a keyworker to set goals, develop a personal safety plan and increase motivation and readiness, followed by a 12-session weekly group intervention delivered in substance use services. Men will be randomly allocated (ratio 1:1) to receive the ADVANCE intervention + TAU or TAU only. Men's female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Regular case management meetings between substance use and ISS will manage risk. Outcome measures will be obtained at the end of the intervention (approximately 4 months post-randomisation) for all male and female participants. The main objective of this feasibility trial is to estimate parameters required for planning a definitive trial including rates of consent, recruitment, and follow-up by site and group allocation. Nested formative evaluation including focus groups and in-depth interviews will explore the intervention's acceptability to participants, group facilitators, keyworkers and ISS workers. Secondary outcomes include substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts, and quality of life. DISCUSSION: Findings from this feasibility trial will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE intervention for reducing IPA and improving the well-being of female (ex)partners. TRIAL REGISTRATION: ISRCTN79435190.