Behavioral Family Counseling: A Tx Development Project

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DESCRIPTION (provided by applicant): Family-involved treatment produces more abstinence than individual treatment for drug abuse and for alcoholism. Particularly in alcoholism, involving the spouse or live-in partner in couples therapy has been studied much more extensively than involving other family members. For example, behavioral couples therapy (BCT), the family treatment with the greatest empirical support, produces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Two recent studies of BCT for drug abuse included family members beyond spouses to improve pharmacotherapy compliance. Whether BCT could be expanded similarly for alcoholic patients, and for broader treatment goals typical of BCT (e.g., increased family cohesion, reduced family conflict) beyond medication compliance, has not been studied. Adapting BCT for alcoholic patients living with an adult family member other than a spouse (e.g., parent, sibling) could produce better outcomes than typical individual-based treatment if results prove similar for broader patient-family dyads as they are for couples. If BCT was broadened to include family members other than spouses, it would nearly double the number of patients who could benefit from BCT. The overall objective of this Stage I treatment development project is to develop and pilot test a Behavioral Family Counseling (BFC) intervention for alcoholic patients who live with family members other than spouses. Phase 1 of the project will develop a 12-session therapist manual and adherence scales for BFC by adapting an existing behavioral couples therapy protocol. We also will refine and revise these methods based on our experience with 12 initial cases. In the Phase 2 pilot study, 60 alcohol-dependent patients will be randomly assigned to one of two equally intensive, manual-guided treatments: (a) BFC plus individual-based treatment (IBT) or (b) IBT for the patient alone. Outcome data will be collected at baseline, during treatment, post treatment, and at 3- and 6- month follow-up. Phase 2 tests the prediction that alcoholic patients who receive BFC +IBT, as compared with those who receive IBT alone, will have superior outcomes of more days abstinent, fewer negative consequences of alcohol and drug use, better family adjustment, and fewer emotional distress symptoms.