Examining the Effects of Behavioral Couples Therapy on Intimate Partner Violence

描述（由申请人提供）：亲密伴侣暴力（IPV）在美国被广泛认为是一个重大的公共卫生问题，一项全国性调查的结果显示，每年有15%-20%的夫妇参与伴侣的身体攻击行为。尽管这些流行率看起来令人震惊，但与报告的接受治疗的滥用药物夫妇的比率相比，它们相形见绌，据估计，这些夫妇中有50%-60%参与IPV。随着使用婚姻和家庭为基础的评估和干预越来越普遍，作为治疗酒精中毒和其他药物紊乱的一部分，提供者越来越多地面临着解决IPV及其负面后遗症，他们的病人和他们的亲密伴侣。不幸的是，面对这一问题的治疗提供者的有效选择非常有限。提供者最常用的方法是（a）忽略这一问题并提供通常的治疗，或（B）将这些案件提交给专门治疗施虐者的机构;有三个基本问题 这个战略。虽然后一种办法似乎是可行的，而且反应迅速，但现有证据表明情况并非如此。首先，大多数提供这些服务的机构只接受法律授权完成其计划的个人。第二，在接受非强制性病人的项目中，大多数滥用药物的病人不接受这种转诊，或者过早地退出。第三，现有证据表明，这些计划在降低IPV方面是无效的。 因此，药物滥用治疗计划必须开发和评估IPV的其他干预替代方案。几项初步研究的结果表明，行为伴侣疗法（BCT）显着降低了已婚或同居酗酒和吸毒患者的IPV。虽然联合治疗IPV存在争议，但在参与BCT的患者及其伴侣中观察到的IPV降低是实质性的，难以忽视。因此，BCT作为IPV干预措施的这些有希望的发现需要进一步更严格的评估。使用NIAAA的PA行为疗法开发计划中描述的阶段模型，本探索性/开发性研究的目的是进行IB阶段（试点）研究，比较专门针对IPV的改良版BCT与治疗性治疗（TAU）在家庭暴力已婚或同居酒精依赖患者治疗期间和治疗后降低IPV方面的疗效（N = 100）。50、你的伙伴效应的潜在介质（例如，减少使用酒精，减少使用适应不良的冲突方法）也将受到审查。如果这项小规模随机临床试验观察到的效果是有希望的，它们将被用来为更大规模的疗效试验的开发提供信息（即，II期研究）。

DESCRIPTION (provided by applicant): Intimate partner violence (IPV) is widely recognized as a significant public health concern in the U.S. with the results of a national survey revealing that 15%-20% of couples engage in acts of partner physical aggression each year. As alarming as these prevalence rates appear, they are dwarfed in comparison to rates reported for substance-abusing couples entering treatment, in which it is estimated 50%-60% of these couples engage in IPV. With the use of marital- and family-based assessments and interventions becoming more common as part of treatment for alcoholism and other drug disorders, providers are increasingly faced with addressing IPV, and its negative sequelae, among their patients and their intimate partners. Unfortunately, effective options for treatment providers who confront this issue are extremely limited. The most common approaches used by providers are to (a) ignore this issue and provide treatment-as-usual, or (b) refer these cases to agencies specializing in batterers treatment; there are three fundamental problems with this strategy. While the latter approach appears viable and responsive, available evidence indicates otherwise. First, most of the agencies offering these services only accept individuals legally mandated to complete their programs. Second, among programs that do accept nonmandated patients, most substanceabusing patients do not accept such referrals or drop out very prematurely. Third, available evidence suggests these programs are ineffective in reducing IPV. Thus, it is imperative that substance abuse treatment programs develop and evaluate other intervention alternatives for IPV. Findings from several preliminary studies suggest Behavioral Couples Therapy (BCT) significantly reduced IPV among married or cohabiting alcoholic and drug-abusing patients. Although use of conjoint treatment for IPV is controversial, the reductions in IPV observed among patients and their partners who participate in BCT are substantial and are difficult to ignore. Thus, these promising findings for BCT as an intervention for IPV require further, more rigorous evaluation. Using the stage model described in NIAAA's PA Behavioral Therapies Development Program, the objective of this exploratory/developmental investigation is to conduct a Stage IB (pilot) study, comparing the efficacy of a modified version of BCT designed to specifically address IPV versus a Treatment-As-Usual (TAU) in terms of reducing IPV during and after treatment for domestically violent married or cohabiting alcohol-dependent patients (N = 50) and their partners. Potential mediators of the effect (e.g., reduced alcohol use, reduced use of maladaptive methods of conflict) will also be examined. If the observed effects of this small-scale randomized clinical trial are promising, they will be used to inform the development of a larger efficacy trial (i.e., Stage II study).