Examining the Effects of Behavioral Couples Therapy on Intimate Partner Violence

描述(申请人提供)：亲密伴侣暴力(IPV)在美国被广泛认为是一个重要的公共卫生问题，一项全国性调查的结果显示，每年有15%-20%的夫妇从事伴侣身体攻击行为。尽管这些患病率看起来令人担忧，但与报告的药物滥用夫妇进入治疗的比率相比，它们相形见绌。据估计，这些夫妇中有50%-60%参与了IPV。随着基于婚姻和家庭的评估和干预作为酒精中毒和其他药物障碍治疗的一部分变得越来越普遍，提供者越来越多地面临着在他们的患者和亲密伴侣中解决IPV及其负面后遗症的问题。不幸的是，面对这一问题的治疗提供者的有效选择极其有限。提供者使用的最常见方法是：(A)忽视这一问题，照常提供治疗，或(B)将这些案件提交专门从事施暴者治疗的机构；有三个基本问题 有了这个策略。尽管后一种方法似乎可行且反应迅速，但现有证据表明并非如此。首先，大多数提供这些服务的机构只接受法律授权完成其项目的个人。其次，在接受非强制患者的项目中，大多数滥用药物的患者不接受这样的转诊，或者过早地退出。第三，现有证据表明，这些计划在降低IPV方面无效。 因此，当务之急是药物滥用治疗方案开发和评估针对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)显著降低了已婚或同居的酗酒和吸毒患者的IPV。尽管联合治疗IPV有争议，但在参与BCT的患者及其伴侣中观察到的IPV的减少是实质性的，很难被忽视。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，这项探索性/发育研究的目标是进行一项IB阶段(试点)研究，比较针对IPV而设计的修改版本的BCT与常规治疗(TAU)在家庭暴力已婚或同居酒精依赖患者(N=50)及其伴侣的治疗期间和治疗后降低IPV的有效性。还将审查影响这一效果的潜在调解人(例如，减少饮酒、减少使用不适应的冲突方法)。如果这个小规模随机临床试验的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(即第二阶段研究)的发展提供信息。

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).