Examining the Effects of Behavioral Couples Therapy on Intimate Partner Violence

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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).