Behavioral Couples Therapy for Female Drug-Abusing Patients

女性药物滥用患者的行为伴侣治疗 多项研究表明，参与行为伴侣疗法(BCT)与健康相关 药物滥用和酗酒患者的积极结果。BCT产生了比典型的更好的结果 已婚或同居的药物滥用和酗酒患者个体化治疗的荟萃分析 在12项对照研究中，显示中等效应大小有利于BCT而不是个别治疗。然而，几乎 所有的BCT研究都是在吸毒或酗酒的男性患者中进行的。 虽然人际冲突和关系因素在实质上起着特别重要的作用 妇女的虐待问题，只有2项对照研究(1项与吸毒有关，1项与酗酒妇女有关) 检查了女性患者接受BCT的疗效。这两项研究都发现了BCT的阳性结果，但发现 对于滥用药物的女性来说，更倾向于BCT而不是IBT的女性不那么健壮，也不那么持久。 与酗酒的女性和吸毒的女性相比，滥用药物的女性可能会对BCT构成特殊的挑战。 虐待或酗酒的男人。他们的人际关系问题比其他类型的物质滥用问题更严重 情侣。这可能会降低BCT的有效性，因为这会使夫妇更难一起工作 共同促进女性药物滥用患者的戒毒。一种变革的理论机制 BCT是在治疗期间，BCT比IBT更能改善关系功能，这种改善的关系 功能正常会在治疗后带来更好的禁欲结果。然而，如果关系的改善只是 BCT比IBT略好，这可能会破坏治疗后一年内禁欲的可持续性。另外， 女性药物滥用患者通常有广泛的精神问题(如抑郁症、创伤后应激障碍)和男性伴侣。 大量饮酒或吸毒的人--这些因素可能会降低(即适度)BCT相对于IBT的影响。 这项拟议的研究将评估女性吸毒者的BCT以确定是否具有优势 在男性中观察到的BCT对IBT结果的评估普遍适用于女性药物滥用患者。这项研究将重复进行， 扩大并克服之前对女性药物滥用患者进行的唯一一项BCT研究的关键局限性。这 随机试验比较了BCT+IBT和单纯IBT治疗女性药物滥用患者的疗效。已婚或同居 寻求门诊治疗的女性吸毒患者(N=160)及其非滥用药物的男性伴侣 将在12周内随机接受24次治疗，其中包括：(A)BCT+IBT；或(B) 单独对患者进行IBT。我们将检验BCT+IBT将产生比单独IBT更好的结果的预测 根据在治疗期间和治疗后立即以及每季度从患者和配偶那里收集的数据显示 治疗后随访12个月。审查的结果领域将包括物质使用和问题， 关系调整和伴侣暴力。我们还将探索可能改善儿童功能的方法 在他们的父母接受BCT后，他们的行为机制和潜在的BCT结果的调节因素。

Behavioral Couples Therapy for Female Drug-Abusing Patients Multiple studies indicate that participation in Behavioral Couples Therapy (BCT) is associated with robust positive outcomes for drug-abusing and alcoholic patients. BCT produced better outcomes than more typical individual-based treatment (IBT) for married or cohabiting drug-abusing and alcoholic patients in a meta-analysis of 12 controlled studies that showed a medium effect size favoring BCT over individual treatment. However, nearly all BCT studies have been done with male drug-abusing or alcoholic patients. Although interpersonal conflict and relationship factors play a particularly important role in the substance abuse problems of women, only 2 controlled studies (1 with drug-abusing and 1 with alcoholic women) have examined the efficacy of BCT with women patients. Both studies found positive results for BCT, but findings favoring BCT over IBT were less robust and less long-lasting for drug-abusing women. Drug-abusing women may present special challenges for BCT, relative to alcoholic women and drug- abusing or alcoholic men. They have greater relationship problems than these other types of substance-abusing couples. This may reduce the effectiveness of BCT by making it more difficult for the couple to work together collaboratively to promote abstinence in the female drug-abusing patient. A theoretical mechanism of change for BCT is that BCT improves relationship functioning during treatment more than IBT and this improved relationship functioning leads to better abstinence outcomes after treatment. However, if relationship improvements are only weakly better for BCT than IBT, this may undermine sustainability of abstinence in the year after treatment. Also, women drug-abuse patients often have extensive psychiatric problems (e.g, depression, PTSD) and male partners who drink heavily or use drugs - factors that may reduce (i.e. moderate) the impact of BCT relative to IBT. Theproposed studywillevaluateBCT for women drug-abusing patientsto determinewhetherthesuperiority of BCT over IBT outcomes observed for men generalizes to women drug-abusing patients. The study will replicate, extend, and overcome key limitations of the only prior study of BCT with female drug-abusing patients. This randomized trial compares BCT plus IBT with IBT alone for women drug-abusing patients. Married or cohabiting female drug-abusing patients(N=160)seeking outpatienttreatment and their non-substance-abusing male partners will be randomized to 24 treatment sessions over a 12-week period consisting of either: (a) BCT plus IBT; or (b) IBT for the patient alone. We will test the prediction that BCT + IBT will produce better outcomes than IBT alone as shown by data collected from patients and spouses during and immediately after treatment and at quarterly follow-ups for 12 months after treatment. Outcome domains examined will include substance use and problems, relationship adjustment, and partner violence. We also will explore possible improvements in children's functioning after their parents receive BCT, mechanisms of action and potential moderators for BCT outcomes.