Behavioral Couples Group Therapy for Alcoholic Patients: Clinical Cost Outcomes

多项研究表明，参与行为夫妻治疗 (BCT) 与稳健的积极情绪相关。 酗酒和吸毒患者在减少物质使用和改善关系方面的结果 发挥作用。然而，基于社区的治疗计划很少向符合条件的患者提供 BCT。据报道 在美国的一项全国治疗计划调查中，医疗服务提供者和管理人员将 BCT 视为 劳动强度极大，这在很大程度上是由于其标准的联合一次一对夫妇的交付格式。 鉴于现在的公共政策氛围不仅强调临床有效性，还强调经济效果 问责制、干预措施的效率（即，有效性与用于提供干预措施的计划资源的比率） 服务）是治疗计划决定采用新干预措施的关键因素。尽管 BCT 具有良好的 尽管 BCT 的有效性已得到证实，但提供者和管理者的共识是 BCT 效率不高。 为了解决这些问题，我们研究了以情侣小组形式提供 BCT。首先，在早期的工作中 PI 制定了一个为期 10 周的 BCT 小组，之前添加了一些联合课程，以帮助情侣和 之后以防复发。虽然结果是有利的，但增加的联合会议和闭门会议 该团体一旦开始就没有增加额外的成员，这使得寻找新成员的社区机构很难接受 更简短的治疗，通常会持续运行小组并定期添加新成员。二、要克服 针对这些问题，PI 和 Co-PI 开发了一种 10 节持续 BCT 小组形式，该形式具有轮换内容 滚动招生，情侣加入小组，完成 10 节课程，然后“毕业”。一大优势 BCT 持续采用的团体形式的一个特点是它与其他类型团体的一般运作方式在实质上是一致的 滥用程序。它在提供商焦点小组中获得了好评，并在试点研究中显示出前景。 这项针对已婚或同居男性吸毒患者的初步研究检验了多种药物的疗效。 夫妻团体治疗版本的 BCT (G-BCT) 与标准联合 BCT (S-BCT) 以及基于个体的治疗相比 仅针对患者的治疗（团体和个人咨询）。结果显示 G-BCT 产生了同等效果 与 S-BCT 相比，在减少药物使用和改善关系调整方面的结果， 但 GBCT 的交付成本较低，并且具有卓越的成本效益和成本效益。 G-BCT 和 S-BCT 与基于个体的治疗相比，产生了更好的临床和成本结果。此外，还进行了一项小规模评估研究 表明 G-BCT 比 S-BCT 更有可能用于社区治疗计划。 因此，这项拟议的研究将进行一项随机临床试验来检查临床有效性， BCT 组 (G-BCT) 与 BCT 组在物质使用、关系功能和心理社会调整方面的比较 针对 160 名酗酒者及其非药物滥用伴侣的标准 BCT (S-BCT)。鉴于可能的 两种干预措施之间的治疗成本存在差异，我们还将研究比较成本- 两种干预措施的效益和成本效益。

Multiple studies indicate that participation in Behavioral Couples Therapy (BCT) is associated with robust positive outcomes for alcoholic and drug-abusing patients, in terms of reduced substance use and improved relationship functioning. Yet, community-based treatment programs rarely offer BCT to incoming eligible patients. As reported by providers and administrators in a national survey of treatment programs in the U.S., BCT was viewed as prohibitively labor intensive, due in large measure to its standard conjoint one-couple-at-a-time delivery format. Given the public policy climate that is now emphasizing not only clinical effectiveness, but also economic accountability, an intervention's efficiency (i.e., the ratio of effectiveness to program resources used to provide the service) is a critical factor in decisions by treatment programs to adopt new interventions. Although BCT has well- proven efficacy, the consensus of providers and administrators is that BCT is not efficient. To address these issues, we have studied couples group formats to deliver BCT. First, in earlier work the PI developed a 10-week BCT group with a number of conjoint sessions added before to prepare couples and afterwards to prevent relapse. While the outcomes were favorable, the added conjoint sessions and the closed group that once begun did not add additional members made it a hard sell for community agencies looking for briefer treatments and typically running ongoing groups with new members added regularly. Second, to overcome these problems, the PI and Co-PI developed a 10-session ongoing BCT group format that has rotating content and rolling admissions in which couples join the group, complete 10 sessions, and "graduate". A major advantage of this ongoing group format for BCT is that it fits with the way other types of groups generally are run in substance abuse programs. It got favorable reviews in provider focus groups and showed promise in a pilot study. The pilot study with married or cohabiting male drug-abusing patients examined the efficacy of a multi- couple group therapy version of BCT (G-BCT) compared to standard conjoint BCT (S-BCT), and individual-based treatment (group and individual counseling) for the patient only. Results showed G-BCT yielded equivalent outcomeswhen compared to S-BCT, in termsof reduction in substanceuseand improved relationship adjustment, but GBCT was less costly to deliver and had superior cost-benefit and cost-effectiveness. Both G-BCT and S-BCT yielded better clinical and cost-outcomes than individual-based treatment. Also, a small-scale evaluation study indicated G-BCT was more likely to be used in community-based treatment programs than S-BCT. Thus, this proposed study will conduct a randomized clinical trial to examine the clinical effectiveness, in terms of substance use, relationship functioning, and psychosocial adjustment, of Group BCT (G-BCT) versus Standard BCT (S-BCT) for 160 alcoholic patients and their nonsubtance-abusing partners. Given the likely differences in cost of treatment delivery between the 2 interventions, we will also examine the comparative cost- benefit and cost-effectiveness of the 2 intervention packages.