Behavioral Couples Group Therapy for Alcoholic Patients: Clinical Cost Outcomes

多项研究表明，参与行为伴侣疗法(BCT)与积极的行为有关 在减少物质使用和改善关系方面，酒精和药物滥用患者的结果 功能正常。然而，以社区为基础的治疗计划很少为即将到来的符合条件的患者提供BCT。如报道所述 在对美国治疗计划的全国性调查中，提供者和管理人员认为，BCT被视为 劳动密集度高得令人望而却步，这在很大程度上是因为其标准的联合交付模式，一次一对夫妇。 考虑到现在的公共政策氛围不仅强调临床有效性，而且强调经济 问责制，干预措施的效率(即，有效性与用于提供 服务)是治疗方案决定采用新干预措施的关键因素。尽管BCT有很好的- 经过验证的有效性，供应商和管理人员的共识是，BCT是无效的。 为了解决这些问题，我们研究了夫妇小组提供最佳CT的形式。首先，在早期的工作中， PI建立了一个为期10周的BCT小组，之前增加了一些联合会议，以准备夫妇和 事后防止复发。在结果良好的情况下，增加了联席会议和闭门会议 一旦开始就没有添加额外的成员，这使得社区机构很难推销它 更简单的治疗，通常是持续运行的小组，定期增加新成员。第二，克服 针对这些问题，PI和Co-PI制定了一个10节持续的BCT小组形式，其中有轮换的内容 以及滚动录取，即夫妇加入小组，完成10个课程，然后“毕业”。一大优势 BCT正在进行的这种小组形式的一个特点是，它与其他类型的小组通常在实质上的运行方式相匹配 滥用程序。它在提供商焦点小组中获得了好评，并在一项试点研究中显示出了希望。 这项针对已婚或同居的男性药物滥用患者的初步研究检查了一种多剂量的 夫妻集体治疗版最佳治疗方案(G-BCT)与标准联合最佳方案(S-方案)的比较，以及基于个体的 仅针对患者的治疗(团体和个人咨询)。结果表明，G-BCT的产量相当于 结果与S-BCT相比，在减少物质使用和改善关系调整方面， 但GBCT的交付成本较低，具有更高的成本效益和成本效益。G-BCT和S-BCT 与基于个人的治疗相比，产生了更好的临床和成本结果。此外，一项小规模的评估研究 提示G-BCT比S-BCT更有可能用于社区治疗项目。 因此，这项拟议的研究将进行随机临床试验，以检查临床效果，在 BCT组(G-BCT)与对照组在物质使用、关系功能和心理社会适应方面的比较 对160例酒精中毒患者及其非滥用者进行标准行为量表(S-行为量表)的测评。考虑到很可能 两种干预措施之间的治疗成本差异，我们还将检查比较成本- 两种干预方案的效益和成本-效果。

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.