Behavioral Couples Group Therapy for Alcoholic Patients: Clinical Cost Outcomes

多项研究表明，参与行为夫妇疗法（BCT）与积极的 酒精和药物滥用患者在减少物质使用和改善关系方面的结果 功能然而，基于社区的治疗方案很少向符合条件的患者提供BCT。报告的 由提供者和管理者在美国的一项全国性治疗计划调查中，BCT被视为 这在很大程度上是由于其标准的一次一对夫妇的联合交付格式。 鉴于公共政策气候，现在不仅强调临床有效性， 问责，干预的效率（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一个关键因素。虽然BCT有很好的- 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，我们研究了夫妇组格式提供BCT。首先，在早期的工作中， PI开发了一个为期10周的BCT组，在此之前增加了一些联合会议，以准备夫妇和 事后，以防止复发。虽然结果是有利的，增加的联合会议和封闭的 一个一旦开始就没有增加额外成员的团体，对社区机构来说， 简短的治疗和通常运行与新成员定期添加持续的组。第二，克服 针对这些问题，主要研究者和共同主要研究者开发了一种10期连续BCT小组形式， 滚动招生，即夫妇加入小组，完成10次会议，并“毕业”。一个主要优点 BCT这种持续的团体形式的一个重要原因是，它与其他类型的团体通常在实质上的运作方式相吻合 滥用程序。它在供应商焦点小组中得到了好评，并在试点研究中显示出了希望。 对已婚或同居的男性吸毒者进行的初步研究检查了多种药物的疗效， 与标准联合BCT（S-BCT）相比，BCT的夫妇组治疗版本（G-BCT），以及基于个体的 仅针对患者的治疗（小组和个人咨询）。结果显示，G-BCT产生等同的 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的实施成本较低，具有优越的上级成本效益和成本效益。G-BCT和S-BCT 比个体化治疗产生更好的临床和成本结果。此外，一项小规模的评估研究 表明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一项随机临床试验，以检查临床有效性， BCT组（G-BCT）与 标准BCT（S-BCT）为160酒精患者及其非物质滥用的合作伙伴。考虑到 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- 2个干预方案的效益和成本效益。

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.