Behavioral Couples Therapy for Female Drug-Abusing Patients

描述（由申请人提供）：针对女性吸毒患者的行为夫妻疗法 多项研究表明，参与行为夫妻疗法 (BCT) 与吸毒和酗酒患者的稳健积极结果相关。对已婚或同居的吸毒和酗酒患者进行的荟萃分析表明，对于已婚或同居的吸毒和酗酒患者来说，BCT 比更典型的个体治疗 (IBT) 产生了更好的结果，该分析显示，与个体治疗相比，BCT 的中等效应有利于 BCT。然而，几乎所有 BCT 研究都是针对男性吸毒或酗酒患者进行的。尽管人际冲突和关系因素在女性药物滥用问题中发挥着特别重要的作用，但只有 2 项对照研究（1 项针对吸毒女性，1 项针对酗酒女性）检验了 BCT 对女性患者的疗效。两项研究均发现 BCT 具有积极效果，但对于吸毒女性而言，BCT 优于 IBT 的研究结果不那么稳健且持久。相对于酗酒的女性和吸毒或酗酒的男性，吸毒的女性可能会给 BCT 带来特殊的挑战。与其他类型的滥用药物的夫妇相比，他们的关系问题更大。这可能会降低 BCT 的有效性，因为夫妻双方更难共同努力促进女性吸毒患者戒毒。 BCT 变化的理论机制是，BCT 比 IBT 更能改善治疗期间的关系功能，并且这种改善的关系功能会导致治疗后更好的戒断结果。然而，如果 BCT 的关系改善仅比 IBT 稍好一些，则可能会破坏治疗后一年禁欲的可持续性。此外，女性药物滥用患者通常有广泛的精神问题（例如抑郁症、创伤后应激障碍），男性伴侣酗酒或吸毒——这些因素可能会降低（即适度）BCT 相对于 IBT 的影响。拟议的研究将评估女性吸毒患者的 BCT，以确定在男性中观察到的 BCT 相对于 IBT 结果的优越性是否适用于女性吸毒患者。该研究将复制、扩展并克服之前唯一一项针对女性吸毒患者的 BCT 研究的主要局限性。这项随机试验对女性药物滥用患者的 BCT 加 IBT 与单独 IBT 进行了比较。寻求门诊治疗的已婚或同居女性吸毒患者 (N = 160) 及其非药物滥用男性伴侣将在 12 周内随机接受 24 次治疗，包括： (a) BCT 加 IBT； (b) 单独针对患者进行 IBT。我们将测试以下预测：BCT IBT 将比单独 IBT 产生更好的结果，如治疗期间和治疗后立即以及治疗后 12 个月的季度随访中从患者和配偶收集的数据所示。检查的结果领域将包括药物使用和问题、关系调整和伴侣暴力。我们还将探讨父母接受 BCT 后儿童功能可能的改善、作用机制以及 BCT 结果的潜在调节因素。 公共健康相关性：在治疗毒瘾方面，许多针对男性患者的研究表明，行为夫妻疗法 (BCT) 可以帮助整个家庭（吸毒者、伴侣及其子女），并且比典型的个人和团体咨询更有效。只有一项针对女性吸毒患者的 BCT 研究，结果令人鼓舞，但并不明确。拟议的研究将测试已婚或同居的女性吸毒患者是否会比针对患者的标准个人咨询产生更积极的结果。

DESCRIPTION (provided by applicant): Behavioral Couples Therapy for Female Drug-Abusing Patients Multiple studies indicates 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. The proposed studywillevaluateBCT for women drug-abusing patients to determine whether the superiority 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 outpatient treatment 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. PUBLIC HEALTH RELEVANCE: In treating drug addiction, many studies of male patients show Behavioral Couples Therapy (BCT) helps the whole family (the drug abuser, the relationship partner, and their children) and is more effective than typical individual and group counseling. Only one study of BCT has been done with female drug-abusing patients, and results were promising but not definitive. The proposed study will test with married or cohabiting female drug-abusing patients whether BCT will produce more positive outcomes for the women, their male partners, and their children than standard individual counseling for the patient alone.