Behavioral Couples Therapy for Female Drug-Abusing Patients

描述（由申请人提供）：女性药物滥用患者的行为夫妻治疗多项研究表明，参与行为夫妻治疗（BCT）与药物滥用和酒精患者的积极结果相关。一项包含12项对照研究的荟萃分析显示，对于已婚或同居的吸毒和酗酒患者，BCT比更典型的基于个体的治疗（IBT）产生更好的结果，BCT比个体治疗具有中等效应。然而，几乎所有的BCT研究都是针对男性吸毒或酗酒患者进行的。虽然人际冲突和关系因素在妇女药物滥用问题中起着特别重要的作用，但只有2项对照研究（1项涉及吸毒妇女，1项涉及酗酒妇女）检验了BCT对妇女患者的疗效。两项研究都发现了BCT的积极结果，但对吸毒妇女来说，BCT优于IBT的结果不那么有力，也不那么持久。与酗酒的妇女和吸毒或酗酒的男子相比，吸毒的妇女可能给BCT带来特殊的挑战。他们比其他滥用药物的夫妻有更大的关系问题。这可能会降低BCT的有效性，因为这使得夫妻更难以共同努力促进女性药物滥用患者的戒断。BCT改变的理论机制是BCT比IBT更能改善治疗期间的关系功能，这种改善的关系功能导致治疗后更好的戒断结果。然而，如果BCT对关系的改善仅比IBT好一点点，这可能会破坏治疗后一年禁欲的可持续性。此外，女性药物滥用患者往往有广泛的精神问题（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（即缓和）BCT相对于IBT的影响。本研究将对女性药物滥用患者的BCT进行评估，以确定在男性中观察到的BCT优于IBT的结果是否也适用于女性药物滥用患者。该研究将复制、扩展并克服先前唯一的女性药物滥用患者的BCT研究的主要局限性。这项随机试验比较了BCT加IBT和单独IBT治疗女性药物滥用患者的效果。寻求门诊治疗的已婚或同居女性药物滥用患者（N=160）及其非药物滥用男性伴侣将被随机分为24个疗程，为期12周，包括：(a) BCT加IBT；或(b)单独对患者进行IBT。我们将通过在治疗期间和治疗后立即收集的患者和配偶的数据以及治疗后12个月的季度随访来验证BCT + IBT比单独IBT效果更好的预测。检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。我们还将探讨父母接受BCT后儿童功能的可能改善、作用机制和BCT结果的潜在调节因素。

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.