Behavioral Couples Therapy for Female Drug-Abusing Patients

描述(申请人提供)：女性药物滥用患者的行为伴侣疗法多项研究表明，参加行为伴侣疗法(BCT)与药物滥用和酗酒患者的积极结果密切相关。在对12项对照研究进行的荟萃分析中，BCT对已婚或同居的药物滥用和酗酒患者产生了比更典型的基于个人的治疗(IBT)更好的结果，这些研究显示中等效应规模有利于BCT而不是个人治疗。然而，几乎所有的BCT研究都是在男性吸毒或酗酒患者身上进行的。尽管人际冲突和关系因素在妇女的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项与吸毒有关，1项与酗酒妇女有关)检验了BCT对女性患者的疗效。这两项研究都发现了BCT的阳性结果，但对吸毒女性来说，支持BCT而不是IBT的结果不那么有力，也不太持久。与酗酒的妇女和吸毒或酗酒的男子相比，吸毒的妇女可能会对最佳预防措施构成特殊的挑战。他们的关系问题比其他类型的滥用药物的夫妇更严重。这可能会降低BCT的有效性，因为这会使这对夫妇更难合作，促进女性药物滥用患者的戒毒。BCT改变的一个理论机制是，BCT在治疗期间比IBT更能改善关系功能，这种改善的关系功能会在治疗后带来更好的戒断结果。然而，如果关系的改善对BCT的改善只比IBT略好，这可能会破坏治疗后一年内禁欲的可持续性。此外，女性药物滥用患者往往有广泛的精神问题(例如，抑郁、创伤后应激障碍)和酗酒或吸毒的男性伴侣--这些因素可能会减少(即适度)BCT相对于IBT的影响。这项拟议的研究将评估女性药物滥用患者的BCT，以确定在男性患者中观察到的BCT优于IBT结果是否适用于女性药物滥用患者。这项研究将复制、扩展和克服之前对女性药物滥用患者进行的唯一一项BCT研究的关键局限性。这项随机试验比较了BCT加IBT和单独使用IBT治疗女性药物滥用患者。寻求门诊治疗的已婚或同居的女性滥用药物患者(N=160)及其非滥用药物的男性伴侣将在12周内随机接受24次治疗，其中包括：(A)BCT+IBT；或(B)单独接受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以及治疗后12个月的季度随访中收集的数据来测试BCT IBT将产生比单独IBT更好的结果的预测。审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。我们还将探索在父母接受最佳治疗后儿童功能可能的改善，行动机制和潜在的最佳治疗结果的调节因素。 公共卫生相关性：在治疗药物成瘾方面，许多男性患者的研究表明，行为伴侣疗法(BCT)有助于整个家庭(吸毒者、关系伴侣及其子女)，比典型的个人和团体咨询更有效。只有一项针对女性药物滥用患者的BCT研究，结果是有希望的，但并不是决定性的。这项拟议的研究将在已婚或同居的女性药物滥用患者中测试BCT是否会比单独为患者提供标准的个人咨询更能为女性、她们的男性伴侣和她们的孩子带来更积极的结果。

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.