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伴侣疗法多项研究表明，参与行为伴侣疗法（BCT）与药物滥用和酗酒患者的积极结果有关。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体的治疗（IBT）更好的结局，这些研究显示BCT优于个体治疗的中等效应量。然而，几乎所有的BCT研究都是在男性吸毒或酗酒患者中进行的。尽管人际冲突和关系因素在女性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项针对药物滥用女性，1项针对酗酒女性）检查了BCT对女性患者的疗效。这两项研究都发现了BCT的积极结果，但对药物滥用妇女来说，支持BCT而不是IBT的结果不太可靠，也不太持久。与酗酒妇女和吸毒或酗酒男子相比，吸毒妇女可能对BCT构成特殊挑战。他们比其他类型的滥用药物的夫妇有更大的关系问题。这可能会降低BCT的有效性，使夫妇更难以共同努力，促进女性吸毒患者的禁欲。BCT改变的理论机制是，BCT在治疗期间改善的关系功能超过IBT，这种改善的关系功能导致治疗后更好的禁欲结局。然而，如果BCT的关系改善仅弱于IBT，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）和男性伴侣酗酒或吸毒-这些因素可能会减少（即缓和）BCT相对于IBT的影响。拟议的研究将评估女性药物滥用患者的BCT，以确定在男性中观察到的BCT优于IBT结局是否适用于女性药物滥用患者。这项研究将复制、扩展并克服先前唯一一项针对女性吸毒患者的BCT研究的关键局限性。这项随机试验比较了BCT加IBT与IBT单独用于女性药物滥用患者。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在12周内随机接受24次治疗，包括：（a）BCT + IBT;或（B）患者单独接受IBT。我们将检验BCT + IBT将产生比单独IBT更好的结局的预测，如在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后儿童功能的可能改善，BCT结果的作用机制和潜在调节剂。 公共卫生相关性：在治疗药物成瘾方面，许多对男性患者的研究表明，行为伴侣疗法（BCT）有助于整个家庭（药物滥用者，关系伴侣及其子女），比典型的个人和团体咨询更有效。只有一项关于BCT的研究是在女性吸毒患者中进行的，结果是有希望的，但不是确定的。这项拟议的研究将测试已婚或同居的女性药物滥用患者是否BCT会产生更多的积极成果，为妇女，他们的男性伴侣，他们的孩子比标准的个人咨询单独的病人。

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.