Mechanisms of Change: Alcohol Behavioral Couple Therapy

描述（由申请人提供）：社会支持是酒精使用障碍（AUDs）康复的重要因素。特别是，在治疗中涉及相关的重要他人（CSO），会产生更积极的结果。一种特殊形式的涉及公民社会的治疗，酒精行为夫妻疗法（ABCT），其疗效得到了强有力的实证支持。然而，对于ABCT如何以及为什么会带来更好的治疗结果，我们知之甚少。拟议研究的总体目标是更好地了解cso相关治疗有效的机制。研究目的是：(1)观察ABCT开始时的CSO和二元行为是否能预测治疗期间的确诊患者（IP）饮酒；(2)观察ABCT过程中CSO和二元行为是否发生变化；(3)观察治疗期间CSO和二元行为的改变是否与IP饮酒行为的改变有关；(4)观察治疗期间CSO和二元行为的变化能否预测治疗后的IP饮酒；(5)观察治疗师行为是否能预测饮酒结果；(6)测试预处理和治疗内变量，包括IP性别、基线关系功能和治疗依从性（出勤和家庭作业）对治疗结果的影响。为了实现这些目标，将对4个随机临床试验中186个首次治疗阶段和136个治疗中期的现有录音带进行编码。所有研究都有关于IP、CSO和一对基线特征的额外数据，以及治疗期间和一年随访数据。磁带将使用与重要他人的动机性访谈编码系统进行编码，以评估CSO和夫妻层面的行为；以及ABCT的治疗完整性评级系统，以规范治疗师的行为。结果应有助于改善AUDS患者的治疗：(1)在治疗开始时为临床医生提供信息，以识别特别积极或有害的行为，这将指导临床医生在以后的治疗中是否参与cso；(2)为临床医生提供行为信息，以实现cso相关治疗的积极效果最大化。

DESCRIPTION (provided by applicant): Social support is an important factor in recovery from alcohol use disorders (AUDs). In particular, involving a concerned significant other (CSO) in treatment, leads to more positive outcomes. A specific form of CSO-involved treatment, Alcohol Behavioral Couple Therapy (ABCT), has strong empirical support for its efficacy. Little is known, however, about how and why ABCT leads to better outcomes of treatment. The overall objective of the proposed study is to better understand the mechanisms by which CSO-involved treatment is effective. Study aims are: (1) To see if CSO and dyadic behaviors at the beginning of ABCT predict Identified Patient (IP) drinking during treatment; (2) To see if CSO and dyadic behaviors change during ABCT; (3) To see if changes in CSO and dyadic behavior are associated with changes in IP drinking behavior during treatment; (4) To see if changes in CSO and dyadic behavior during treatment predict post-treatment IP drinking; (5)To see whether therapist behaviors predict drinking outcomes; (6) To test the effects of pretreatment and within treatments variables, including IP sex, baseline relationship functioning, and treatment compliance (attendance and homework) on treatment outcome. To accomplish these aims, existing audiotapes of 186 first session and 136 mid- treatment sessions from four randomized clinical trials of ABCT will be coded. Additional data on IP, CSO, and couple baseline characteristics, and within treatment and one-year follow-up data are available for all studies. Tapes will be coded using the Motivational Interviewing with Significant Others coding system to rate CSO and couple-level behavior; and the Treatment Integrity Rating System for ABCT to code therapist behavior. Results should contribute to improved treatment for patients with AUDS by: (1) providing information to clinicians to identify particularly positive or toxic behaviors at the start of treatment that would guide decisions about CSO-involvement in later sessions; and (2) providing information to clinicians about behaviors to target in CSO-involved treatment to maximize positive outcomes. PUBLIC HEALTH RELEVANCE: Alcohol use disorders exact a toll on the individual, family, and society. Development of more effective treatments is an important research goal. One promising approach is to involving family members in treatment - research consistently shows that family involvement leads to better outcomes. The proposed research is designed to provide better knowledge about of why family involvement is helpful in treatment, knowledge that should help clinicians to be more effective when families are involved in alcoholism treatment.