Mechanisms of Change: Alcohol Behavioral Couple Therapy

描述(由申请人提供)：社会支持是从酒精使用障碍(AUDS)中恢复的一个重要因素。特别是，让关心的另一半(CSO)参与治疗，会产生更积极的结果。一种特定形式的CSO参与治疗，酒精行为夫妇疗法(ABCT)，其有效性得到了强有力的经验支持。然而，关于ABCT如何以及为什么导致更好的治疗结果，人们知之甚少。拟议研究的总体目标是更好地了解CSO参与的治疗有效的机制。研究的目的是：(1)观察在ABCT开始时CSO和二元行为是否可以预测治疗期间已确定的IP饮酒；(2)观察在ABCT过程中CSO和二元行为是否发生改变；(3)观察CSO和二元行为的变化是否与治疗期间IP饮酒行为的改变相关；(4)观察治疗期间CSO和二元行为的变化是否可以预测治疗后IP饮酒；(5)观察治疗师行为是否可以预测饮酒结果；(6)测试治疗前和治疗内变量，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ABCT的四个随机临床试验的186个第一阶段和136个中期治疗阶段的现有录音带进行编码。关于IP、CSO和夫妇基线特征的其他数据，以及治疗内和一年随访数据可用于所有研究。磁带将使用与重要他人的动机访谈编码系统进行编码，以对CSO和夫妇级行为进行评级；并使用ABCT的治疗完整性评级系统对治疗师的行为进行编码。研究结果将有助于改善对AUDS患者的治疗：(1)在治疗开始时向临床医生提供信息，以识别特别积极或有毒的行为，从而指导以后的会议决定是否参与CSO；以及(2)向临床医生提供有关在CSO参与治疗中针对行为的信息，以最大限度地提高积极结果。 公共卫生相关性：酒精使用障碍对个人、家庭和社会造成损失。开发更有效的治疗方法是一个重要的研究目标。一种有希望的方法是让家庭成员参与治疗--研究一直表明，家庭参与会带来更好的结果。这项拟议的研究旨在更好地了解为什么家庭参与有助于治疗，这些知识应该有助于临床医生在家庭参与酒精中毒治疗时更有效。

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.