Behavioral Couples Group Therapy for Alcoholic Patients: Clinical Cost Outcomes

描述（由申请人提供）：多项研究表明，在减少物质使用和改善关系功能方面，参与行为夫妻治疗（BCT）与酗酒和吸毒患者的积极结果相关。然而，以社区为基础的治疗项目很少向新来的符合条件的患者提供BCT。根据美国医疗服务提供者和管理人员在一项全国治疗项目调查中的报告，BCT被认为是劳动密集型的，这在很大程度上是由于其标准的一对夫妇一次的联合交付形式。鉴于现在的公共政策环境不仅强调临床效果，而且强调经济责任，干预措施的效率（即，用于提供服务的有效性与项目资源的比率）是治疗项目决定采用新干预措施的关键因素。尽管BCT的有效性得到了很好的证明，但提供者和管理者的共识是，BCT并不有效。为了解决这些问题，我们研究了提供BCT的成对组格式。首先，在早期的工作中，PI开发了一个为期10周的BCT组，其中增加了一些联合会议，之前为夫妇做准备，之后防止复发。虽然结果是有利的，但增加的联合会议和一旦开始就没有增加额外成员的封闭小组使得社区机构很难接受更简短的治疗，并且通常会定期增加新成员来运行持续的小组。其次，为了克服这些问题，PI和Co-PI开发了一种10期持续的BCT小组形式，该小组有轮换的内容和滚动招生，夫妻加入小组，完成10期，然后“毕业”。这种正在进行的BCT小组形式的一个主要优点是，它符合其他类型的小组通常在药物滥用项目中运行的方式。它在供应商焦点小组中获得了好评，并在试点研究中显示出希望。这项针对已婚或同居男性药物滥用患者的初步研究，检验了多对夫妇团体治疗版本的BCT （G-BCT）与标准联合BCT （S-BCT）的疗效，以及仅针对患者的以个人为基础的治疗（团体和个人咨询）。结果显示，与S-BCT相比，G-BCT在减少药物使用和改善关系调整方面取得了相同的结果，但GBCT的交付成本更低，具有更高的成本效益和成本效益。G-BCT和S-BCT均比基于个体的治疗产生更好的临床和成本结果。此外，一项小规模评估研究表明，G-BCT比S-BCT更有可能用于社区治疗方案。因此，本研究将进行一项随机临床试验，对160名酒精患者及其非药物滥用伴侣进行BCT组（G-BCT）与标准BCT组（S-BCT）在药物使用、关系功能和心理社会适应方面的临床效果进行检验。考虑到这两种干预措施在治疗成本上可能存在差异，我们还将研究这两种干预措施的相对成本效益和成本效益。

DESCRIPTION (provided by applicant): Multiple studies indicate that participation in Behavioral Couples Therapy (BCT) is associated with robust positive outcomes for alcoholic and drug-abusing patients, in terms of reduced substance use and improved relationship functioning. Yet, community-based treatment programs rarely offer BCT to incoming eligible patients. As reported by providers and administrators in a national survey of treatment programs in the U.S., BCT was viewed as prohibitively labor intensive, due in large measure to its standard conjoint one-couple-at-a-time delivery format. Given the public policy climate that is now emphasizing not only clinical effectiveness, but also economic accountability, an intervention's efficiency (i.e., the ratio of effectiveness to program resources used to provide the service) is a critical factor in decisions by treatment programs to adopt new interventions. Although BCT has well- proven efficacy, the consensus of providers and administrators is that BCT is not efficient. To address these issues, we have studied couples group formats to deliver BCT. First, in earlier work the PI developed a 10-week BCT group with a number of conjoint sessions added before to prepare couples and afterwards to prevent relapse. While the outcomes were favorable, the added conjoint sessions and the closed group that once begun did not add additional members made it a hard sell for community agencies looking for briefer treatments and typically running ongoing groups with new members added regularly. Second, to overcome these problems, the PI and Co-PI developed a 10-session ongoing BCT group format that has rotating content and rolling admissions in which couples join the group, complete 10 sessions, and "graduate". A major advantage of this ongoing group format for BCT is that it fits with the way other types of groups generally are run in substance abuse programs. It got favorable reviews in provider focus groups and showed promise in a pilot study. The pilot study with married or cohabiting male drug-abusing patients examined the efficacy of a multi- couple group therapy version of BCT (G-BCT) compared to standard conjoint BCT (S-BCT), and individual-based treatment (group and individual counseling) for the patient only. Results showed G-BCT yielded equivalent outcomes when compared to S-BCT, in terms of reduction in substance use and improved relationship adjustment, but GBCT was less costly to deliver and had superior cost-benefit and cost-effectiveness. Both G-BCT and S-BCT yielded better clinical and cost-outcomes than individual-based treatment. Also, a small-scale evaluation study indicated G-BCT was more likely to be used in community-based treatment programs than S-BCT. Thus, this proposed study will conduct a randomized clinical trial to examine the clinical effectiveness, in terms of substance use, relationship functioning, and psychosocial adjustment, of Group BCT (G-BCT) versus Standard BCT (S-BCT) for 160 alcoholic patients and their nonsubstance-abusing partners. Given the likely differences in cost of treatment delivery between the 2 interventions, we will also examine the comparative cost- benefit and cost-effectiveness of the 2 intervention packages. PUBLIC HEALTH RELEVANCE: In treating alcoholism, many studies show Behavioral Couples Therapy (BCT) is more effective than typical counseling, but BCT is not widely used because standard BCT delivered one couple at a time is costly to deliver and does not fit with the primary group therapy focus of most community clinics. The proposed study will test with married or cohabiting alcoholic patients whether a group format for BCT will produce similar positive outcomes as standard BCT, and deliver these results at a lower cost. If outcomes are favorable, this could prompt clinics to start using group BCT and improve outcomes for alcoholic patients and their families.