Behavioral Couples Group Therapy for Alcoholic Patients: Clinical Cost Outcomes

描述（由申请人提供）：多项研究表明，参与行为伴侣疗法（BCT）与酗酒和药物滥用患者在减少物质使用和改善关系功能方面的积极结果有关。然而，基于社区的治疗方案很少向符合条件的患者提供BCT。正如提供者和管理者在美国全国治疗计划调查中所报告的那样，BCT被视为劳动密集型，在很大程度上是由于其标准的联合一对夫妇在一个时间交付格式。鉴于公共政策环境现在不仅强调临床有效性，而且强调经济责任，干预的效率（即，有效性与用于提供服务的方案资源的比率）是治疗方案决定采用新干预措施的一个关键因素。虽然BCT有很好的疗效，但提供者和管理者的共识是BCT效率不高。为了解决这些问题，我们研究了夫妇组格式提供BCT。首先，在早期的工作中，PI开发了一个为期10周的BCT组，在此之前增加了一些联合会议，以准备夫妇和之后，以防止复发。虽然结果是有利的，但增加的联合会议和封闭的小组，一旦开始就没有增加额外的成员，这使得社区机构很难找到更简短的治疗方法，并且通常运行定期添加新成员的持续小组。其次，为了克服这些问题，PI和Co-PI开发了一种10节持续BCT组格式，该格式具有旋转内容和滚动录取，其中夫妇加入该组，完成10节课程，并“毕业”。这种持续的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得到了好评，并在试点研究中显示出了希望。对已婚或同居男性药物滥用患者进行的初步研究检查了多对夫妇团体治疗版本的BCT（G-BCT）与标准联合BCT（S-BCT）以及仅针对患者的基于个体的治疗（团体和个体咨询）的疗效。结果表明，G-BCT产生等效的结果相比，S-BCT，在减少物质使用和改善关系的调整，但GBCT是成本较低的交付和具有优越的上级成本效益和成本效益。G-BCT和S-BCT的临床和成本结果均优于个体化治疗。此外，一项小规模的评估研究表明，G-BCT比S-BCT更有可能用于社区治疗计划。因此，这项拟议的研究将进行一项随机临床试验，以检查临床有效性，在物质使用，关系功能，和心理社会调整，组BCT（G-BCT）与标准BCT（S-BCT）的160酒精患者和他们的非物质滥用的合作伙伴。考虑到两种干预措施的治疗成本可能存在差异，我们还将研究两种干预措施的成本效益和成本效益比较。 公共卫生相关性：在治疗酒精中毒方面，许多研究表明行为伴侣疗法（BCT）比典型的咨询更有效，但BCT并没有被广泛使用，因为标准的BCT一次提供一对夫妇的成本很高，并且不适合大多数社区诊所的主要群体治疗重点。这项拟议的研究将测试已婚或同居的酗酒患者是否会产生与标准BCT相似的积极结果，并以较低的成本提供这些结果。如果结果是有利的，这可能会促使诊所开始使用组BCT，并改善酗酒患者及其家庭的结果。

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.