Behavioral Family Counseling: A Tx Development Project

描述（由申请人提供）：家庭参与的治疗比单独治疗药物滥用和酗酒产生更多的禁欲。特别是在酗酒的情况下，在夫妻治疗中涉及配偶或同居伴侣的研究比涉及其他家庭成员的研究更广泛。例如，行为夫妻治疗（BCT），最大的经验支持的家庭治疗，产生更大的禁欲和更好的关系功能比典型的个人为基础的治疗，并减少社会成本，家庭暴力，和夫妻的孩子的情绪问题。最近两项针对药物滥用的BCT研究包括配偶以外的家庭成员，以提高药物治疗依从性。BCT是否可以类似地扩展到酒精中毒患者，以及BCT典型的更广泛的治疗目标（例如，增加家庭凝聚力，减少家庭冲突）超出药物依从性，尚未研究。 调整BCT适用于与配偶以外的成年家庭成员生活在一起的酗酒患者（例如，父母，兄弟姐妹）可以产生更好的结果比典型的个人为基础的治疗，如果结果证明类似的更广泛的患者家庭的二人组，因为他们是夫妇。如果BCT扩大到包括配偶以外的家庭成员，那么可以从BCT中受益的患者数量将增加近一倍。 第一阶段治疗开发项目的总体目标是为与配偶以外的家庭成员生活在一起的酗酒患者开发和试点测试行为家庭咨询（BFC）干预。该项目的第一阶段将通过调整现有的行为夫妻治疗方案，为BFC开发12个疗程的治疗师手册和依从性量表。我们还将根据12例初始病例的经验对这些方法进行改进和修订。 在2期初步研究中，60名酒精依赖患者将被随机分配到两个 同等强度的手动指导治疗：（a）BFC加个体化治疗（IBT）或（B）针对患者单独的IBT。将在基线、治疗期间、治疗后以及3个月和6个月随访时收集结局数据。第2阶段测试预测接受BFC +IBT的酒精患者与接受IBT的患者相比，将具有更长的戒酒天数、更少的酒精和药物使用的负面后果、更好的家庭适应和更少的情绪困扰症状的上级结局。

DESCRIPTION (provided by applicant): Family-involved treatment produces more abstinence than individual treatment for drug abuse and for alcoholism. Particularly in alcoholism, involving the spouse or live-in partner in couples therapy has been studied much more extensively than involving other family members. For example, behavioral couples therapy (BCT), the family treatment with the greatest empirical support, produces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Two recent studies of BCT for drug abuse included family members beyond spouses to improve pharmacotherapy compliance. Whether BCT could be expanded similarly for alcoholic patients, and for broader treatment goals typical of BCT (e.g., increased family cohesion, reduced family conflict) beyond medication compliance, has not been studied. Adapting BCT for alcoholic patients living with an adult family member other than a spouse (e.g., parent, sibling) could produce better outcomes than typical individual-based treatment if results prove similar for broader patient-family dyads as they are for couples. If BCT was broadened to include family members other than spouses, it would nearly double the number of patients who could benefit from BCT. The overall objective of this Stage I treatment development project is to develop and pilot test a Behavioral Family Counseling (BFC) intervention for alcoholic patients who live with family members other than spouses. Phase 1 of the project will develop a 12-session therapist manual and adherence scales for BFC by adapting an existing behavioral couples therapy protocol. We also will refine and revise these methods based on our experience with 12 initial cases. In the Phase 2 pilot study, 60 alcohol-dependent patients will be randomly assigned to one of two equally intensive, manual-guided treatments: (a) BFC plus individual-based treatment (IBT) or (b) IBT for the patient alone. Outcome data will be collected at baseline, during treatment, post treatment, and at 3- and 6- month follow-up. Phase 2 tests the prediction that alcoholic patients who receive BFC +IBT, as compared with those who receive IBT alone, will have superior outcomes of more days abstinent, fewer negative consequences of alcohol and drug use, better family adjustment, and fewer emotional distress symptoms.