Behavioral Couples Therapy (BCT) is associated with positive outcomes for couples in which one of the partners abuses drugs or alcohol, both in terms of reduced psychoactive substance use and improved relationship functioning. However, a major practical limitation of the use of BCT with substance-abusing patients is that it has been delivered either as an adjunct to an intensive outpatient treatment regimen, typically requiring 15-20 couples sessions along with individual sessions or group counseling, or is offered as the primary or only intervention. A recent survey of substance abuse treatment programs strongly suggests that, despite its effectiveness, a very small minority use BCT (or other couples-based treatments). Nearly all program administrators interviewed noted they would be unwilling to provide BCT or other couples treatment as (a) a primary intervention or (b) over the course of so many sessions if it were used as an adjunct intervention to other treatments. Nearly all programs noted they would use a couples-based intervention as an adjunct to other services if it was brief, shown to be effective in reducing substance use and improving other psychosocial outcomes, and could be integrated into existing treatments (e.g., individual counseling, group counseling). Thus, the mandate for investigators is to develop an abbreviated version of BCT that retains the effectiveness of standard BCT and could therefore be more attractive and more widely implemented within the substance abuse treatment community. Thus, the PRIMARY OBJECTIVE of the proposed study is to conduct a randomized clinical trial with 214 married or cohabiting drug-abusing patients and their nonsubstance-abusing partners to examine the comparative clinical efficacy, in terms of 1-year posttreatment drug-using behavior, relationship functioning, and other psychosocial outcomes, or Abbreviated BCT (i.e., ABCT) versus (a) standard BCT, (b) Individual-Based Treatment, and (c) a Psychoeducational Attention Control Treatment. The SECONDARY OBJECTIVE is to compare the cost-benefit and cost-effectiveness of the treatment conditions. Pilot data indicate ABCT is as clinically effective as standard BCT, but is far less costly to deliver, primarily due to the significantly reduced number of sessions required to deliver ABCT. This Stage II study extends pilot studies conducted by the investigators with ABCT by (a) recruiting more participants, (b) including substance-abusing women and their nonsubstance-abusing partners, (c) recruiting a more homogeneous patients sample (i.e., primary cocaine-abusing patients) of which a smaller proportion are mandated to treatment by the legal system, and (d) using a longer posttreatment follow-up period.
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