The results of multiple studies over the last 25 years indicate that, compared to traditional individual-based treatments, use of Behavioral Couples Therapy (BCT) for married or cohabiting alcoholic and drug-abusing patients results in superior outcomes across multiple domains of psychosocial functioning, including reduced substance use, increased relationship satisfaction, reduced levels of domestic violence, and improved family adjustment. However, despite its demonstrated efficacy, the results of a recent survey indicate BCT is rarely used in community-based substance abuse treatment programs. One of the barriers identified in the survey as interfering with the transfer of BCT from research settings into these programs was that BCT was perceived as costly to deliver, due largely to the staff resources required to provide BCT in the standard conjoint format (i.e., one or two therapists treating a patient and his or her partner for a clinical hour). The mandate for investigators is to develop a version of BCT that is less costly to deliver and yet retains the clinical effectiveness of standard BCT. A potential solution to the problem of the high treatment delivery costs for BCT is to develop a clinically effective version of BCT that can be conducted in a multi-couple group; such a format would allow for the more efficient use of limited staff resources. Thus, the proposed project has two primary aims which will be addressed in two sequential phases. In Phase I, we will develop and refine a 12-session treatment manual for conducting Behavioral Couples Therapy in a group therapy format (G-BCT) for married or cohabiting substance-abusing men and their nonsubstance-abusing intimate female partners. In Phase II of the project, we will conduct a small pilot study in which subjects participating in G-BCT plus Individual Drug Counseling (IDC) will be compared to subjects who participate in an equally intensive Standard BCT (S-BCT) plus IDC and those who receive treatment as usual [i.e., group-based drug abuse counseling (GDQ plus IDC] in terms of clinical outcomes (e.g., substance, dyadic adjustment, family functioning), as well as cost outcomes (e.g., cost-benefit and cost-effectiveness). If the objectives of the proposed study are met, an efficacious variant of BCT would be available that community-based treatment programs could provide using a comparatively efficient delivery format.
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