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APPENDIX A. Search Strategies

Database: Ovid MEDLINE(R)

Search Strategy:

--------------------------------------------------------------------------------

1 exp family/ 

2 couples.mp. 

3 exp home nursing/ 

4 (grandparent: or grandmother: or grandfather:).mp. 

5 exp legal guardians/ 

6 or/1-5 

7 couples therapy/ or family therapy/ or marital therapy/ 

8 6 or 7 

9 exp Infertility/ or exp Infertility, Male/ or exp Infertility, Female/ or exp Fertilization in 

Vitro/ or exp Reproductive Techniques, Assisted/ or exp Insemination, Artificial/ 

10 8 not 9 

11 limit 10 to (english language and yr=”1980 -Current”) 

12 limit 11 to (“newborn infant (birth to 1 month)” or “infant (1 to 23 months)” or “preschool 

child (2 to 5 years)” or “child (6 to 12 years)”) 

13 11 not 12 

14 limit 13 to meta analysis 

15 (systematic adj review:).mp. 

16 13 and 15 

17 14 or 16 

18 limit 13 to randomized controlled trial 

Database: PsycINFO

Search Strategy:

--------------------------------------------------------------------------------

1 exp family/ or exp family members/ or exp spouses/ or exp couples/ 

2 exp caregivers/ or exp stepparents/ or exp siblings/ or caretaker:.mp. 

3 exp grandparents/ or legal guardian:.mp. 

4 or/1-3 

5 couples therapy/ or family therapy/ or marital therapy/ 

6 4 or 5 

7 exp Infertility/ or exp Reproductive Technology/ 

8 6 not 7 

9 limit 8 to (english language and yr=”1980 -Current”) 

10 limit 9 to 100 childhood <birth to age 12 yrs> 

11 9 not 10 

12 meta analysis/ or (systematic adj review:).mp. 

13 11 and 12 

14 (randomized or rct).mp. 

15 11 and 14 
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Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

APPENDIX B. Criteria Used in Quality Assessment62

Risk of bias Internal validity: study design and the quality of individual studies 

included in the review. Study design limitations may bias the estimates 

of treatment effect (such as lack of allocation concealment, or lack of 

blinding). Other areas for potential bias include stopping early for benefit 

and selective outcome reporting.

Consistency The effect sizes from the included studies are similar and have the same 

direction of effect (positive or negative). 

Directness Interventions are directly related to health outcomes. For CERs, headto-head comparisons are made. Indirectness is suspected if surrogate or 

intermediate outcomes are used instead of health outcomes. For CERs, 

indirectness is also suspected if more than one body of evidence is 

needed to link interventions, ad in the das with placebo controlled trials.

Directness also includes applicability and relevance of the included 

studies to the VA population or to specific subpopulations within the VA. 

Applicability may also include settings (e.g., primary care vs. specialty 

care) and physician experience.

Precision The degree of certainty surrounding an estimate of effect for each 

outcome of interest. Uncertainty of effect does not allow for a clinically 

useful conclusion, and is unable to rule out an important benefit or harm.

Risk of publication bias Publication bias can result in an overestimate of effect. Publication bias 

is suspected if evidence is derived from a small number of commercially 

funded trials with small sample sizes and a small number of event.
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eer Review Comments/Author Responses

RESPONSE

 methods for this review clearly described? 

0-387 signed in Oct 2008 added Marriage and Family Counseling and dropped 

nnected Veterans. The May 2010 PL just added primary caregivers to eligible 

We have revised this part of the introduction to clarify that PL 110-387 expanded coverage and that PL 111 added primary caregivers to eligible folks. 

mbiguity about the goals and scope of this review. This ambiguity is generated 

ghlights the legislation that expands the services to family members (the 2010 

es to 2008 legislation that provides for marriage counseling as a VA service). 

rimary impetus for this legislation was the national pressure on VA to provide 

ers, in reference to greater mental health needs of family members, and the 

al health issues of Veterans have on families. The focus of the review, however, 

orders, and not on outcomes of family members as individuals or the marital/

nnect in the reader’s mind about the rationale for the review. 

vices, however, does include that family members constitute important 

is is a key part to the rationale that a review is needed to examine the 

ement does improve outcomes. A more nuanced and spelled out rationale 

ations a bit better.

treatments defined by Baucom et al. were described as part of the background, 

egarding these classifications of how family members are involved in treatment 

f occasional mentions). Thus, the review is not really a proper follow-up to 

f this is that the review did not place marital distress or family dysfunction as 

et al., where the authors treated those outcomes as treatable entities in and 

cted given the background/introduction of the review. Although the Limitations 

be highlighted in the beginning of the review

as made on relationship distress as a moderator in the review, with only 

s therapy interventions for ED and also for depression. This is potentially 

e pre-1995 period of time prior was that couples therapy for depression may 

vised in couples who do not consider themselves maritally distressed, only 

s finding may be relevant for other disorders, and although few studies have 

s, it should be part of the dialogue from the beginning of the review and part of 

ns for future research.

CT) versions as treatments for substance abuse and alcohol use disorders were 

no qualifier that these are variants of BCT specifically designed to treat these 

ed descriptions of the Appendices (which may not get read by many readers). 

d in standard BCT or expanded Integrative Behavioral Couples Therapy 

tress. IBCT being disseminated throughout VA currently would very likely not 

 alcohol use disorders. This ambiguity could be very misleading to readers 

1) We have clarified in the introduction the rationale for the 

review. 

2) We have clarified the scope of the review in the introduction 

and highlighted the review is not intended as a strict update to Baucom and colleagues’ review.

3) We agree this is an important issue. We have highlighted 

throughout the results section when this information is available and included a discussion of findings relevant to this question in the discussion.

4) Thank you for your suggestion. We have clarified this in the 

results section for substance use disorders and refer to BCT as a ‘disorder specific couple/family treatment’ in additional places for clarity.

bed. Methodology is rigorous and effectively implemented. Outcomes of interest 

 include and exclude studies seem sensible given the intent to extrapolate 

s. 

Thank you.

s are clearly articulated and findings are clearly summarized in multiple 

 findings are particularly facilitative (e.g., Table 8). 

Thank you.
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in our synthesis of the evidence? 

ale, I believe that given the undeveloped nature of this literature, limiting the 

n overly limiting to understand the relevant clinical issues, trends, or promising 

We certainly agree with the need to disseminate information on those promising interventions underdevelopment that are currently or soon to be subjected to more rigorous RCTs to evaluate their efficacy. Given the size of this review as it currently stands, limited to RCTs, it was beyond the scope of the project to expand our search to other study designs (e.g., open trials; quasi-experiments). We have added this to the limitation section.

published studies that we may have overlooked?

Glynn and Lisa Dixon These reviews have both been integrated into the discussion 

section specific to findings for schizophrenia.

have been overlooked.

 literature search process is clearly displayed in Figure 2. Thank you.

Candice Monson’s work on couples therapy for PTSD was included. I don’t 

t may be that is because they were not RCTs. If so, see my comment above.

You are correct. Dr. Monson’s currently published work did not meet our inclusion criteria (i.e., currently she has no published RCTs). We referenced this work in our limitations.

ggestions or comments below. If applicable, please indicate the page and 

rt.

or Future Research – PL lists eligible individuals for family services and that 

timate partner unless they are residing with the Veteran.

d Caregiver Services are administered from two different Program Offices and 

erhaps introducing caregivers brings in a different topic?

We have revised the introduction to better describe the two laws that have expanded services. In this explanation we also describe that PL 111-163 is only for a select group of family members. We have also highlighted the issue of who is eligible for these services in the discussion.

sive and inclusive, providing a critical snapshot of the state of the evidence for 

ments for mental health conditions of relevance to Veterans.

Thank you.
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he findings of this review with the findings from Baucom et al. (1998). 

view with the previous is important since many interventions showing strong 

mily Psychoeducation for schizophrenia spectrum disorders), have not been 

od from 1995 forward. As stated above, this review did not continue with 

nvolvement, which significantly weakens our understanding of the actual 

n in the recommendations of comorbidity as a factor examined in very few of 

entioned earlier and in greater detail since comorbidity is the norm for Veterans 

rans or not. This recommendation should be front and center. 

as used consistently in the section on family involved treatments of substance 

thors mean “lower rate of relapse” since most or all of the findings are rates at 

ibe a slope or growth curve of relapse across time.

st prior reviews have focused on specific conditions (i.e., depression or 

he ability of past work to generalize to family-involved mental health care more 

roadly“ means: Comorbidity? Special populations? Non-symptom outcomes?

studies of AUD, all trials report better outcomes for BCT or BMT than IBT 

e points, but many of these differences were not statistically significant.” The 

tatistically significant findings are actually reportable as “better outcomes.”

n the controversy over Fals-Stewart’s findings very economically and fairly. 

the public charges of fabrication and of his death, a reputable news source, for 

d one fairly quickly). 

pears in the text when it likely [should list the author/year citation].

ble XX, when the next table is 15. 

cited when the correct citation is Baucom et al. (1998).

We have taken better care to highlight the specific interventions that are reviewed and which category of intervention they fall under throughout the document (results and discussion section).We have included a more explicit review of the types of cooccurring problems that were inclusion and exclusion criteria in the trials reviewed. We have also expanded the discussion of this issue in our future research section.Following the review of this draft, we conducted pooled analyses of the BCT studies which allowed us to draw more definitive conclusions about the efficacy of BCT compared to individual treatment. See results section.We have clarified this in the IntroductionWe have removed discussion of non-significant differences between conditions.We have included a citation of both the NY State Attorney General’s press release and a copy of the felony complaint filed by the AG’s office. Corrected.Corrected.Corrected.

questions of interest was, unfortunately, very limited. The studies reviewed 

ns but the number of trials for the same interventions was very few. This 

number of promising findings from single trials, but evidence in these cases 

lication. One finding with moderate strength of evidence, that behavioral 

of relapse for substance abuse disorders, appears to overstate the impact of 

 related to more important outcomes such as abstinence rates were mixed. 

on page 60, it is stated that Behavioral Couples Therapy is superior to 

use disorders, but this conclusion does not seem warranted given the mixed 

 Family Therapy did seem to have a consistently positive effect on family 

r studies that reported outcomes in this domain; possibly, this finding should 

Given the lack of the research base, it may be worth expanding the Future 

eport can prompt more methodologically strong research on family interventions 

Regarding the strength of evidence of BCT, since the initial peer review, we have conducted pooled analyses comparing BCT to individual treatment in improving rates of abstinence and improving family adjustment. These findings are more supportive of BCT then our previous narrative review of the number of studies finding significant versus non-significant differences.
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regarding work by Fals-Stewart – it may be helpful to provide this background 

 regarding studies (Fals-Stewart – 1996, 2002, 2003 etc...)

borders (gridlines) to facilitate ease of reading. 

ppear to be a focus of studies presented. Wonder about this as an outcome for 

A), and whether it would be useful to include discussion regarding this in the 

arch. 

page 34 line 2 – Fals-Stewart, 1996, 200, 2002...) – also Higgins 2009 

om list (this reviewer was interested in this publication so it was looked for all 

Thank you for the suggestion. This has been done.Done.Thank you for your suggestion. We have addressed this in Future Research.Thank you for your attention to detail. We have attended closely to these issues in the final report draft.

patient outcomes is a limitation. Not clear why previous reviews such as meta

merous sophisticated quantitative reviews have been published. 

tment” or “no treatment” means in the comparison condition for KQ1. Does that 

e active treatment? The reason for asking is that drug treatment would typically 

nd that might be mentioned. 

erall, the studies reviewed appeared to favor comparisons between a family

t, limiting our conclusions for this key question. (page 3).” Does that mean 

y of the landmark studies? The review’s findings regarding schizophrenia 

mber of studies and meta-analyses supporting the effectiveness of family 

umping” vs “splitting” issue. This review splits studies by diagnosis. However, 

not narrowly offered, and they share techniques. Miklowitz’s FFT is similar to 

ve way to understand the literature is across diagnoses. 

Our literature search identified systematic reviews and metaanalyses in additions to RCTs. Several recent reviews are mentioned in the report. We also looked at reference lists of recent reviews to identify primary studies our literature search might have missed. We have taken care to be more explicit in integrating these reviews into our results discussion for each set of mental health conditions reviewed. We were interested in reviewing the evidence of the efficacy of family involved interventions (compared to no intervention or non-psychosocial interventions), as well as the degree to which family involved interventions are superior to an alternative individually-focused or family involved intervention (i.e., specificity). The ‘medication only’ conditions involve interventions that were solely pharmacological including medication and monitoring of medication use, but where the medication condition was not intended as a psychosocial treatment or psychotherapy. This has been clarified in the introduction and the wording of the Key Questions, We have also clarified what additional provider contact was included in intervention conditions we considered ‘medication only’This is due to the scope of our review. We did not include non-US studies or studies published prior to 1996. However, we highlighted the work prior to our review that established the efficacy of these treatments in Table 1 and discussed our findings within the context of other reviews throughout the document in the executive summary, results, and discussion sectionsWe have addressed this in the limitations section.

Mental Health Services, not just Office of Mental Health

f areas for future research in two areas in the paper, the role of nontraditional 

d. In the substance use disorder section, I appreciated that the results were 

veness re: initiation, attendance, and adherence. On pg 34, although it is a 

hing that the issues around the work of Drs. Fals-Stewart are addressed.

This has been corrected. Thank you.Thank you for your positive feedback.
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ance measures, programs, quality improvement measures, patient care 

l be directly affected by this report? If so, please provide detail. 

Thank you – we will share these suggestions with the people responsible for dissemination of the report.

nce to the mission of the VA’s Family Services Program

be affected by this report in that the effectiveness of family involved services, 

ubstance abuse and alcohol disorders

evidence for most couples and family-based interventions is largely insufficient 

ion within VHA. The intervention that does appear to be supported by 

 very well suited to implementation within VHA because it is delivered by a 

ily member whose loved on is not seeking treatment. It may have important 

-based providers and possibly staff members of Vet Centers. The other finding 

, that behavioral couples therapy can slow the rate of relapse for substance 

sive given the lack of impact of this intervention on arguably more important 

.

Regarding the strength of evidence of BCT, since the initial peer review, we have conducted pooled analyses comparing BCT to individual treatment in improving rates of abstinence and improving family adjustment. These findings are more supportive of BCT then our previous narrative review of the number of studies finding significant versus non-significant differences. 

ave implications in terms of future VA research funding. May also have 

ased treatment rollouts.

ions should review to determine if there is any relevance of the information in 

formation System, which monitors a variety of practices in the field. 

dations on how this report can be revised to more directly address or 

line – probably effective – won’t cause harm? How does the research 

pare to the research supporting other interventions currently being used in the 

To adequately address how family interventions compare to the population of interventions currently provided by the VA, a systematic review of individually-oriented interventions would be required. This is beyond the scope of the review.However, we have taken care to better highlight the primary take home points in the executive summary and in our final discussion section. We have included additional pooled analyses of the BCT studies comparing BCT to individual therapy, which provide greater clarity to our conclusions regarding the comparative effectiveness of BCT to individual therapy. 

ings of the report is that the state-of-the-science is that more efficacy 

ed on Veteran-focused family-involved psychosocial treatments to inform 

We agree and have highlighted these issues in the discussion section.

be expanded significantly to discuss effective implementation strategies, but 

e for VA. 

s the rule, rather than the exception, and very few studies address comorbidity. 

as to how to proceed in these circumstances. A brief (and very common) 

problem: A 34 yo Veteran with PTSD, depression, and TBI violently pushes 

ver money, his at-risk alcohol use, and discipline of their children. He recently 

tment. Possible interventions include individual alcohol treatment, BCT for 

ement, and cognitive rehabilitation. The couple is asking for couples counseling 

ze it upsets their 4 yo son. The Veteran is unconvinced he has a drinking 

We agree that identifying and evaluating effective implementation strategies would be valuable; however, it is outside the scope of this report.See above. 
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ld recommend research priorities related to the area. Several interventions are 

ted and trials with Veterans are lacking. A set of recommendations about which 

r investigation within VHA research mechanisms might be helpful. 

We have included a more expansive future research section and address these issues there.

 greater consideration of how family interventions might be used in clinical care 

parameters and what is found clinically. 

We have included a more direct discussion of the need for studies examining patients with multiple problems (e.g., substance use, TBI, intimate partner violence) in the Future Research section.

uestion #3 and #4. I am afraid that the super rigorous limitation of the review to 

or identifying promising practices for pilot projects in the field.

See above.
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vidence Tables

ormation – Substance Abuse Studies

ics

Inclusion/Exclusion

Criteria

Treatment Groups Intervention Characteristics Outcomes Assessed Quality

d

sis

4.4%

%

d

nt 

pioids 

pioid 

ics:

MH Condition: Substance useAssessed by: DSM clinical interviewSO: non-abusing parent, spouse, child, sibling or close friendInclusion: Seeking tx for opioid dependenceExclusions:Significant medical condition that would contraindicate Naltrexone; did not have significant other; met DSM criteria for schizophrenia or bipolar or was in substance use treatment within past 3 months

1) SO relationship counseling added to standard tx (Naltrexone) with voucher-based contingency management (CM)N=482) Standard tx (Naltrexone) with voucher-based contingency management N=353) Standard tx (receive Naltrexone) onlyn=44Treatment adherence5 did not initiate treatment10 removed from tx protocol (not clear from which groups they dropped)

Format: Standard tx or contingency management or contingency management plus 6 sessions of reciprocal relationship counselingManualized: YesSession: 6 sessionsApproach: All participants in all three groups were randomized to receive Naltrexone in addition to cognitive behavioral group therapy. 

One group was offered reciprocal relationship counseling in addition to group therapy and vouchers redeemable for goods and services contingent on taking Naltrexone and drug-free urine screens (contingency management). A second group received group therapy, Naltrexone and contingency management. The third group received group therapy and Naltrexone only. 

Patient OutcomesSymptom Improvementa. Drug free urineb. Opiate free urinec. Cocaine free urined. % of drug free urinee. PDA opioidsf. PDA cocaineg. Maximum PDAFamily Outcomes:Psychosocial functioning (including family functioning):a. ASIIntermediate Outcomes:Attendance: a. weeks in treatmentAdherence: a. # Naltrexone doses

Allocation concealment:unclearBlinding: treating clinicians and outcome assessorsIntention to treat analysis: yesWithdrawals adequately described: yesTreatment integrity:Naltrexone adherence monitored by urine screens. No report of tx integrity for CM or SO sessions. Study Quality:Good
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ics

Inclusion/Exclusion

Criteria

Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

e 

%

ears/SD): 

d

tient 

inics 

cipate

ics:

ale 

s/SD):

MH Condition:Substance useAssessed by:Diagnostic interviewSO: wivesInclusions:Husband: between 20 and 60; married at least 1 year or in stable relationship for 2; met abuse or dependence criteria for at least one psychoactive substance use, primary drug not alcohol; medical clearance for tx;refrain from using;refrain from additionaltreatment except selfhelp meetings; Exclusions: wife met DSM criteria for substance use; husband or wife had delusional disorder;husband or wife in methadone program and looking for adjunctive outpatient support

1) Behavioral couple therapy (BCT) N=402) Individual treatment - behavioral therapy for husbands N=40

1) Format: CoupleManualized: YesSessions: 56BCT Approach: Treatment included IBT through group (once weekly) and individual counseling (once weekly) plus BCT through one conjoint (once weekly) 2) Format: IndividualManualized: YesSessions: 56Approach: Cognitive-BehavioralTreatment included group (once weekly) and individual counseling (twice weekly)

Patient OutcomesSymptom Improvementa. Urine screensb. PDA (alcohol and drugs)c. Blood alcoholIntermediate Outcomes:Attendance:a. Sessions attendedSatisfaction with carea. CSQ-8Family Outcomes:Couple functioning:a. MATb. ACQc. % of days separatedConflict:a. Response to conflict

Allocation concealment: noBlinding: noIntention to treat analysis: noWithdrawals adequately described: yesTreatment integrity:PI supervised 1 hr week and reviewed progress notesStudy Quality:Poor

art 1996 Same as Fals-Stewart 1996 Same as FalsStewart 1996 Same as Fals-Stewart 1996 Patient Outcomes Symptom Improvement

a. PDAFamily Outcomes:Couple functioning:a. Locke Wallace Marital adjustment test (MAT) 

Same as FalsStewart 1996
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ics

Inclusion/Exclusion

Criteria

Treatment Groups Intervention Characteristics Outcomes Assessed Quality

art 1996 Same as Fals-Stewart 1996 Same as FalsStewart 1996 Same as Fals-Stewart 1996 Patient Outcomes Symptom Improvement

a. % of days of alcohol or drug useFamily Outcomes:Couple functioning:a. MATIntimate Partner Violence:a. CTS – male to female

Same as FalsStewart 1996

s

e

rs

ting 

ears): 

d

om 

bstance 

one of 

ed meth

 clinics. 

ics:

 or 

rs

ears): 

MH Condition: Abuse or dependence for a psychoactive substance use disorder (intravenous opiate users)Assessed by: DSM-III-R interviewSO:Inclusion: male; age 21-60 years; married ≥1 year or living with significant other ≥2 years; medical clearance to engage in methadone maintenance treatment; refrain from seeking other substance abuse treatment except for self help meetings during duration of treatment (unless recommended by primary therapist) Exclusions: if female partner met DSM-III-R criteria for psycho-active substance use disorder in last six months; either partner met DSM-III-R criteria for organic mental, paranoid, or other psychotic disorder or schizophrenia; either partner had plans for imminent departure from geographic region

1) BCT treatment packageN= 212) IBMM services (Individual based methadone maintenance), standard treatmentN=22Treatment adherence1) 19/21 (90%) remained in treatment through analysis 2) 17/22 (77%) remained in treatment through analysis 

1) Format: BCTManualized: YesSessions: 2 sessions weekly for 12 weeksApproach: In addition to an individual weekly session (similar to IBMM below), partners met conjointly with a therapist once weekly for 60 minute sessions. Verbal agreement made to have a daily “sobriety trust discussion.” Weekly homework reinforcing session content. 2) Format: IBMMManualized: YesSessions: 2 sessions weekly for 12 weeksApproach: Subject met with therapist alone, twice weekly; adapted from cognitive behavioral treatment programs for alcoholism; emphasis on coping skills training. Standard methadone dose of 60 mg/day, increased at patient’s request or when opiate positive urine sample. 

Patient OutcomesSymptom Improvementa. ASI - alcohol and drug compositeb. Urine samplesFamily Outcomes:Couple functioning:a. DASb. ASI (family-social composite)Intermediate Outcomes:Satisfactiona. CSQAttendancea. # sessions attended

Allocation concealment: NRBlinding: NRIntention to treat analysis: noWithdrawals adequately described: yesTreatment integrity:Manualized;counselors supervised weekly for consistent treatment techniques; randomly audiotaped sessionsStudy Quality:Fair
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ics

Inclusion/Exclusion

Criteria

Treatment Groups Intervention Characteristics Outcomes Assessed Quality

d

sis

e 

ears/SD): 

d

men 

reatment 

 clinics 

cipate.

ics:

MH Condition: substance useAssessed by: Structured clinical interviewSO: family memberInclusions:Men with opioid dependence; living with someone not abusing drugs/alcohol and without diagnosis of serious mental illness; able to forgo any other substance use counseling except for selfhelp groupsExclusion:Physical condition that could interfere with tx; allergic to Naltrexone; dependent on other psychoactive drug other than opioid that requires inpatient hospitalization for detoxification; suicidal or homicidal; in methadone tx within 30 days of tx.

1) Naltrexone + Behavioral Family Therapy (BFT) N=62 2) Naltrexone + individual based therapy (IBT) N=62

1) Format: Behavioral Family TherapyManualized: YesSession: 56 sessions for IBT; 16 additional BFT Approach: BFT Approach: Treatment included IBT through group (once weekly) and individual counseling (once weekly) plus BFT through one conjoint session (once weekly) 2) Format: IndividualManualized: YesSessions: 56Approach: Treatment individual cognitive behavior therapy through group (once weekly) and individual counseling (twice weekly)

Patient OutcomesSymptom Improvementa. Abstinence – opioid free urine screensb. Abstinence – drug free urine screensc. PDA opioidsd. PDA cocainee. PDA alcoholf. PDA drugsg. Length of continuous abstinenceFamily Outcomes:Family functioninga. ASI sub-scaleIntermediate Outcomes:Attendance:a. Sessions attendedAdherence:a. # days took NaltrexoneSatisfaction with carea. CSQ

Allocation concealment: NR Blinding: NRIntention to treat analysis: yesWithdrawals adequately described: yesTreatment integrity:Recordedsessions;counselors assessed for adherence (NS); counselors assessed for competence (NS)Study Quality:Fair
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ics

Inclusion/Exclusion

Criteria

Treatment Groups Intervention Characteristics Outcomes Assessed Quality

d

sis

e 

ng:

ears/SD): 

d

married 

tient 

ed to 

ics:

ale

MH Condition: substance useAssessed by: NRSO: wife/intimate partnerInclusions:Men, 20-60 yrs old; married >1 yr or cohabitating >2 yrs.; meet DSM criterion for alcohol dependence; medical clearance; agreed to abstain from drugs/alcohol; restrain from other tx programs;Exclusions:Any psychoactive drug dependence within last 6 months, any serious mental illness for participant and/or SO. 

1) Brief Relationship Therapy N=252) Standard Behavioral Couples Therapy N=253) Individual based therapy (IBT) N=254) Psychoeducational attention control treatment (PACT)N=25

1) Format: Brief Relationship Therapy Manualized: YesSession: 18 Approach: Group session weekly and an additional session with partner every other week; focus on couple communication, problems solving and reinforcing sobriety2) Format: Standard Behavioral Couples Therapy Manualized: YesSession: 24 Approach: One 12-step group and 1 conjoint (with spouse) session weekly. Conjoint session focused on focused on couple communication, problems solving and reinforcing sobriety.3) Format: IBT Manualized: YesSession: 18 Approach: One group session/week and 1 individual counseling every other week4) Format: PACT Manualized: YesSession: 18 Approach: One group session weekly and 6 additional sessions with partner every other week. Partner was a passive participant, listening to lectures on substance use. 

Patient OutcomesSymptom Improvementa. PDHDFamily Outcomes:Couple functioning:a. DASIntermediate Outcomes:Attendance:a. Sessions attendedSatisfaction with carea. CSQ

Allocation concealment: NRBlinding: NRIntention to treat analysis: unclearWithdrawals adequately described: yesTreatment integrity:All sessions were audiotaped; 20% of sessions rated for competence and adherence; manualized; no significant differences across groupsStudy Quality:Fair
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ics

Inclusion/Exclusion

Criteria

Treatment Groups Intervention Characteristics Outcomes Assessed Quality

d

sis

ale

ng:

ears/SD): 

d

g 

patient 

ol 

sked to 

ics:

e

12.9

MH Condition: alcohol useAssessed by: Structured clinical interviewSO: husband/intimate male partnerInclusions:Women, 20-60 yrs old; married >1 yr or cohabitating >2 yrs.; meet DSM criterion for alcohol dependence; have alcohol as primary drug of abuse; agreed to abstain from drugs/alcohol; restrain from other tx programsExclusions: Male partner met DSM criteria for any psychoactive drug dependence, any serious mental illness for participant and/or SO 

1) Standard Behavioral Couples Therapy (S-BCT) N=462) Individual based therapy (IBT) N=463) Psychoeducational attention control tx (PACT) N=46

1) Format: S-BCT Manualized: YesSession: 32Approach: 20 individual sessions and 12 conjoint (with spouse) sessions. Conjoint session focused on couple communication, problems solving and reinforcing sobriety.2) Format: IBT Manualized: YesSession: 32 Approach: 32 individual sessions3) Format: PACT Manualized: YesSession: 32 Approach: 20 individual sessions and 12 conjoint (with spouse) sessions. Conjoint sessions were designed so partner was a passive participant, listening to lectures about alcoholism and sobriety.

Patient OutcomesSymptom Improvementa. PDAFamily Outcomes:Couple functioning:a. DASPartner violencea. TLFB-Spousal ViolenceIntermediateOutcomes:Attendance:a. Sessions attendedSatisfaction with careb. CSQ

Allocation concealment: yesBlinding: NRIntention to treat analysis: unclearWithdrawals adequately described: yesTreatment integrity:Sessions audiotaped, reviewed and rated. Study Quality:Good
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ics

Inclusion/Exclusion

Criteria

Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

 27% 

ng:

ears/SD): 

d

rried/

nd 

patient 

ed to 

ics:

 73% 

14.4

MH Condition: substance useAssessed by: NRSO: spouse/intimate partnerInclusions:Men or women, 20-60 yrs old; married >1 yr or cohabitating >2 yrs.; meet DSM criterion for psychoactive substance use disorder and be dependent on a drug other than alcohol or nicotine; medical clearance; agreed to abstain from drugs/alcohol; restrain from other tx programs;Exclusions:Partners met DSM criteria for any psychoactive drug dependence within last 6 months, any serious mental illness for participant and/or SO. 

1) Brief BCT N=462) Standard BCT N=463) Individual based therapy (IBT) N=464) Psychoeducational attention control treatment (PACT) N=46

1) Format: B-BCT Manualized: YesSession: 18 Approach: 12 group sessions and 6 conjoint sessions with partner, where partner is an active participant. Conjoint sessions focused on couple communication, problems solving and reinforcing sobriety.2) Format: BCT Manualized: YesSession: 24 Approach: 12 group sessions and 12 conjoint sessions with partner, where partner is an active participant. Conjoint sessions focused on couple communication, problems solving and reinforcing sobriety.3) Format: IBT Manualized: YesSession: 18 Approach: 12 group sessions and 6 individual counseling sessions4) Format: PACT Manualized: YesSession: 18 Approach: 12 group sessions and 6 conjoint sessions with partner, but partner is a passive participant. Conjoint sessions were lecture based sessions about alcoholism 

Patient OutcomesSymptom Improvementa. PDAFamily Outcomes:Couple functioning:a. DASIntermediate Outcomes:Attendance:a. Sessions attendedSatisfaction with carea. CSQ

Allocation concealment: NRBlinding: NRIntention to treat analysis: unclearWithdrawals adequately described: yesTreatment integrity:Recorded; 20% assessed for adherence and competenceStudy Quality:Fair
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s

e

5.0

ics:

e

ale

13.3 

ics:

ale

d

tering 

sorder 

h center 

nd asked 

MH Condition: current alcohol abuse or dependence Assessed by: Structured interview with DSM-IV criteriaSO: gay or lesbian partnerInclusions: gay or lesbian sexuality, alcohol as primary drug of abuse, living with SO in stable relationship ≥1 year; ≥18 yrs old; agreed to refrain from alcohol/drugs during treatment; not in any other SA treatment.Exclusions: if partner met DSM-IV criteria for any current substance use disorder (except nicotine), or if either pt or partner had schizophrenia or psychotic disorder

1) Behavioral Couples Therapy N = NR2) Individual based treatment N=NR

1) Format: Behavioral Couples Therapy treatmentManualized: YesSessions: 32 x 60 minutesTxt Length: 20 weeksApproach: Same program as IBT for 20 sessions (individual therapy); remaining 12 conducted with partner (substance and relationship focused interventions)2) Format: Individual treatmentManualized: modified from Individual Drug Counseling ManualSessions: 32 x 60 minutesTxt Length: 20 weeksApproach: Individual therapy, using 12 step facilitation; participants encouraged total abstinence 

Patient OutcomesSymptoms: a. PDHDFamily OutcomesCouple functioning:a. DASIntermediate OutcomesAttendance:a. # sessions attendedTreatment Satisfactiona. CSQ

AllocationConcealment: NRBlinding: NRIntention-to-treat analysis: yesWithdrawals adequately described: noTreatment IntegrityLimitation; 80% of participants refused to be video-taped.Study Quality:Poor
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s

e

rs

ears):

d

rom 

 and 

ics:

ale 

MH Condition: Opioid useAssessed by: Self reportSO: Pregnant partnerInclusion: Eligibility initially based on eligibility of a pregnant partner. Pregnant woman needed to be age ≥18, ≤30 weeks pregnant, meet DSM-IV criteria for current opioid dependence. With referral from pregnant woman, her male partner then became subject. His eligibility requirements: male; age ≥18 years; see the pregnant woman ≥thrice weekly; no evidence of physical violence toward woman, self reported opioid use of ≥4 days/week each week in the past month.Exclusions: either pregnant woman or partner if diagnosed with a medical or psychiatric condition that contraindicated study participation or signing informed consent. 

Drug abusers1) HOPE: Helping Other Partners ExcelN=452) Usual careN= 17

1) Format: HOPE (couples based)Manualized: YesSessions: 22 weeks; 6 individual male partner sessions, then 12 manualized couples education.Approach: Four components – motivational enhancement therapy for male partners, case management and proactive counseling, 12 weeks couple’s group therapy and education sessions, contingency management to initiate and sustain drug abstinence. 2) Format: Usual care Manualized: NRSessions: 22 weeks; 1 60 minute weekly sessionApproach: Weekly support group for male partner only; drug education and other topics. Couples’ counseling available upon request.Free methadone maintenance for 6 months; or inpatient detoxification followed by 6 months of outpatient care provided to male partners in both groups (subject choice)

Patient OutcomesSymptom Improvementa. ASI b. Days use, past 30 days (heroin)c. % with heroin useGlobal Functioning:a. Depression (BDI)Family Outcomes:Couple functioning:a. Partner Support Questionnaire (based on Norbeck Social Support Questionnaire)b. Relationship Assessment form

Allocation concealment: NRBlinding: NRIntention to treat analysis: yesWithdrawals adequately described: yesTreatment integrity:Weekly supervision, training of counselors, feedback on audiotaped sessions. Study Quality:Fair
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

d

sis

cohol 

e

ting 

ears):

d

rom 

n 

 or drug 

ics:

 or 

ears):

MH Condition: Abuse or dependence for a psychoactive substance use disorderAssessed by: DSM-III-R criteriaSO: wives or female SOInclusion: male; age 20-60 years; married ≥1 year or living with significant other ≥2 years; medical clearance to engage in abstinence oriented treatment; agree to refrain from alcohol or illicit drugs during treatment, refrain from seeking other substance abuse treatment except for self help meetings; have at least one child age 6-16 living in household for whom one or both adults were legal guardians.Exclusions: if female partner met DSM-III-R criteria for psycho-active substance use disorder in last six months; either partner in methadone maintenance program; either partner met DSM-III-R criteria for organic mental, paranoid, or other psychotic disorder or schizophrenia.

Alcohol abusers1) BCTN=25 2) IBT onlyN= 223) Psychoeducational attention control treatment (PACT)N= 24Drug abusers1) BCTN=222) IBT onlyN= 223) PACTN= 21

1) Format: BCTManualized: YesSessions: 32Approach: Both partners attend 12 treatment sessions, used to help male partners remain abstinent, teach effective communication, increase positive exchanges, eliminate aggression. In remaining 20 sessions, subjects participated in individual CBT. 2) Format: IBTManualized: YesSessions: 32Approach: After a baseline assessment, the partner no longer participated in treatment. Subject alone attended 20 IBT sessions (same as BCT group), followed by 12 coping skills based sessions. 3) Format: PACTManualized: YesSessions: 32Approach: Subject alone attended 20 IBT sessions (same as BCT and groups), followed by 12 educational lectures that both partners attended (not couples therapy). 

Patient OutcomesSymptom Improvementa. PDA Family Outcomes:Couple functioning:a. DASIntermediate Outcomes:a. Session attendance

Allocation concealment: NRBlinding: NRIntention to treat analysis:yes; missing data imputation describedWithdrawalsadequatelydescribed: yesTreatment integrity:ManualizedStudy Quality:Fair
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

ysis

lowing 

ics:

.3%

d

spaper 

Participants: Family or significant other of drug abuser (FSO)MH Condition: FSO report of family member drug abuseAssessed by: Condition was assessed by FSO self-reportSO: drug user not involved in interventionInclusions: FSOs were over 18, had contact with drug user >3 times/week, concern about illicit drug user, drug user not in tx, FSO not in tx. 

1) Individual counseling and psychoeducation (community reinforcement training intervention or CRT)2) Self help (Narcotics Anonymous)

1) Format: CRT Manualized: NoSession: 14X60 minutesTxt Length: 10 weeksApproach: Individual counseling sessions, that includes motivation to change, communication, coping strategies, and developing social support2) Format: Self-help groupManualized: YesSession: 10X75 minutesTxt Length: 10 weeksApproach: Group counseling sessions that included discussion of 12 steps, self-esteem, views about addiction, responsibility and detachment. 

Patient OutcomesSymptoms: a. FSO ratings of patient drug use during after treatmentHealth CareUtilization:a. % of patient entry into treatment during FSO treatmentFamily Outcomes:Family functioning:a. SAS family unit subscaleCouple functioning:a. SAS marital subscaleIntermediate OutcomesAttendance:a. FSO attendance, b. Treatment completion

Allocation concealment:UnclearBlinding: UnclearIntention to treat analysis: NoWithdrawals adequately described:Drop outs after randomization discussed; no explanation of what was done with missing dataTreatment IntegritySupervised counselingStudy Quality:Poor
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

e

ting: 

12.9

ics:

dren 

d in 

13.6

d

ed 

alcohol 

child 

cipate 

mission 

MH Condition: alcohol use disorder per DSM-IV criteriaAssessed by:structured clinical interview (for both pt and SO)SO: female partners (wife or SO)Inclusions:Male, ≥18, married ≥1 year or cohabitating ≥2 years; female partner did NOT mean DSM-IV criteria for substance abuse or dependence, had legal guardianship of at least one child between ages 8-12 living in the home.Exclusions: N/A

1) PSBCT (Parent Skills with Behavioral Couples Therapy) N = 102) Behavioral Couples Therapy (BCT) N= 103) Individual based treatment (IBT)N=10

1) Format: PSBCT. Manualized: YesSessions: 24Txt Length: 12 weeks (2/wk x 60 minutes)Approach: 12 individual sessions plus 6 core BCT plus 6 parent skills training sessions. Partner attended the BCT and parent sessions with participant. 2) Format: BCTManualized: YesSessions: 24Txt Length:12 weeks (2/wk x 60 minutes)Approach: 12 individual sessions plus 12 manualized BCT sessions. Partner attended the BCT with participant; BCT included communication and problem solving skill building.3) Format: IBTManualized: yesSessions: 24Txt Length:12 weeks (2/wk x 60 minutes)Approach: 12 individual plus 12 individual based coping sessions using Cognitive Behavioral Therapy (CBT)All three treatment groups received 12 weekly standard CBT sessions; the second weekly session content differed by treatment group.

Patient OutcomesSymptoms: a. PDAFamily OutcomesCouple functioninga. DASInter-personal Violence:a. TLFB –Spousal Violence Intermediate OutcomesAttendance:a. % of sessions attended

AllocationConcealment: NRBlinding: NRIntention-to-treat analysis: YesWithdrawals adequately described: No; not defined by treatment groupTreatment integrity:Videotaped training sessions for each therapist reviewed for guideline adherence and competency.Study Quality:Fair
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

e 

ars

13.4 

ics: 

ale 

ars

3.7 (2.0)

d

 female 

hrough 

t 

y 

sements 

herapy 

MH Condition: alcohol dependenceAssessed by: Structured clinical screening interview SO: female partnersInclusions: Men who were married or in cohabitating relationship >6 months, met criteria for alcohol dependence or abuse; not dependent on other drug; not psychotics; without signs of severe organic brain syndrome; partners did not have alcohol problems, drug dependence or psychosis. 

1) Alcohol focused spouse involvementplus behavioral marital therapy (ABMT)N=302) Alcohol focused spouse involvementplus behavioral marital therapy (ABMT) PLUS AA/Al Anon N=313) Alcohol focused spouse involvementplus behavioral marital therapy plus relapse prevention N=29 

1) Format: ABMT Manualized: YesSessions: 15Txt Length: 15 weeks (1/wk x 90 minutes)Approach: BMT that included behavioral self-recording, stimulus and consequence control procedures; communication and problem solving skill Partner attended the BCT with participant. 2) Format: ABMT/AAManualized: YesSessions: 15Txt Length: 15 weeks (1/wk x 90 minutes)Approach: BMT that included communication and problem solving skill, encouragement to go to AA/Al-Anon, homework and used common language to AA.3) Format: ABMT/AA/RPManualized: YesSessions: 19 minimumTxt Length: 15 weeks (1/wk x 90 minutes)Approach: BMT that included communication and problem solving skill, encouragement to go to AA/Al Anon, homework and used common language to AA plus 4 maintenance sessions over 12 months to reduce relapse. 

Patient OutcomesSymptoms: a. Mean % drinking daysb. Mean # drinks per drinking day Intermediate OutcomesAttendancea. Session attendanceb. Homework completed

Allocation concealment: NRBlinding: NRIntention to treat analysis: NoWithdrawals adequately described: YesTreatment integrity:Manualized; audiotaped treatment adherence assessed rigorouslyStudy Quality:Fair
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199672 Same as McCrady 199672 Same as McCrady 

199672

Same as McCrady 199672 Patient Outcomes

Symptoms: a. PDAb. PDHDc. Mean length of drinking episodesd. % continuous abstinente. % non-problem drinkingf. % drinking, but improvedg. % unimprovedIntermediate OutcomesAttendancea. Mean # sessions attendedb. Mean #days in treatment

Same as McCrady 199672

199672 Same as McCrady 199672 Same as McCrady 

199672

Same as McCrady 199672 Patient Outcomes

Symptoms: a. PDAFamily OutcomesCouple functioninga. MHS

Same as McCrady 199672
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

d

ale

14.91

ics:

ers(SO): 

d

rough 

he 

rrals 

 

MH condition: current alcohol abuse or dependenceAssessed by:Structured clinical Interview for DSM-IVSO: male partner Inclusions:Female, married, cohabitating for >6 months, or committed relationship for >1 year (with intent to continue).Exclusions:Neither party <25 on MMSE , signs of psychotic disorder, current drug or physiological dependence, no evidence of domestic abuse in past 12 months OR if aggression reported on Modified CTS, a) victim does not fear retribution & b) violence occurred only when intoxicated or resulted in no injuries. 

1) Alcohol Behavior Couples Therapy(N =50)2) Alcohol Behavior Individual Therapy(N=52)

1) Format: CouplesManualized: Yes Sessions: 20 x 90 minutesTxt Length: Maximum 6 monthsApproach: CBT, same as individual plus intervention for partner to support abstinence and improve couple relationship.2) Format: IndividualManualized: Yes Sessions: 20 x 60 minutesTxt Length: Maximum 6 monthsApproach: CBT including self monitoring, functional analysis of drinking, coping skills.

Patient OutcomesSymptoms:a. PDA b. PDHDc. % complete abstinence after treatmentd. % no heavy drinking daysHealth Care Utilization:a. % pts receiving additional formal treatment.b. # day’s treatment.Family OutcomesCouple functioning:a. % separated during treatment.b. Days length of separationIntermediate OutcomesAttendance:a. % Attended all sessions.b. # sessionsTreatment adherencea. % Homework completed (patient)

Allocation Concealment: YesBlinding: noneIntention-to-treat analysis: NoWithdrawals adequately described: YesTreatment integrity:Therapists met weekly to review cases, audiotapes reviewed randomly; MATCH Treatment rating scale used (no significant differences).Study Quality:Good
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ysis

 over 

ics: 

rtner: 

amily 

d

through 

ring 

, drug 

MH Condition:psychoactive substance use disorder other than alcoholAssessed bySCI for DSM–IVSO: a first-degree relative, spouse, intimate partner, or someone who lives with the IP; who has contact with the patient on at least 40% of the last 90 days.Inclusions: ≥ age 18; live within 60 miles of the project; describe the loved one in a manner consistent with theDSM–IV diagnoses for a psychoactive substance use disorder other than alcohol; consent to participate.Exclusions: SOs of an individual with a substance use disorder who would be interested in entering treatment.

1) Community Reinforcement and Family Training (CRAFT) N = 29 2) CRAFT + aftercareN = 30 3) Al-Anon or Narcotics Anonymous facilitation therapyN = 31 *Skills taught in CRAFT: domestic violence precautions, motivational strategies, assessment of the context of the patient’s use, communication training, positivereinforcement training, discouragementof drug use, training CSOs to reward themselves, and suggesting treatment to the patient

1) Format: CRAFT in individual sessions with the SOManualized: YesSessions: 1 2-14 Txt Length: NRApproach: SO taught skills* for impacting drinker’s alcohol use and decision to enter treatment and improving their own quality of life 2) Format: CRAFT conducted in individual sessions with the SOManualized: YesSessions: 12-14 + aftercare group therapy for up to 6 monthsTxt Length: NRApproach: See above + openended groups for after care for up to 6 months; aftercare used same CRAFT principles3) Format: Al-Anon or Narcotics Anonymous facilitation therapyManualized: YesSessions: 1 2Txt Length: NRApproach: parallels 12-step program and adds emphasis on getting patient to enter formal treatment 

Patient OutcomesHealth Care Utilizationa. % of patients who came to treatment after their significant others were recruited for the study

AllocationConcealment: NRBlinding: NRIntention-to-treat analysis: NRWithdrawals adequately described: NoTreatment integrity:Weekly supervision; sample of sessions were videotaped and reviewed.Study Quality:Fair
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mized

sis

e

 22 

7 years)

: 53%

%

14 

ics: 

d

 or help 

haviors 

om they 

marily 

cements 

. 

MH Condition: alcohol use disorderAssessed by: SO report using the Structured Clinical Interview for the DSM-III-RSO: close relative (parent, child, grandchild, sibling) or a spouse or unmarried intimate partnerInclusions: Concerned SO must be 1) living with a problem drinker who is a close relative or intimate partner, 2) within 60 miles of research site, 3) in contact with drinker on at least 40% of the past 90 days, with no planned change (e.g., separation) in the next 90 days, 4) age ≥18 (both SO and drinker), 5) willing to participate in research, 6) describes the drinker in a manner consistent with DSM-III diagnostic criteria for alcohol abuse or dependence, and 7) evidence that the drinker refused to seek treatment and had not received and treatment (other than detoxification) for alcohol or drug problems in the past 3 months

1) CRAFTN = 45 (44 completed)2) Johnson Institute interventionN = 40 (36 completed)3) AlcoholicsAnonymousN = 45 (42 completed)*Skills taught in CRAFT: awareness training (incorporating the style of motivational interviewing), contingency management, communication skills training, planned activities that compete with drinking, outside activities for SO self-care, handling dangerous situations, suggesting counseling, and functional analysis of triggers and reinforcers for nondrinking

1) Format: CRAFT in individual sessions with the SOManualized: YesSessions: 12 1-hr sessionsApproach: SO taught skills* for impacting drinker’s alcohol use and decision to enter treatment and improving their own quality of life2) Format: Johnson Institute interventionManualized: YesSessions: 6 2-hr sessionsApproach: Special form of family intervention; family members are prepared to confront problem drinking with their own experiences and observations about drinking and related problems, encourage treatment entry in a supportive manner, and apply sanctions if the drinker fails to enter tx 3) Format: Alcoholics-AnonymousManualized: YesSessions: 812-hr sessionsApproach: parallels 12-step program – philosophy that SO is powerless to control drinker, must detach, and instead accept AlAnon and strengthen own mental health

Primary outcomesUtilization a. Patient engagement in at least an initial assessment and one treatment session of substance use treatmentFamily OutcomesFamily functioninga. FES (Family cohesion)b. RHS Conflicta. FES (Family conflict)Intermediate OutcomesAttendance:a. session attendance

AllocationConcealment: NRBlinding: NRIntention-to-treat analysis: YesWithdrawals adequately described: YesTreatment integrity:Therapists thoroughly trained, certified in tx, and then supervised. All sessions videotaped and randomly selected tapes were monitored. Study Quality:Good
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

e 

2.73

ics: 

ale

3.0 

d

d from 

cation 

nd 

ol 

m, and 

d media 

MH Condition: Alcohol Abuse or DependenceAssessed by: MASTSO: Wife/female cohabitating partnerInclusions: Legally married male alcoholics with nonalcoholic spouses or in stable common law marriage for at least 3 yrs; living together; ages 25-60 yrs.; husband met DSM criteria for alcohol dependence; had consumed alcohol sometime 120 prior to initial assessment; score >7 on MAST; accepted abstinence as goal; refrained from other tx or counseling during trial. Exclusions: Wife abused alcohol or had been abstinent< 6 months; wife or husband had psychoactive substance use disorder (other than alcohol); serious mental illness; separated and not willing to reconcile for trial.

1) Behavioral Marital Therapy (BMT) + Relapse Prevention (RP) N = 30 2) Behavioral Marital Therapy N = 29 

1) Format: BMT + RPManualized: YesSessions: BMT NR + 15 Relapse Prevention sessionsTxt Length: 5-6 months for BMT + 1 yearApproach: Couple therapy delivered first with only the couple and provider then in groups of couples later in the treatment + couples therapy for relapse prevention with only the couple and the provider Behavioral marital therapy with Antabuse contracts to promote abstinence, behavioral assignments, and communication /negotiation training + relapse prevention to maintain behaviors and gains, deal with unresolved problems, to develop and rehearse a relapse prevention plan2) Format: BMT only Manualized: YesSessions: NRTxt Length: 5-6 monthsApproach: Couple therapy delivered first in with only the couple and provider then in groups of couples later in the treatment. Behavioral marital therapy with Antabuse contracts to promote abstinence, behavioral assignments, and communication/ negotiation training

Patient OutcomesSymptomsa. PDAFamily OutcomesCouple functioninga. Marital Adjustment Test b. CBQ (marital behaviors scale)Intermediate OutcomesAdherence:a. CBQ (participation in Antabuse contract scale)

AllocationConcealment: NoBlinding: noIntention-to-treat analysis: NoWithdrawals adequately described: YesTreatment integrity:Extensive training, weekly supervision, coauthor leading or observing 80% of sessionsStudy Quality:Fair
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

e

%

 

2.47 

34)

ics:

ale 

12.4 

d

olics in 

in the 

atient 

ed to 

MH ConditionAlcohol Use DisorderAssessed by: MASTSO: wife/female partnerInclusions: Legally married male alcoholics with nonalcoholic spouses; living together; no older than 60yrs.; score >7 on MAST. Exclusions: Patient refused to accept sobriety as goal; had psychotic or had organic memory deficits; wife had drinking problem, nervous disorder, or was psychotic. 

1) Behavioral Marital Therapy N = 102) Interactional Couples TherapyN = 12 3) Individual treatment onlyN = 12

1) Format: Individual treatment for alcoholism + BMT Manualized: YesSessions: 10Txt Length: 10 weeks/2hrs. Approach: Used behavioral rehearsal and homework to decrease drinking and alcohol related interactions; develop communication skills2) Individual treatment for alcoholism + Interactional Couples therapyManualized: NoSessions: 10Txt Length: 10 weeks/2 hrs. Approach: less structured group; not manualized or pre-planned; emphasized mutual support, sharing of feelings, problem solving through discussion and providing verbal insight on the relationship3) Format: Individual treatment for alcoholism onlyManualized: NASessions/Txt Length: NAApproach: NA

Family OutcomesCouple functioninga. Sexual Adjustment Questionnaire – multiple subscales

AllocationConcealment NRBlinding: YesIntention-to-treat analysis: NoWithdrawals adequately described: NoTreatment integrity:Audiotaped, supervised sessions. Ratings of tx integrity used.Study Quality:Fair
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s (one 

ation) 

e

ics: NR

d

 a 

tient 

ere 

MH Condition: Alcohol dependence (with or without comorbid drug diagnosis)Assessed by: inpatient unit/medical recordsSO: wives, parents, or SO partnerInclusions:admitted to a inpatient detoxification unit, ages 21-65; living with wife, parent(s) or female partner prior to admit, live within 45 minutes driving distance of treatment center, no evidence of schizophrenia, organic mental disorder, paranoid disorder, other psychotic disorderExclusions: None

1) Brief Family Treatment Intervention N=242) Treatment as usual (TAU) N=213) Brief Family Treatment subsetN=9 

1) Format: Brief Family TreatmentManualized: YesSessions: 2 sessionTxt Length: NRApproach: First session was in person or in depth telephone conference with patient and family member to develop a strategy for continuing care and to review options; help make practical plans for continuing care. Second call was phone call 2 weeks after detoxification discharge to find out success and troubleshoot continuing care 2) Format: TAUManualized: NoSessions: NATxt Length: 3-4 days inpatient detoxificationApproach: Participants admitted for substance use detoxification; to assist with withdrawal symptoms; monitor risks for developing serious problems during withdrawal. Family not involved during detoxification unit stay (confirmed by medical record review). 3) Subset of Brief Family treatment group that compared in-person session to phone delivered session 

Patient OutcomesSymptoms: a. % days substance use Utilization:a. % entered continuing care post inpatient detoxification b. Days attended continuing care

AllocationConcealment: Yes - urnBlinding: NRIntention-to-treat analysis: YesWithdrawals adequately described: YesTreatment integrity:Counselors provided detailed steps for tx; cases reviewed weeklyStudy Quality:Poor
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s 

g: NR

2.9

ics:

4.1

d

ving 

er other 

who 

nt clinic 

use 

MH Condition: Substance useAssessed by: unclearSO: non-spouse with whom patient lives. Inclusions: (a) age 18-65; living with adult family member other than a spouse or partner for at least 6 months in prior year; participant meets DSM criteria for alcohol or drug dependence or both; family member without current drug or alcohol dependence; patient and family member without serious mental illness, suicidal ideation or homicide risk; agreement to refrain from other substance use counseling except for selfhelp; agree to abstinence during study period. Exclusions:History in past 3 years of domestic violence when not using drugs/alcohol or if family voiced fear of violence due to tx; opioid use or maintenance in past 12 months; dependence on alcohol, heroin or other opioids that required detox; history of drug overdose or attempted suicide. 

1) BFT+IBT (n=15)2) IBT only (n=14)

1) Format: BFT+IBTManualized: YesSessions: 24 (2/week, 60 min): 12 BFT, 12 IBTTxt Length: 12 weeksApproach: Patient and family members attended one session/week which included “daily trust discussion.” Tx emphasized daily support of abstinence, less on relationships enhancement to fit non-spousal relationship. IBT used Project MATCH manual 2) Format: IBTManualized: YesSessions: 24 (2/week, 60 min)Txt Length: 12 weeks (2/week)Approach: Participants attended therapy by themselves. Project MATCH manual used (repeating each session twice). 

Patient OutcomesSymptoms: a. PDAb. % days primary substance use Family Outcomesa. RHS-dyad scoreIntermediate OutcomesAttendancea. mean # sessions attended 

AllocationConcealment:NRBlinding: NRIntention-to-treat analysis: YesWithdrawals adequately described: YesTreatment integrity:Weekly supervision; review of audiotaped sessions Study Quality:Poor
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

e

ars

: 98%

abitating: 

NR

d

ements 

g 

”

ics:

ale 

rs

: 95%

MH Condition: Alcohol abuseAssessed by: Medical evaluationSO: wife or cohabitating partnerInclusion: Male subject drank ≥10 drinks/week; both subject and spouse willing to accept subject’s goal of reduced drinking. Exclusions: Subject psychiatric hospitalization in past 5 years, or multiple lifetime psych hospitalizations. For both subject and partner: 1) no alcohol related arrests in past year or no more than 2) lifetime alcohol related arrests; 2) concurrent alcohol treatment (other than self help group; 3) history of alcohol related hospitalization or detox; 4) serious domestic violence; 5) current separation; and 6) for unmarried couples, living together <6 months. 

1) C/AF – couples with alcohol focus N=212) C/AF + BCT – couples with alcohol focus + Behavior Couples Therapy N=21 3) PDO – problem drinker only N=22Treatment adherenceNR by group

1) Format: C/AF Manualized: YesSessions: 10 weeks x 2 hours weekly Approach: During first hour strategies to reduce alcohol consumption, strategies to increase spouse behaviors supportive of drinking reduction; last hour, alcohol and health lections, with encouraged discussion between partners. 2) Format: C/AF +BCTManualized: YesSessions: 10 weeks x 2 hours weekly Approach: During first hour strategies to reduce alcohol consumption, strategies to increase spouse behaviors supportive of drinking reduction; last hour, BCT series of treatment components to equip couples with skills to increase cohesion and positive relationship aspects, enhance communication and conflict resolution. 3) Format: PDO Manualized: YesSessions: 10 weeks x 2 hours weeklyApproach: During first hourstrategies to reduce alcohol consumption, last hour-alcohol and health lectures

Patient OutcomesSymptom Improvementa. TLFB – heavy days drinking/monthb. TLFB – abstinent/light days drinking/monthc. TLFB – time to heavy drinking episodeGlobal Functioninga. Drinker Inventory of Consequences Family Outcomes:Couple functioning:a. Partner Interaction Questionnaireb. Significant Other Behavior Questionnairec. DAS

Allocation concealment: NRBlinding: NRIntention to treat analysis: YesWithdrawals adequately described: YesTreatment integrity:Weekly supervision, training of counselors, sessions audiotaped and checked against a session checklist. Study Quality:Fair
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Treatment Groups Intervention Characteristics Outcomes Assessed Quality

s

ale 

g:100%

2.3

ics: 

er: 

g:100%

d

ating 

or 

e asked 

MH Condition: Drug AbuseAssessed by: Diagnostic clinical interviewSO: Male intimate partnerInclusions: age 20-60; married ≥ 1 yr or living with SO in a stable common law relationship ≥ 2 yrs; meet abuse or dependence criteria for ≥ 1 psychoactive substance use disorder (not nicotine), primary drug of abuse not alcohol; agree to refrain from psychoactive substances during treatment; no additional substance-abuse treatment except self-help meetings during treatment unless recommended by primary individual therapistsExclusions: male partner met criteria for psychoactive substance use disorder in past 6 months; male or female partners met criteria for organic mental disorder, schizophrenia, delusional (paranoid) disorder, or other psychotic disorders; or female partners were in a methadone maintenance program and seeking treatment for adjunctive outpatient support.

1) Behavior Couples Therapy and Individual Behavioral TherapyN = 372) Individual Behavioral TherapyN = 38

1) Format: Individual and group counseling + couple therapyManualized: YesSessions: 56; Weeks 1-12: 1 group; 1 individual; 1 couple therapy session per week; Weeks 13-20: 1 individual session per week; emergency sessions as neededTxt Length: 20 weeksApproach: Individual cognitivebehavioral therapy for skills building + Behavioral Couples Therapy including a sobriety contract daily between couples, communication skills, and positive behavioral exchange2) Format: Group, individual, and behavioral couples therapyManualized: YesSessions: 56; Weeks 1-12: 1 group; 2 individual per week; Weeks 13-20: 1 individual session per week; emergency sessions as neededTxt Length: 20 weeksApproach: Individual cognitivebehavioral therapy for skills building

Patient OutcomesSymptomsa. PDAFamily OutcomesCouple functioninga. DASb. MHS Intermediate OutcomesAttendancea. session attendanceTreatment Satisfactiona. CSQ 

AllocationConcealment: NRBlinding: NRIntention-to-treat analysis: YesWithdrawals adequately described: YesTreatment integrity:Trained and supervisedStudy Quality:Good

l; SO = significant other or family member included; DSM = Diagnostic and Statistical Manual of Mental Disorders; CM = Contingency 

Behavioral couple therapy; PDA = percent days abstinent; ASI = Addiction Severity Index; CSQ =Client Satisfaction Questionnaire; MHS = Marital 

hange Questionnaire; PI = Principal Investigator; MAT=Locke Wallace Marital adjustment test; CTS =Conflict Tactics Scale; IBMM = Individual 

 = not significant; BFT = Behavioral Family Therapy; IBT = Individual Based Therapy; PACT = Psychoeducational Attention Control Treatment; 

; DAS=Dyadic Adjustment Scale; S-BCT=Standard Behavioral Couples Therapy; TLFB=Time Line Follow Back interview; HOPE = Helping Other 

sion Inventory; CRT= Community reinforcement training intervention; PSBCT = Parent Skills with Behavioral Couples Therapy; BMT = Behavioral 

cused spouse involvement plus behavioral marital therapy; AA = Alcoholics Anonymous; RP = Relapse prevention; MMSE = Mini mental Status 

cement and Family Training; CSO = concerned significant other; FES = Family Environment Scale; RHS = Relationship Happiness Scale; CBQ = 

TAU = Treatment as usual; C/AF = couples with alcohol focus; PDO= problem drinker only; MAST = Michigan Alcoholism Screening Test
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ree Urine Screens 

(15.1) N=48(13.6) N=35

12.0) N=44

) (p=0.35)

vs. 3) (p=0.02)

Opiate Free Urine Screens1) 20.2 (15.5) N=482) 18.9 (13.7) N=353) 13.5 (12.0) N=441) vs. 2) (p=0.48)1) & 2) vs. 3) (p=0.04)Cocaine Free Urine Screens1) 18.5 (15.0) N=482) 16 (13.5) N=353) 12.2 (12.6) N=441) vs. 2) (p=0.44)1) & 2) vs. 3) (p=0.06)% Drug-Free Urine1) 59.7% (39.7)2) 57.4% (39.1)3) 45.2% (39.3)1) vs. 2) (p=.77)1) & 2) vs. 3) (p=0.08)PDA, Opioids1) 89% (20.3)2) 87.5% (20.9)3) 79.8% (25.5)1) vs. 2) (p=.37)1) & 2) vs. 3) (p=0.06)PDA, Cocaine1) 88.6% (14.9)2) 84.3% (24.5)3) 82.6% (23.0)1) vs. 2) (p=.77)1) & 2) vs. 3) (p=0.06)Maximum PDA, Opioids1) 53.4% (36.5)2) 49.1% (32.7)3) 37.7% (32.8)1) vs. 2) (p=0.60)1) & 2) vs. 3) (p=0.05)
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Maximum PDA, Cocaine1) 51.7% (35.4)2) 49.1% (32.7)3) 37.7% (32.8)1) vs. 2) (p=0.39)1) & 2) vs. 3) (p=0.09)

rugs

% (30.1)% (30.4)

PDA, drugs1) 97.1% (9.2)2) 94.1% (8.6)p=ns

PDA, drugs1) 84.4% (25.3)2) 73.2% (23.3)(authors reported significant difference, but p-value NR)

PDA, drugs1) 76.6% (27.7)2) 69.4% (22.1)(authors reported significant difference, but p-value NR)

cohol

% (46.5)% (40.7)

PDA, alcohol1) 97.4% (21.1)2) 96.3% (20.4)p=ns

PDA, alcohol1) 84.3% (28.7)2) 78.6% (29.9)p=ns

PDA, alcohol1) 77.4% (34.9)2) 71.6% (33.6)p=ns

cohol and drugs

% (38.6)% (34.4)

PDA, alcohol and drugs1) 95.4% (15.4)2) 91.1% (14.1)p=ns

PDA, alcohol and drugs1) 81.5% (28.6)2) 70.4% (24.5)(authors reported significant difference, but p-value NR)

PDA, alcohol and drugs1) 73.2% (29.8)2) 65.1% (26.9)(authors reported significant difference, but p-value NR)% change in days abstinent% improved 1) 83%2) 60% p=.03% Unchanged1) 17%2) 40% p=NR

 alcohol/drug use

% (38.6)% (34.4), 

% days alcohol/drug use1) 19.0% (26.9)2) 29.7% (26.1) (authors reported significant difference, but p-value NR)

 drug use

% (30.1)% (30.4) 

% days drug use1) 16.5% (25.1)2) 26.1% (24.0) (authors reported significant difference, but p-value NR)

 alcohol use

% (46.5)% (40.7) 

% days alcohol use1) 16.4% (30.3)2) 22.3% (29.9) (authors reported significant difference, but p-value NR)

 heavy alcohol use 

% (31.2)% (33.6) 

% days heavy alcohol use 1) 8.4% (19.2)2) 16.9% (20.4) (authors reported significant difference, but p-value NR)
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 composite score 

(.06) N=19(.07) N=17

Alcohol composite score of ASI1) 0.27 (.06) N=192) 0.34 (.08) N=17Paired t-test, p=ns for both BCT and IBMM

omposite score of 

(.08) N=19(.09) N=17

Drug composite score of ASI1) 0.16 (.09) N=192) 0.28 (.08) N=17p<0.01

PDA from opioids 1) 69.3% (21.4)2) 56.3% (20.2) p<.01PDA from cocaine 1) 74.4% (22.9)2) 61.8% (24.2)p<0.05PDA from alcohol 1) 69.4% (23.2)2) 60.1% (24.2) p<0.05PDA from drugs 1) 59.6% (26.4)2) 49.3% (28.4) p<0.05

2% (22.41)1% (24.34)7% (25.23)6% (26.12) 

PDHD1) 5.0% (12.2)2) 5.2% (14.3)3) 4.9% (15.1)4) 5.0% (17.0) p=NR

PDHD1) 15.0% (18.0)2) 14.1% (19.3)3) 23.6% (15.0)4) 24.3% (15.0)p=NR

PDHD1) 19.5% (20.2)2) 19.2% (38.2)3) 38.2% (25.6)4) 37.3% (27.0) p=NR

Piecewise growth model for effect of tx condition on PDHD:Equivalence test between:1) vs. 2): z=0.16, p<0.05Group differences between:1) vs. 3): z=-0.06, p=ns 1) vs. 4): z=-0.01, p=ns 

Piecewise growth model for effect of tx condition on PDHD after tx:Equivalence test between:1) vs. 2): z=0.13, p<0.05Group differences between: 1) vs. 3): z=-2.02, p<0.05 1) vs. 4): z=2.34, p<0.05 
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1% (35.10)2% (34.26)0% (30.64)

PDA1) 96.3% (16.3)2) 93.6% (17.7)3) 94.5% (14.8) p=ns

PDA1) 85.9% (18.1)2) 75.0% (20.3)3) 74.4% (22.5) p=ns

PDA1) 79.3% (29.7)2) 60.2% (20.9)3) 62.1% (21.6)p<0.01

Piecewise growth model for effect of tx condition on PDA:Group differences between: 1) vs. 2): z=1.02, p=ns 1) vs. 3): z=0.99, p=ns 

Piecewise growth model for effect of tx condition on linear rate of change in PDA after tx:Group differences between: 1) vs. 2): z=-3.3, p<0.05 1) vs. 3): z =2.4, p<0.05 

% (29.4)% (32.1)% (30.5)% (32.2) 

PDA1) 93.7% (12.6)2) 94.1% (13.4)3) 88.3% (13.0)4) 89.6% (14.1)p=NR

PDA1) 83.4% (27.2)2) 84.1% (26.5)3) 70.3% (27.1)4) 69.5% (25.1)p=NR

PDA1) 75.6% (26.7)2) 74.1% (25.8)3) 60.2% (27.3)4) 58.9% (31.2) p=NR

Piecewise growth model for effect of tx condition on PDA:Equivalence test between:1) vs. 2): z=0.02, p<0.05Group difference between:1) vs. 3): z=0.2, p=ns1) vs. 4): z=0.1, p=ns 

Piecewise growth model for effect of tx condition on PDHD after tx:Equivalence test between:1) vs. 2): z=0.2, p<0.05Group differences between: 1) vs. 3): z=2.1, p<0.05 1) vs. 4): z=2.3, p<0.05 

 PDHD (men)

(18.7) N=NR(21.6) N=NR

TLFB – PDHD (men)1) 6.0 (13.6) N=NR2) 5.3 (14.9) N=NR p=NR

TLFB – PDHD (men)1) 13.6 (18.9) N=NR2) 25.4 (21.1) N=NR p<0.05

TLFB – PDHD (men)1) 18.0 (20.5) N=NR2) 32.2 (23.5) N=NR p<0.05

 PDHD (women)

(16.4) N=NR(19.7) N=NR

TLFB – PDHD (women)1) 5.1 (14.1) N=NR2) 5.3 (14.1) N=NR p=NR

TLFB – PDHD (women)1) 11.9 (15.8) N=NR2) 20.6 (18.2) N=NR p<0.05

TLFB – PDHD (women)1) 15.7 (20.4) N=NR2) 27.9 (20.6) N=NR p<0.05

Multi-level growth model for effect of tx condition on PDHD (men):Group difference between:1) vs. 2): z= -1.1, p=ns

Multi-level growth model for effect of tx condition on PDHD after tx (men):Group difference between:1) vs. 2): z= -2.1, p<0.05

Multi-level growth model for effect of tx condition on PDHD (women):Group difference between:1) vs. 2): z= 0.4, p=ns

Multi-level growth model for effect of tx condition on PDHD after tx (women):Group difference between:1) vs. 2): z= 2.4, p<0.05
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f heroin use

(1.4) N=45(2.4) N=17

Days of heroin use (mid-tx -4 weeks)1) 4.9 (1.7)2) 16.2 (2.6)p<0.001

Days of heroin use1) 9.8 (1.9)2) 3.4 (6.2)p<0.001

use past 30 days

% N=45% N=17

Heroin use past 30 days (mid tx – 4 weeks)1) 63% (0.40)2) 91% (1.05)p=NR

Heroin use past 30 days1) 53% (0.40)2) 61% (1.16)p=0.25

mposite, Drugs

(0.02) N=45(0.03) N=17

ASI Composite, Drugs (mid tx – 4 weeks)1) 0.19 (0.02)2) 0.23 (0.04)p=NR

ASI Composite, Drugs1) 0.20 (0.03)2) 0.12 (0.08)p=0.32

cohol abusing pts)

(35.5) N=25(33.3) N=22(29.2) N=24

PDA (alcohol abusing pts)1) 90.2 (21.9)2) 86.6 (17.4)3) 87.4 (18.2)p=ns

PDA (alcohol abusing pts)1) 80.6 (27.2) vs. 2) 71.4 (26.2)1) 80.6 (27.2) vs. 3) 70.4 (25.3)p<0.05 

PDA (alcohol abusing pts)1) 70.9 (25.6) vs. 2) 60.4 (22.4)1) 70.9 (25.6) vs. 3) 57.9 (32.1)p<0.05

rug abusing pts)

(33.7) N=22(33.6) N=22(36.9) N=21

PDA (drug abusing pts)1) 85.9 (22.7)2) 81.8 (26.2)3) 83.4 (24.4)p=ns

PDA (drug abusing pts)1) 77.6 (25.8) vs. 2) 63.6 (24.3)1) 77.6 (25.8) vs. 3) 61.5 (26.8)p<0.05

PDA (drug abusing pts)1) 66.9 (35.6) vs. 2) 53.4 (24.8)1) 66.9 (35.6) vs 3) 51.2 (32.2)p<0.05 

SO knowledge of current drug use (5=sure he is using; 1=sure he is not using)

 2.201) 2.432)

p=ns

(28.1) N=10(25.4) N=10(29.7) N=10

): z=0.24, ns; ): z=0.11; ns; r-0.02

PDA1) 90.1 (18.6) N=102) 92.3 (15.2) N=103) 88.3 (16.7) N=10p=NRr≥0.5 large1) vs. 3): z=-0.28, ns; r=0.031) vs. 2): z=0.39; ns; r-0.23

PDA1) 84.3 (22.4) N=102) 85.1 (20.7) N=103) 78.2 (22.6) N=10p=NRr≥0.5 large1) vs. 3): z=-1.08, ns; r=0.231) vs. 2): z=0.13; ns; r-0.02

PDA1) 78.6 (19.4) N=102) 77.8 (20.2) N=103) 70.2 (18.6) N=10p=NRr≥0.5 large1) vs. 3): z=-1.4, ns; r=0.331) vs. 2): z=0.10; ns; r-0.02
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% drinking days

(24.6) N=22(21.1) N=23

1.1) N=22

 drinks per drinking 

9.7) N=145.0) N=192.7) N=17

(32.0) N=21(24.3) N=26(30.0) N=24

PDA1) 80.0 (27.2)2) 83.2 (22.7)3) 87.6 (20.6)p=ns

PDA1) 82.4 (25.3) N=21 2) 72.8 (33.6) N=263) 82.6 (24.5) N=24p=ns

PDHD1) 10.0 (19.1)2) 9.4 (15.7)3) 6.6 (16.9) p=ns

PDHD1) 6.1 (11.3) N=142) 17.1 (25.2) N=153) 9.0 (17.0) N=16p=ns

ength of Drinking 

s

7.6) vs. 2 ) 8.4 (14.6)

.7) vs. 2 ) 8.4 (14.6)

% participants continuously abstinent1) 31.8 N=222) 41.7 N=243) 41.7 N=24p=NR% non-problem drinking, mostly controlled 1) 18.2 N=222) 4.2 N=243) 8.3 N=24p=NR% drinking but improved 1) 18.2 N=222) 8.3 N=243) 25.0 N=24p=NR% unimproved (pre to post-6 months)1) 31.8 N=222) 45.8 N=243) 25.0 N=24p=NR
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PDA1) 79.51 (29.6) N=20 2) 70.41 (37.32) N=243) 80.63 (30.28) N=22p=NR

PDA1) 82.7 (30.7) N=20 2) 78.7 (33.4) N=243) 83.1 (29.4) N=22p=NR

(29.2) N=50(28.0) N=52

PDA1) 80.5 (27.7) N=502) 74.2 (35.0) N=52p=NR 

PDA1) 75.7 (34.3) N=502) 61.4 (39.5) N=52p=NR

PDA1) 75.4 (34.7) N=502) 63.1 (37.6) N=52p=NR

Latent growth curve models for PDA:Differences between groups: d =0.31 (small effect), p=ns 

(28.9) N=50(32.3) N=52

PDHD1) 10.5 (22.2) N=502) 18.7 (34.6) N=52p=NR

PDHD1) 12.3 (27.4) N=502) 23.8 (37.6) N=52p=NR

PDHD1) 12.8 (26.2) N=502) 22.7 (34.2) N=52p=NR

Latent growth curve models for PDHD:Differences between groups: d =0.19 (small effect), p=ns

% complete abstinence after treatment1) 36.0 N=502) 34.6 N=52p=NR

% complete abstinence after treatment1) 16 N=502) 15.4 N=52p=NR (ns)

% no heavy drinking days1) 60.0 N=502) 55.8 N=52p=NR

% no heavy drinking days 1) 26.0 N=502) 28.8 N=52p=NR

(27.6)(25.4) 

PDA1) 98.9 (4.4)2) 98.0 (6.6) p=ns

PDA1) 96.9 (6.9)2) 87.6 (21.2)p=0.03

PDA1) 84.9 (25.3)2) 82.7 (26.1)p=ns

% days alcohol/

e

N=24N=19

TLFB - % days alcohol/drug use1) NR N=243) NR N=19p=NRr=NR

TLFB - % days alcohol/drug use1) 22.6 (36.3) N=243) 36.1 (40.3) N=19p=0.25r=0.17 small

% days alcohol or 

e (in person subset)

N=9N=19

TLFB - % days alcohol or drug use (in person subset)2) NR N=93) NR N=19p=NRr: NR

TLFB - % days alcohol or drug use (in person subset)2) 10.6 (28.3) N=93) 36.1 (40.3) N=19p= 0.07r=0.33 medium
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(33.42)(27.3) 

PDA1) 71.1(37.0)2) 43.6 (41.9) p=0.09

PDA1) 57.7 (40.4)2) 46.4 (32.0) p=ns

U

(29.5)(27.7) 

PDPSU1) 19.9 (27.5)2) 41.1 (37.3) p=ns

PDPSU1) 29.2 (41.4)2) 38.7 (30.6) p=ns

nt/light days 

g/month

(7.7) N=21(7.1) N=21(9.1) N=22

Abstinent/light days drinking/month1) 22.2 (4.9) N=202) 21.4 (7.0) N=213) 16.2 (8.9) N=22p=NR

Abstinent/light days drinking/month1) 21.2 (7.8) N=202) 20.8 (6.7) N=213) 16.7 (9.6) N=21p=NR

Abstinent/light days drinking/month

1) 22.9 (5.4) N=202) 20.1 (8.0) N=213) 17.1 (10.4) N=20p=NR

days drinking/month

4.2) N=213.9) N=218.8) N=22

Heavy days drinking/month1) 1.5 (1.8) N=20 2) 1.8 (2.3) N=213) 4.7 (4.5) N=22p=NR

Heavy days drinking/month1) 3.1 (4.9) N=202) 2.1 (3.2) N=213) 5.5 (6.1) N=21p=NR

Heavy days drinking/month1) 2.6 (4.7) N=202) 1.9 (2.5) N=213) 5.8 (7.7) N=20p=NR

(29.2)(28.3) 

PDA1) 94.2 (6.4)2) 90.2 (8.0)p=ns

PDA1) 81.9 (16.3)2) 71.9 (17.9)p<0.05

PDA1) 74.2 (22.2)2) 65.4 (26.1)p=ns

entry into treatment 

FSO treatment

% pts receiving add’l tx1) 18.02) 11.5p=NR (ns)Days add’l tx1) 37.6 (26.6)2) 24.7 (24.7) p= NR

Pt completes a baseline assessment and schedules a substance use tx session1) 58.6%2) 76.7%3) 29.0%, p<0.01Both CRAFT conditions (1 & 2) better than condition 3, but no significant differences between conditions 1 and 2
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% completing at least an initial assessment and 1 substance use treatment session 1) 64.4% vs. 2) 30.0%1) 64.4% vs. 3) 13.3%p<0.001

% completing at least an initial assessment and 1 substance use treatment session 1) 66.7% vs. 2) 35.0%1) 66.7% vs. 3) 20.0%p<0.001

% continued care in 30 day period post detoxification (1 month post-treatment)1) 92% N=242) 62% N=21p=0.02; r=0.36 mediumDays attended continuing care in 3 months post tx (3 months posttreatment)1) 12.4 (11.4) N=242) 7.2 (11.3) N=19p=0.13; r=0.22 small

epression Inventory 

(1.5) N=45(2.4) N=17

Beck Depression Inventory Mid-treatment (4 weeks):1) 6.6 (1.7)2) 14.3 (2.6)p=NR

Beck Depression Inventory 1) 9.7 (5.6)2) 7.5 (1.9)p=0.56

 Inventory of 

uences

(9.9) N=19(1.7) N=21(18.4) N=21

Drinker Inventory of Consequences1) 12.2 (13.2) N=162) 13.5 (11.9) N=183) 15.5 (12.1) N=17p=NR

Drinker Inventory of Consequences1) 12.8 (14.4) N=172) 15.6 (16.1) N=183) 11.6 (8.4) N=15p=NR

ard deviation) unless otherwise noted. 

st-treatment, unless otherwise noted; Long term=12 months post-treatment, unless otherwise noted. If an outcome had a final measure reported 

ong term follow up column and noted. 

tive tables but not reported here if either 1) the authors did not report findings from these measures or 2) they did not test for differences between 

R = not reported; N/A = not applicable; tx = treatment; Completers = findings for analyses conducted only with treatment completers; ITT = 

-to-treat approach.

erapy; BFT = Behavioral Family Therapy ; CBT = Individual Cognitive-Behavioral Therapy; BBCT = Brief Behavioral Couples Therapy; IBT = 

Assertive Community Treatment; MFG = Multiple Family Group; SAS-FV = Social Adjustment Scale III, Family Version; AFM = Applied Family 

mily Management; SC = Standard care; MSANS = Modified Scale for Assessment of Negative Symptoms; PDA = Percent Days Abstinent; PDHD 

O = family member or significant other; CRT = Community Reinforcement Training; PSBCT = Parent Skills with Behavioral Couples Therapy; 

 marital therapy; AA = Alcoholics Anonymous/Al-Anon; RP = relapse prevention; TAU = Treatment as usual.
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ubstance Abuse Studies

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

Addiction Severity Index(z-score)1) vs. 2) 2.30 p=0.021) vs. 2) & 3) = -2.4, p=0.02

amily functioning subscale of 

ddiction Severity Index

 0.4 (.08) 0.5 (.09)

uthors reported significant 

fference, but p-value NR

Family functioning subscale of Addiction Severity Index1) 0.2 (.1)2) 0.3 (.1)authors reported significant difference, but p-value NR

Social Adjustment Scale (family unit subscale, pre-post change) 1) -.642) -.54p=ns

O’s report of Family nvironment Scale – Family 

ohesion

 5.6 (2.6) 4.4 (2.2) 5.3 (2.9) 

=ns

SO’s report of Family Environment Scale – Family Cohesion1) 6.2 (2.8)2) 5.2 (3.0)3) 5.8 (2.7)p=ns

SO’s report of Family Environment Scale – Family Cohesion1) 6.8 (2.3)2) 5.9 (2.6)3) 5.7 (2.9)p=ns

O’s report of Relationship 

appiness Scale

 4.9 (2.8) 4.8 (2.0) 5.6 (2.3) 

=ns

SO’s report of Relationship Happiness Scale1) 5.9 (2.8)2) 4.8 (2.6)3) 5.6 (2.7) p=ns

SO’s report of Relationship Happiness Scale1) 6.4 (2.7)2) 5.9 (2.6)3) 6.3 (2.8) p=ns
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arital Adjustment Test 

 67.5 (20.1) 66.9 (20.8)

uthors reported significant 

fference, but p-value NR

Marital Adjustment Test 1) 97.3 (17.2)2) 70.8 (17.5)authors reported significant difference, but p-value NR

Marital Adjustment Test 1) 71.7 (19.3)2) 70.2 (18.4)p=ns

Marital Adjustment Test 1) 71.6 (21.2)2) 70.2 (18.8)p=ns

reas of Change Questionnaire 

 34.4 (10.9) 36.2 (13.0)

uthors reported significant 

fference, but p-value NR

Areas of Change Questionnaire 1) 20.0 (11.9)2) 32.7 (13.8)authors reported significant difference, but p-value NR

Areas of Change Questionnaire 1) 35.0 (11.7)2) 38.7 (12.1)p=ns

Areas of Change Questionnaire 1) 34.1 (11.8)2) 37.0 (12.0)p=ns

 days separated  19.8 (17.7) 17.6 (18.4)

=NR

% days separated 1) 3.5 (4.3)2) 15.1 (16.3)p=NR

% days separated 1) 7.4 (18.6)2) 22.4 (24.6)p=NR

% days separated 1) 20.7 (21.4)2) 22.4 (29.1)p=ns

% change on Marital Adjustment Test% Improved 1) 60%2) 35% (p=0.03)% unchanged 1) 38%2) 50% (p=0.26)deteriorated1) 2%2) 15% (p=0.05)

ggregated MAT scores 

 67.5 (20.1) 66.9 (20.8)

uthors reported significant 

fference, but p-value NR

Aggregated MAT scores 1) 76.0 (20.4)2) 69.9 (19.0)authors reported significant difference, but p-value NR

ggregated ACQ scores 

 34.4 (10.9) 36.2 (13.0)

=ns

Aggregated ACQ scores 1) 32.4 (11.9)2) 37.3 (13.4)p=ns

yadic Adjustment Scale

 72.8 (18.1) N=19 75.1 (19.4) N=17

=ns

Dyadic Adjustment Scale*1) 97.9 (16.4) N=192) 79.2 (18.1) N=17p<0.01*using baseline DAS as a covariate
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SI – Family-Social Composite core

 0.47 (0.08) N=19 0.54 (0.09) N=17

=NR 

ASI – Family-Social Composite Score*1) 0.23 (0.06) N=192) 0.46 (0.08) N=17p<0.05

yadic Adjustment Scale 

 88.26 (21.64) 89.94 (22.61) 90.61 (24.27) 89.21 (22.61)

=NR 

Dyadic Adjustment Scale 1) 114.3 (14.0)2) 119.3 (11.9)3) 104.6 (11.6)4) 106.3 (13.0)p=NR 

Dyadic Adjustment Scale1) 109.4 (15.3) 2) 112.6 (16.2)3) 98.4 (11.6)4) 97.9 (13.2)p=NR 

Dyadic Adjustment Scale1) 107.3 (16.3)2) 109.3 (17.2)3) 96.0 (19.3)4) 93.0 (20.2)p=NR 

Piecewise growth model for effect of tx condition on DAS:Equivalence test between:1) vs 2): z=1.7, p=nsGroup differences between: 1) vs 3): z=-2.6, p<.01 1) vs 4): z=-2.5, p<.01

Piecewise growth model for effect of tx condition on DAS after tx:Equivalence test between:

1) vs 2): z=1.0, p=ns

Group differences between: 1) vs 3): z=-2.2, p<0.05 1) vs 4): z=2.0, p<0.05 

yadic Adjustment Scale 

 94.64 (19.36) 96.11 (18.44) 95.34 (18.40)

=NR

Dyadic Adjustment Scale 1) 123.0 (12.1)2) 111.2 (18.6) 3) 109.8 (13.3) p=NR

Dyadic Adjustment Scale 1) 117.2 (13.7)2) 102.2 (14.4) 3) 100.1 (15.2)p=NR

Dyadic Adjustment Scale 1) 112.4 (14.0)2) 98.0 (18.8) 3) 98.0 (16.2)p=NR

Piecewise growth model for effect of tx condition on DAS:Group differences between: 1) vs. 2): z=2.6, p<.01 1) vs. 3): z=2.7, p<.01 

Piecewise growth model for effect of tx condition on linear rate of change in DAS after tx:Group differences between: 1) vs. 2): z=2.2, p<0.05 1) vs. 3): z=2.0, p<0.05
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yadic Adjustment Scale 

 85.0 (16.7) 83.8 (17.1) 86.8 (20.8) 85.9 (21.0)

=NR

Dyadic Adjustment Scale 1) 112.3 (15.2)2) 114.2 (15.1)3) 101.9 (13.6)4) 100.1 (11.8)p=NR

Dyadic Adjustment Scale1) 107.2 (15.3)2) 109.8 (16.0)3) 94.1 (14.8)4) 93.0 (15.9) p=NR

Dyadic Adjustment Scale1) 104.4 (16.9)2) 106.9 (16.5)3) 87.3 (17.2)4) 88.7 (18.6)p=NR

Piecewise growth model for effect of tx condition on DAS:Test of equivalence between:

1) vs. 2): z=1.6, p=nsGroup differences between: 

1) vs. 3): z=-2.9, p<.01 1) vs. 4): z=2.8, p<.01

Piecewise growth model for effect of tx condition on DAS after tx:Test of equivalence between:

1) vs 2): z=-0.8, p=ns

Group differences between: 1) vs. 3): z=-2.8, p<0.01 1) vs. 4): z=2.0, p<0.05

AS (men)

 88.2 (22.9) N=NR 86.8 (23.1) N=NR

=NR 

DAS (men)1) 119.4 (13.6) N=NR2) 110.4 (14.2) N=NRp<0.05

DAS (men)1) 109.5 (16.2) N=NR2) 95.4 (18.2) N=NRp <0.05

DAS (men)1) 106.0 (22.8) N=NR2) 92.0 (20.3) N=NRp<0.05

AS (women) 

 92.7 (20.4) N=NR 93.2 (23.1) N=NR

=NR 

DAS (women) 1) 111.4 (12.7) N=NR2) 103.2 (15.2) N=NRp<0.05

DAS (women) 1) 104.9 (17.5) N=NR2) 95.4 (19.5) N=NRp <0.05

DAS (women) 1) 101.4 (22.8) N=NR2) 92.0 (22.7) N=NRp <0.05

Multi-level growth model for effect of tx condition on DAS (men):Group differences between: 1) vs. 2): z=-2.8, p<.01 

Piecewise growth model for effect of tx condition on linear rate of change in DAS after tx (men):Group differences between: 1) vs. 2): z=2.0, p<0.05 

Multi-level growth model for effect of tx condition on DAS (women):Group differences between: 1) vs. 2): z=2.1, p<.05 

Piecewise growth model for effect of tx condition on linear rate of change in DAS after tx (men):Group differences between: 1) vs. 2): z=1.4, p=ns

artner Support Quest. (mean, E) 

 3.3 (0.2) N=45 3.5 (0.3) N=17

>0.4

Partner Support Quest.(mid-tx -4 weeks)1) 3.6 (0.2)2) 2.6 (0.3)p=NR

Partner Support Quest.1) 2.6 (0.2)2) 3.4 (0.8)p=NR
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Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

elationship Assessment score 

mean, SE)

 61.8 (1.7) 59.0 (2.9)

>0.4

Relationship Assessment score (mid-tx 4 weeks)1) 62.5 (2.0)2) 62.1 (3.1)p=NR

Relationship Assessment score 1) 68.5 (2.2)2) 65.6 (6.9)p=0.83

AS (alcohol abusing pts)

 85.3 (21.4) N=25 84.6 (22.2) N=22 83.3 (22.4) N=24

=ns

DAS (alcohol abusing pts)1) 115.4 (18.2)*2) 102.2 (19.1)3) 104.6 (21.6)p<0.05 (significantly higher than baseline)*significantly higher than the other treatment groups

DAS (alcohol abusing pts)1) 103.9 (16.2)*2) 86.7 (19.2)3) 85.8 (23.0)p<0.05 (significantly higher than baseline)*significantly higher than the other treatment groups

DAS (alcohol abusing pts)1) 91.4 (19.9)*2) 82.1 (20.7)3) 80.0 (19.6)p<0.05 (significantly higher than baseline)*significantly higher than the other treatment groups

AS (drug abusing pts)

 75.2 (22.7) N=22 77.3 (19.8) N=21 74.4 (20.2) N=21

=ns

DAS (drug abusing pts)1) 103.6 (22.1)*2) 88.7 (16.4)3) 86.4 (21.7)p<0.05 (significantly higher than baseline)

DAS (drug abusing pts)1) 93.6 (17.2)*2) 77.8 (18.7)3) 80.0 (19.2)p<0.05 (significantly higher than baseline)*significantly higher than the other treatment groups

DAS (drug abusing pts)1) 907 (22.3)*2) 75.8 (20.4)3) 77.2 (21.6)p<0.05 (significantly higher than baseline)*significantly higher than the other treatment groups

SAS (marital subscale, pre-post change) 1) -.182) -.05 (p=ns)

yadic Adjustment scale 

 86.7 (19.1) N=10 84.2 (20.6) N=10 83.6 (22.4) N=10

=NR

Dyadic Adjustment Scale 1) 112.3 (18.6) N=102) 114.4 (16.8) N=103) 98.1 (17.9) N=10p=NRWithin group over time:

1) r≥0.5 large2) r≥0.5 large3) r≥0.3 medium

Paired contrasts:

1) vs. 3) medium2) vs. 3) medium 1) vs. 2) negligible

Dyadic Adjustment Scale1) 104.0 (19.2) N=102) 105.9 (19.6) N=103) 93.9 (20.2) N=10p=NRWithin group over time:

1) r≥0.5 large2) r≥0.5 large3) r≥0.2 clinically meaningful

Paired contrasts:

1) vs. 3) medium2) vs. 3) medium 1) vs. 2) negligible

Dyadic Adjustment Scale1) 98.3 (20.2) N=102) 99.8 (20.3) N=103) 88.9 (22.0) N=10p=NRWithin group over time:

1) r≥0.3 medium2) r≥0.3 medium3) r=negligible

Paired contrasts:

1) vs. 3) medium2) vs. 3) medium 1) vs. 2) negligible
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Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

Marital Happiness Scale(18 months)1) 5.2 (1.0)2) 5.0 (1.0)3) 5.1 (1.1)p=ns% separated during follow up 1) 20.0%2) 11.5%p=NRLength separation (days)1) 251.0 (186.4)2) 128.2 (125.0)p=NR

arital Adjustment Test (husband 

port, patient) 96.1 (20.4) 86.6 (31.7)

=ns

Marital Adjustment Test (husband report, patient)1) 108.3 (21.9)2) 104.1 (30.0)p=ns

Marital Adjustment Test (husband report, patient)1) 112.7 (22.4) 2) 102.4 (30.6)p=ns

Marital Adjustment Test (husband report, patient)1) 112.4 (19.3)2) 96.7 (36.1)p=ns Final (30 months):1) 102.5 (29.9)2) 89.8 (39.6)p=ns

BQ (marital behaviors) – 

verage couple response

 3.5 (0.7) 3.3 (0.8)

=ns

CBQ (marital behaviors) – Average couple response1) 2.5 (0.9)2) 2.2 (0.9)p=ns

CBQ (marital behaviors) – Average couple response1) 2.5 (0.9)2) 2.2 (1.0)p=ns Final (30 months):1) 2.1 (1.1) 2) 1.9 (1.1) p=ns
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exual Adjustment Questionnaire 

satisfaction with privacy and 

ontext

 2.9 (0.9) 3.3 (1.2) 3.7 (3.9)

=ns

Sexual Adjustment Questionnaire - satisfaction with privacy and context1) 3.8 (1.3)*2) 3.5 (1.2)3) 3.9 (1.2)p=0.003*changes for group 1 were significant, but not other groups

exual Adjustment Questionnaire 

requency of intercourse 4.2 (1.9) 5.0(1.5) 5.0 (2.1)

=ns

Sexual Adjustment Questionnaire - frequency of intercourse1) 4.7 (2.0)2) 5.1 (1.7)3) 4.0 (1.9)p=ns

HS dyad score

 42.4 (19.5) 42.5 (11.9)

=NR

RHS dyad score1) 58.8 (13.9)2) 54.8 (11.7)p=NR; r=0.07

RHS dyad score1) 52.8 (17.6)2) 51.2 (15.2)p=NR; r=0.07

yadic Adjustment Scale 

 104.1 (12.3) N=20 107.6 (13.3) N=19 108.5 (22.0) N=21

=ns

Dyadic Adjustment Scale 1) 103.7 (15.7) N=192) 108.4 (14.4) N=193) 105.4 (26.2) N=21p=ns

Dyadic Adjustment Scale 1) 106.0 (12.4) N=182) 107.8 (12.7) N=163) 108.3 (25.6) N=15p=ns

Dyadic Adjustment Scale 1) 109.0 (10.1) N=172) 101.2 (15.9) N=173) 113.6 (23.0) N=14p=ns

yadic Adjustment Scale 

 81.4 (32.7) 83.6 (31.8)

=ns

Dyadic Adjustment Scale 1) 105.3 (13.2)2) 97.2 (16.1)p=0.05

Dyadic Adjustment Scale 1) 93.4 (22.7)2) 84.3 (23.6)p=ns

Dyadic Adjustment Scale 1) 86.2 (25.2)2) 82.8 (25.9)p=ns
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ale to female partner violence

 = NR for all)

Twisted partner’ arm: 1) 8% vs. 2) 10% Pushed, grabbed partner:1) 25% vs. 2) 30%Slapped partner:

1) 10% vs. 2) 13%

 Forced sex on partner:

1) 13% vs. 2) 15%

 Shaken partner:

1) 20% vs. 2) 23%

Thrown partner:

1) 3% vs. 2) 3%

 Thrown object at partner:

1) 10% vs. 2) 13%

 Choked / strangled partner:

1) 0% vs. 2) 0%

Kicked, bitten, hit partner:

1) 18% vs. 2) 18%

Hit or tried to hit partner:

1) 20% vs. 2) 23%

 Beaten up partner:

1) 0% vs. 2) 3%

Threatened partner with knife

or gun:

1) 0% vs. 2) 0%

. Used knife or gun on partner: 

1) 0% vs. 2) 0%

=NR

Male to female partner violence(p = NR for all)Male to female partner violence(p = NR for all)a. Twisted partner’ arm: 

1) 3% vs. 2) 8%

b. Pushed, grabbed partner:

1)10% vs. 2) 23%

c. Slapped partner:

1) 8% vs. 2) 8%

d. Forced sex on partner:

1) 5% vs. 2) 13%

e. Shaken partner:

1) 5% vs. 2) 23%

f. Thrown partner:

1) 0% vs. 2) 3%

g. Thrown object at partner:

1) 5% vs. 2) 10%

h. Choked / strangled partner:

1) 0% vs. 2) 0%

i. Kicked, bitten, hit partner:

1) 5% vs. 2) 15%

j. Hit or tried to hit partner:

1) 8% vs. 2) 15%

k. Beaten up partner:

1) 0% vs. 2) 0%

l. Threatened partner with knife or gun:

1) 0% vs. 2) 0%

m. Used knife or gun on partner:

1) 0% vs. 2) 0%

p=NR

TLFB-SV, Male-to-Female1) 1.7 (4.9)2) 3.4 (4.2)3) 3.9 (9.7)p<0.05

TLFB-SV, Female to Male1) 1.7 (3.8) vs. 2) 4.0 (4.2)1) 1.7 (3.8) vs 3) 4.1 (4.4)p<0.05
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LFB –SV M-to-F, % days 

 2.4 (3.0) N=10 2.4 (2.5) N=10 2.4 (2.5) N=10

=NR

TLFB –SV M-to-F, % days 1) 1.3 (1.9) N=102) 1.2 (2.2) N=103) 1.4 (2.2) N=10p=NRWithin group over time:

1) r≥0.2 clinically meaningful2) r≥0.2 clinically meaningful3) r=negligible

Paired contrasts:

1) vs. 3) negligible2) vs. 3) negligible1) vs. 2) negligible

TLFB –SV M-to-F, % days 1) 1.5 (1.9) N=102) 1.5 (2.0) N=103) 1.7 (2.8) N=10p=NRWithin group over time:

1) r≥0.2 clinically meaningful2) r≥0.2 clinically meaningful3) r=negligible

Paired contrasts:

1) vs. 3) negligible2) vs. 3) negligible1) vs. 2) negligible

TLFB –SV M-to-F, % days 1) 1.4 (1.7) N=102) 1.4 (2.2) N=103) 1.8 (2.5) N=10p=NRWithin group over time:

1) r≥0.2 clinically meaningful2) r≥0.2 clinically meaningful3) r=negligible

Paired contrasts:

1) vs. 3) negligible2) vs. 3) negligible1) vs. 2) negligible

esponse to conflict scale

 112.4 (30.8) 107.6 (27.3)

=NR

Response to conflict scale 1) 79.8 (26.1)2) 102.3 (26.9)p=ns

Response to conflict scale1) 106.4 (30.0)2) 103.4 (27.2)p=ns

Response to conflict scale 1) 106.9 (27.7)2) 103.9 (21.9)p=ns

O’s report of Family nvironment Scale – Family 

onflict 

 3.4 (2.5) 3.6 (2.0) 3.5 (2.5) 

=ns

SO’s report of Family Environment Scale – Family Conflict 1) 2.7 (2.4)2) 2.8 (1.9)3) 3.2 (2.3) p=ns

SO’s report of Family Environment Scale – Family Conflict 1) 2.5 (2.1)2) 2.9 (2.3)3) 2.8 (2.4) p=ns

ard deviation) unless otherwise noted. 

st-treatment, unless otherwise noted; Long term=12 months post-treatment, unless otherwise noted. If an outcome had a final measure reported 

ong term follow up column and noted. 

tive tables but not reported here if either 1) the authors did not report findings from these measures or 2) they did not test for differences between 

R = not reported; N/A = not applicable; tx = treatment; Completers = findings for analyses conducted only with treatment completers; ITT = 

-to-treat approach.

 BFT = Behavioral Family Therapy ; ICBT = Individual Couple Behavioral Therapy; IBT = Individual Based Treatment; ICT = Individual Couple 

ounseling; BBCT = Brief Behavioral Couples Therapy; S-BFT=Standard Behavioral Couples Therapy; BMT = Behavioral Marital Therapy; BRT 

= Psychoeducational Attention Control Treatment; FSO = family member/significant other ; PSBCT = Parent Skills with Behavioral Couples 

Behavioral Marital Therapy; AA= Alcoholics Anonymous; AA/Al-Anon; RP = Relapse prevention; ABCT= Alcohol Behavior Couples Therapy; 

Therapy; CRAFT = Community Reinforcement and Family Training; ACQ = Area of Change Questionnaire; ASI = Addiction Severity Index; DAS= 

= Time Line Follow Back Interview , Spousal Violence; M-to-F= male to female; FES = Family Environment Scale; CBQ = Couples Behaviors 

Happiness Scale; SO = Significant Other 
149

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Conditions: A Review of the Evidence Evidence-based Synthesis Program

Table 4. Intermediate Outcomes – Substance Abuse Studies

Study, Year

Interventions

Sample

Outcome

Post-Treatment1

ATTENDANCE

Carroll, 200177

1) Significant Other+Contingency Management+Naltrexone

2) Contingency Management+Naltrexone

3) Naltrexone

# weeks in therapy

1) 7.4 (5.1); 2) 7.4 (4.4); 3) 5.6 (4.5) 

1) vs. 2) ns

1) & 2) vs. 3) p=0.05

Fals-Stewart, 199666

1) Behavioral Couples Therapy

2) Individual Based Treatment

# sessions attended

1) 42.9 (13.2); 2) 42.5 (12.2)

p=ns

Fals-Stewart, 200167

1) Behavioral Couples Therapy

2) Individual based methadone maintenance 

ITT

Session attendance

1) 20.3 (4.2) N=21; 2) 19.6 (5.4) N=22

p=ns

Fals-Stewart, 200368

1) Naltrexone+Brief Family Treatment

2) Naltrexone+Individual Based Treatment

# sessions attended

1) 34.2 (14.9); 2) 26.5 (15.2)

p<0.05

Fals-Stewart, 200569

1) Brief Relationship Therapy

2) Standard Behavioral Couples Therapy

3) Individual Based Treatment

4) Psychoeducational Attention Control Treatment

# sessions attended

1) 0.8 (0.2); 2) 0.8 (0.2); 3) 0.9 (0.2); 4) 0.8 (0.2) 

p=ns

Fals-Stewart, 200674

1) Standard Behavioral Couples Therapy

2) Individual Based Treatment

3) Psychoeducational Attention Control Treatment

# sessions attended

1) 23.9 (4.0); 2) 25.6 (4.1); 3) 23.6 (4.8)

p=ns

#emergency sessions attended 

1) 1.1 (2.0); 2) 1.0 (0.8); 3) 1.2 (1.3)

p=ns

Fals-Stewart, 200878

1) Brief Behavioral Couples Therapy

2) Behavioral Couples Therapy

3) Individual Based Treatment

4) Psychoeducational Attention Control Treatment

#sessions attended

1) 0.8 (0.2); 2) 0.8 (0.2); 3) 0.8 (0.2); 4) 0.8 (0.2)

p=ns

Fals-Stewart, 200979

1) Behavioral Couples Therapy

2) Individual Based Treatment

# sessions attended (men)

1) 24.3 (3.6); 2) 23.0 (3.0)

p=ns

# sessions attended (women)

1) 22.7 (4.9); 2) 24.9 (5.1)

p=ns

Kelley, 200263

1) Behavioral Couples Therapy

2) Individual Based Treatment

3) Psychoeducational Attention Control Treatment

ITT

# of sessions (alcohol-abusing pts) 

1) 23.7 (4.2) N=25; 2) 22.8 (4.0) N=22; 3) 23.0 (4.2) 

N=24

p=ns

# of sessions (drug-abusing pts) 

1) 22.4 (5.7) N=22; 2) 22.9 (5.1) N=22 3) 22.6 (4.0) 

N=21

p=ns

Kirby, 199980

1) Community Reinforcement Training Intervention 

2) Self Help

# weeks for FSO

1) 8.6; 2) 5.2

p<0.001

% FSOs completing therapy

1) 85.7%; 2) 38.8%

p<0.01
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Conditions: A Review of the Evidence Evidence-based Synthesis Program

Study, Year

Interventions

Sample

Outcome

Post-Treatment1

Lam, 200971

1) Parent Skills Behavioral Couples Therapy

2) Behavioral Couples Therapy

3) Individual Based Treatment

Attendance rates

1) 84%; 2) 86%; 3) 83%

p=ns

McCrady, 1996,72 199986

1) Alcohol Focused Spouse Involvement+ Behavioral Marital 

Therapy

2) Alcohol Focused Spouse Involvement+ Behavioral Marital 

Therapy+AA/Al-Anon

3) Alcohol Focused Spouse Involvement+ Behavioral Marital 

Therapy+Relapse Prevention

# therapy sessions attended (patients)

1) 10.5 (6.0) N=30; 2) 10.6 (5.8) N=31 3) 11.1 (5.7) 

N=29

p=ns

# patients who dropped therapy (≤5 session) 

1) 26.7 N=8; 2) 22.6 N=7; 3) 24.1 N=7

p=ns

 # therapy sessions attended (couples)

1) 10.4 (5.9) N=15; 2) 10.6 (5.8) N=14; 3) 11.1 (5.7) 

N=16

p=ns

# days in therapy attended (couples)

1) 155.9 (42.5) N=15; 2) 145.9 (42.7) N=14; 3) 172.8 

(44.3) N=16

p=ns

McCrady, 200975

1) Alcohol Behavioral Couples Therapy

2) Alcohol Behavior Individual Therapy 

Completers

% attended all sessions

1) 24%; 2) 44%

p<0.05

# sessions attended

1) 12.4 (6.4); 2) 14.9 (6.5)

p=0.05

Miller, 199981

1) Community Reinforcement and Family Training 

2) Johnson Institute

3) Al-Anon

Session attendance by SOs (mean #/#sessions, %)

1) 10.7/12 (89%); 2) 3.2/6 (53%); 3) 11.4/12 (95%)

p=NR

O’Farrell, 201082

1) Behavioral Family Counseling +Individual Based 

Treatment

2) Individual Based Treatment

ITT

Session attendance

1) 17.1 (6.7); 2) 12.0 (6.3) 

p=0.05

Winters, 200276

1) Behavioral Couples Therapy+Individual Behavioral 

Therapy

2) Individual Couple Behavioral Therapy

ITT

Session attendance

1) 39.5 (10.6); 2) 38.4 (12.2) 

p=ns

ADHERENCE

Carroll, 200177

1) Significant other +contingency management+Naltrexone

2) Contingency management+Naltrexone

3) Naltrexone

# doses in therapy

1) 19.4(15.4); 2) 17.8 (13.4); 3) 14.2 (12.4)

1) vs. 2) = ns

1) & 2) vs. 3) = ns

Fals-Stewart, 200368

1) Naltrexone+Brief Family Treatment

2) Naltrexone+Individual Based Treatment

# days on Naltrexone 

1) 102.6 (41.3); 2) 79.4 (46.3)

p<0.01

McCrady, 1996,72 199986

1) Alcohol Focused Spouse Involvement+ Behavioral Marital 

Therapy

2) Alcohol Focused Spouse Involvement+ Behavioral Marital 

Therapy+AA/Al-Anon

3) Alcohol Focused Spouse Involvement+ Behavioral Marital 

Therapy+Relapse Prevention

% homework completed 

1) 76.9%; 2) 66.4%; 3) 66.7%

p=ns

McCrady, 200975

1) Alcohol Behavioral Couples Therapy

2) Alcohol Behavior Individual Therapy 

Completers

% homework completed (among treatment 

completers)

1) 72.8% (16.6); 2) 73.7% (24.2)

p=NR
151

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Study, Year

Interventions

Sample

Outcome

Post-Treatment1

O’Farrell, 1998a4

1) Behavioral Marital Therapy + Relapse Prevention 

2) Behavioral Marital Therapy

Couples Behaviors Questionnaire 

(participation in Antabuse contract learned in BMT), 

averaged across the dyad

Post-treatment

1) 4.2 (1.2); 2) 4.5 (0.8) 

p = NR

Short-term Follow-up (6 months)

1) 2.9 (1.8); 2) 1.6 (1.9)

p=0.008

Long-term Follow-up (12 months) 

1) 2.0 (2.0); 2) 0.8 (1.2)

p=0.004

Final Follow-up (30 months)

1) 0.9 (1.6); 2) 0.4 (0.8) 

p=ns

SATISFACTION WITH CARE

Fals-Stewart, 199666

1) Behavioral Couples Therapy

2) Individual Based Treatment

Client Satisfaction Questionnaire

1) 25.3 (5.2); 2) 26.4 (6.0)

p=ns

Fals-Stewart, 200167

1) Behavioral Couples Therapy

2) Individual based methadone maintenance 

ITT

Client Satisfaction Questionnaire

1) 27.9 (6.4) N=21; 2) 25.5 (6.7) N=22

p=ns

Fals-Stewart, 200368

1) Naltrexone+Brief Family Treatment

2) Naltrexone+Individual Based Treatment

Client Satisfaction Questionnaire-8

1) 23.2 (3.8); 2) 24.4 (4.0)

p=ns

Fals-Stewart, 200569

1) Brief Relationship Therapy

2) Standard Behavioral Couples Therapy

3) Individual Based Treatment

4) Psychoeducational Attention Control Treatment

Client Satisfaction Questionnaire-8

1) 24.7 (2.9); 2) 26.2 (3.9); 3) 24.1 (4.1); 4) 24.0 (4.0)

p=ns

Fals-Stewart, 200674

1) Behavioral Couples Therapy

2) Individual Based Treatment

3) Psychoeducational Attention Control Treatment

Client Satisfaction Questionnaire

1) 24.3 (4.5); 2) 25.0 (5.2); 3) 23.0 (6.4)

p=ns

Fals-Stewart, 200878

1) Brief Behavioral Couples Therapy

2) Behavioral Couples Therapy

3) Individual Based Treatment

4) Psychoeducational Attention Control Treatment

Client Satisfaction Questionnaire-8

1) 23.8 (4.0); 2) 24.3 (4.1); 3) 25.0 (4.4); 4) 23.1 (4.6)

p=ns

Fals-Stewart, 200979

1) Behavioral Couples Therapy

2) Individual Based Treatment

Client Satisfaction Questionnaire-8 (Men)

1) 23.74 (3.91); 2) 24.00 (4.12)

p=ns

Client Satisfaction Questionnaire-8 (Women)

1) 22.9 (4.5); 2) 24.0 (4.9)

p=ns

Winters, 200276

1) Behavioral Couples Therapy+ Individual Behavioral 

Therapy

2) Individual Couple Behavioral Therapy

ITT

Client Satisfaction Questionnaire

1) 24.1 (3.7); 2) 22.9 (4.4) 

p=ns

Outcomes reported as mean (standard deviation) unless otherwise noted. 

ns = not significant (at 5% level); NR = not reported; N/A = not applicable; Completers = findings for analyses 

conducted only with treatment completers; 

ITT = findings for analyses using an intent-to-treat approach.

1

Outcomes are reported post-treatment, unless otherwise noted. 
152

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

ormation - Bipolar Disorder Studies

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

ized 

ed

male

rs

 NR

NR

R

teristics:

r of 

ethod:

cutively 

atient and ices were 

inclusion

MH Condition: major affective disorder or bipolar disorder, manic, depressed, or mixedAssessed by: Interview using Schedule for Affective Disorders and SchizophreniaSO: spouse or partner of opposite sex, married or living together ≥ 6 monthsInclusions: 21 to 65 years old; admission diagnosis of major affective disorder or bipolar disorder, manic, depressed, or mixed; married or living with significant other of opposite sex ≥6 monthsExclusions: organic brain syndrome, current primary diagnosis of alcohol or drug abuse, pregnancy, contraindications to use of lithium or carbamazepine

1) Medical management + marital intervention (N=18)2) Medical management only (N=15)Randomized:N=46Analysis:Baseline: N = 33Post-treatment (Final 11 months):N=33

Format: marital therapyManualized: YesSession: 25 (one weekly for first 10; then bimonthly)Txt Length: 11 monthsApproach: psychoeducational

NOTE: all patients received standardized medications in each of 3 classes: mood stabilizers, antidepressants, and antipsychotics

Patient Outcomes:Symptomsa. SADS-CFunctioninga. Global Assessment ScaleIntermediate Outcomes:a. Medication Adherence using study developed scale (1-6 rating, poor to excellent)Family Outcomes:NoneOutcome timeframe:Baseline Post-treatment (Final): 11months

Allocation concealment: UnclearBlinding: UnclearIntention to treat analysis: NoWithdrawals adequately described: NoTreatment Integrity: audio tapes of marital intervention sessions were sampled for adherence to procedures outlined in manualStudy Quality: Poor
153

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

mized

ed

male

 

 55% 

abiting

R

teristics:

55% 

iblings, 

ring

ethod:

 4 psy

nt units 

tudy as 

MH Condition: Bipolar I disorder, manic, mixed, or depressionAssessed by: Structured Clinical Interview for DSM-III-R SO: “close relatives” including parents, spouses, siblingsInclusions: DSM-II-R diagnosis of bipolar I disorder, manic, mixed, or depressed episode in previous 3 months; age 18-60 yrs; no neurologic disorder or developmental disability; no DSMIII-R drug or alcohol disorders in previous 6 months; living with or in regular contact (4+ hrs/wk) with close relative; willing to commit to pharmacotherapy with mood stabilizers or antipsychotic medications; English speaking; patient and relative willing to consentExclusions: no additional criteria reported

1) Family-focused treatment with pharmacotherapy (N=31)2) Crisis management with pharmacotherapy (N=70) (“treatment as usual” condition with 2 home-based family education sessions, emergency counseling as needed, minimum of monthly telephone call to monitor status)Randomized: N=101Analysis: Baseline: N=101Long term (Final): 12 months:N=79

Format: Family-focused (family or marital) Manualized: YesSession: up to 21 sessions, 1 hour, in the family’s homeTxt Length: 9 monthsApproach: psychoeducation, communication skills, 

problem definition and solution

Patient Outcomes: Symptomsa. SADS-Cb. Relapsec. SurvivalIntermediate Outcomes:a. Medication ComplianceFamily Outcomes: NoneOutcome timeframe:Baseline Long Term (Final): 12 months

Allocation concealment: UnclearBlinding: Yes (medication intensity and compliance ratings)Intention to treat analysis: NoWithdrawals adequately described: YesTreatment Integrity: audio tapes reviewed for adherenceStudy quality: Good

witz 

Same as Miklowitz 200090MH Condition:Assessed by:SO:Inclusions:Exclusions:Same as Miklowitz 200090

Same as Miklowitz 200090

1) Family-focused treatment with pharmacotherapy (N = 22 completed 2 years)2) Crisis management with pharmacotherapy(N = 43 completed 2 years)

Same as Miklowitz 200090 Same as Miklowitz 

2000902 year outcomes

Same as Miklowitz 200090
154

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

mized

zed

male

 

%

an 4% 

an <1% 

slander 

 

Unmarried 

d 31%

teristics:

 “typically 

nts, or 

ethod:

atment 

Program 

order 

MH Condition: Bipolar I or II disorder and current major depressive episodeAssessed by: Structural Clinical Interview for DSM-IV and MiniInternational Neuropsychiatric InterviewSO: Family members Inclusions: 18+ years; DSM-IV criteria for current bipolar I or II disorder and a current major depressive episode; current treatment with mood stabilizer or willing to start treatment; no current psychotherapy (or willing to discontinue or taper); English speaking, able to consentExclusions: require immediate treatment for DSM-IV substance or alcohol abuse or dependence disorder (except nicotine); pregnant or planned pregnancy in next yr; history of intolerance, nonresponse, or medical contraindication to paroxetine or buproprion; required initiation or dose changes of antipsychotic medications

1) Family-focused treatment (FFT)* (N=26)2) Interpersonal and social rhythm therapy (IPSRT) (N=62)3) Cognitive behavior therapy (CBT) (N=75)4) Collaborative care (CC) – control group (N=130)NOTE: All patients received pharmacotherapy*Assignment to FFT possible only if willing family members Randomized:N=293Analysis: Baseline: N=293Long term (Final): 12 months:N=293

1) Format: FFTManualized: YesSession: up to 30 50-min sessionsTxt Length: 9 monthsApproach: psychoeducation, communication enhancement, problem solving

2) Format: IPSRTManualized: Yes Session: up to 30 50-min sessionsTxt Length: 9 monthsApproach: Social Rhythm Metric for stable social rhythms, problem resolution, rehearsed strategies3) Format: CBTManualized: YesSession: up to 30 50-min individual sessions Txt Length: 9 monthsApproach: psychoeducation, life events scheduling, 

cognitive restructuring, problem-solving, detection and intervention for mood episodes, interventions for comorbidities4) Format: CCManualized: YesSession: 3 50-min individual sessionsTxt Length: 6 weeksApproach: psychoeducation

Patient Outcomes: 1) Recovery2) Time to recovery Clinical Monitoring Form - depression and mania items used to define recovery (≤2 moderate symptoms for ≥8 of the previous weeks) and compute time to recovery and total time in recovery over 1 year of observationIntermediate Outcomes:AttendanceFamily Outcomes:NoneOutcome timeframe:Baseline Long Term (Final): 12 months

Allocation concealment: UnclearBlinding: unclearIntention to treat analysis: YesWithdrawals adequately described: YesTreatment Integrity: audio tapes rated for adherence to treatmentStudy quality: Good
155

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

 male

 

 

Unmarried 

d 32%

teristics: 

Same as Miklowitz 200792

MH Condition:Assessed by:SO:Inclusions:Exclusions:

1) Psychosocial Treatment (combined FFT, IPSRT, and CBT groups) (N=84)2) Collaborative Care (CC) (N=68 )

Same as Miklowitz 200792 Patient Outcomes:

a. Functioning (LIFE-RIFT total score)Intermediate Outcomes: NoneFamily Outcomes:a. Relationship functioning & satisfaction domains (LIFE-RIFT)Outcome timeframe: BaselineLong term (Final): 9 months

Same as Miklowitz 200792

ized

ed

male

 NR

 

15%

orced/

rs): 13 

teristics:

1%

ethod: In

l hospital 

utpatients 

ty-affiliat

clinic

MH Condition: Bipolar I disorder mood episode (mania, major depression, or mixed)Assessed by: Structured Clinical Instrument for DSM-III-R-Patient Version SO: patient and family membersInclusions: current bipolar I disorder mood episode; no DSMIII-R alcohol or drug dependence within 12 months of enrollment; age 18-65 yrs; living with or in regular contact with relative or significant other; English speaking Exclusions: no additional criteria reported

1) Pharmacotherapy + family therapy (N=33)2) Pharmacotherapy + multifamily psychoeducational group (MFG) therapy (N=30)3) Pharmacotherapy alone (N=29)Randomized:N=92Analysis: Baseline: N=92Long term (Final): 28 months:N=92

1) Format: Family therapyManualized: YesSession: 6 to 10 50-min sessions Txt Length: NR*Approach: Problem Centered Systems Therapy of the Family2) Format: MFG therapy (4-6 patients and family members > 12 yrs)Manualized: YesSession: 6 90-min sessions Txt Length: 6 weeks*Approach: Psychoeducational 3) Format: PharmacotherapyManualized: YesSession: weekly for 1 mo then every 3 monthsTxt Length: NR*Approach: medication adjustment, support, encouragement

Patient Outcomes:Symptomsa. Recovery (defined as 2 consecutive months scores of <7 on HAM-D and <6 on BRMS)Intermediate Outcomes:a. Pharmacotherapy sessions attendedFamily Outcomes:NoneOutcome timeframe:Baseline Long Term (Final): 28 months

Allocation concealment: UnclearBlinding: Yes (rating of pharmacotherapy)Intention to treat analysis: YesWithdrawals adequately described: NoTreatment Integrity: Treatments monitored and evaluated at weekly meetings of study clinicians and investigatorsStudy Quality: Fair
156

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

male

rs

 NR

 NR

R

teristics:

lysis

d not 

S at 

ethod: 

ial 

ts, and 

m a 

ated 

c (96% 

zed)

Same as Miller 200489Analysis using proportional measures of long-term course of illness and based on level of family impairment according to McMaster Clinical Rating Scale (MCRS)Additional Exclusions reported: DSM-IIIR for alcohol/drug dependence in the last year; mood disorder secondary to a general medical condition; illness that contraindicates mood stabilizer use; pregnant, or not using contraception.

Same as Miller 200489

Baseline N = 91High impairment:N = 60 (66%)Low impairmentN = 31 (34%)Final (28 months) N= 82High impairment:N = 55 (67%)Low impairmentN = 27 (33%)

Same as Miller 200489

except indicates target was 10-15 family-therapy sessions (vs. 6-10)

Patient Outcomes:a. Recovery/ relapse (% who recovered and relapsed based on HAM-D and BRMS for high and low family impairment subgroups)Intermediate Outcomes:NoneFamily Outcomes:NoneOutcome timeframe:Baseline Long Term (Final): 28 months

Same as Miller 200489
157

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

46

male

 

%

an 7.5%

% 

ting 15%

ced/ 

%

55%

regivers 

al Center

 = 46

male

 

%

an 5% 

 

ting 44% 

rced/ 

% 

23%

teristics: 

Spouse 

ult child 

 neighbor 

ethod:

ental 

s

MH Condition: Bipolar I or II disorderAssessed by: Structured Clinical Interview for DSM-IV Axis I DisordersSO: CaregiverInclusions: age 18+; primary caregiver of relative with bipolar I or II; meet at least 3 (2 for nonrelatives) criteria: a) spouse or parent, b) more frequent contact than any other caregiver, c) helps support patient financially, d) is contacted by treatment staff for emergencies, e) involved in patient’s treatment; current physical and mental health problemsExclusions: no additional criteria reported

1) Family-Focused Treatment-Health Promoting Intervention (FFT-HPI) (N=25 caregivers)2) Health education (HE) (N=21 caregivers)NOTE: recruited caregivers who were primary caregiver of relative with conditionRandomized:N = 46 caregivers of 46 patientsAnalysis: Baseline: N=43 caregivers of 40 patientsPost-treatment (Final): 5 months:N = 43 caregivers of 40 patients

1) Format: Family focused (but only the caregiver was involved)Manualized: YesSession: 12-15 sessionsTxt Length: approx 5 monthsApproach: Psychoeducation and goal setting, behavioral analysis of selfcare barriers2) Format: Individual (via DVD)Manualized:Session: 8-12 sessions via DVDTxt Length: approx 5 monthsApproach: health education

Patient Outcomes:Symptom Improvementa. HAM-Db. YMRSIntermediate Outcomes: NoneFamily Outcomes:NoneOutcome timeframe:Baseline Post-treatment (Final): 5 months

Allocation concealment: YesBlinding: Yes (assessor and participants during administration of the initial assessment; posttest assessment)Intention to treat analysis: NoWithdrawals adequately described: NoTreatment Integrity: Randomly selected treatment tapes rated for competence and adherenceStudy quality: Fair
158

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

ized

ed

male

 

%

an 23% 

n 9%  

teristics:

bers (29 

thers, 1 

pouses, 7 

ndmother, 

s

ethod:

arge hos

MH Condition: Bipolar disorder, manic typeAssessed by: DSM-III-R with confirmation by Present State Examination (PSE) with supplementary mania itemsSO: “close family member”;66% had one relative to participated, 34% had multiple relativesInclusions: diagnosis of bipolar disorder, manic type; age 18-45, able to give consent, currently taking mood-regulating medications; at least one close family member available to participateExclusions: evidence of organic central nervous system disorder or chronic alcohol or substance abuse/dependence

1) Family-focused treatment with pharmacotherapy (N=28)2) Individually focused patient treatment with pharmacotherapy (N=25)Randomized:N=53Analysis: Baseline: N=53Post-treatment: N=53Long term (Final): 24 months:N=29

1) Format: Family-focused or individual Manualized: YesSession: 21 one-hour sessions over 9 months (medication management continued to 12 months)Txt Length:12 monthsaApproach: psychoeducation, communication 

enhancement training, problem-solving training2) Format: Individually focused patient treatmentManualized: Not statedSession: 21 30-min sessions over 9 months (medication management continued to 12 months)Txt Length:12 monthsa

Approach: supportive, problem-focused, educationalaAt 12 months, patients 

were referred to and assisted in transitioning to community providers

Patient Outcomes:a. Relapse (based on BPRS and supplementary items from SADS-C)b. Rehospitalization(Patient and relative reports verified by inpatient records where possible)Intermediate Outcomes:a. Medication Compliance(Psychiatristcompleted form)Family Outcomes: NoneOutcome timeframe:Baseline Post-treatment Long term (Final): 24 months

Allocation concealment: UnclearBlinding: Yes (outcomes)Intention to treat analysis: NoWithdrawals adequately described: YesTreatment Integrity: Videotapes rated for therapist adherence and competenceStudy quality: Good
159

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

acteristics Inclusion and Exclusion 

Criteria

Treatment Groups Intervention Outcomes

Assessed

Quality

male

 NR

 66% 

g with 

19%, 

orced/

rs): 13 

teristics: 

up

ethod: 

ial 

ts, and 

m a 

ated 

c

Same as Miller 200489

Analysis of recurrence of mood episodes and hospitalizations for 53 subjects who recovered from intake mood episode

Same as Miller 200489 Same as Miller 200489 Patient Outcomes:

Symptoms:a. Frequency of mood episode recurrence (based on HAM-D>15 or BRMS>5)Utilization:a. HospitalizationIntermediateOutcomes:NoneFamily Outcomes:NoneOutcome timeframe:Baseline Long Term (Final): 28 months

Same as Miller 200489

other or family member included; SADS-C = Schedule for Affective Disorders and Schizophrenia-Change Version; DSM = Diagnostic and 

rs; tx = treatment; BRMS = Bech-Rafaelsen Mania Scale; HAM-D = Hamilton Depression Rating Scale; LIFE-RIFT = Longitudinal Interval Follow

Functioning Tool; YMRS = Young Mania Rating Scale; DVD = digital video disk; BPRS = Brief Psychiatric Rating Scale

patient basis for up to 28 months
160

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

ipolar Disorder Studies

Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

SADS-C1) 55.9 N=182) 62.0 N=15

SADS-C1) 49.8 N=182) 54.8 N=15p=ns for test of differences 

between treatment groups over time 

SADS-C (Total affective symptoms)1) 2.2 (0.6) N=282) 2.2 (0.6) N=51Completers onlyp = NR

SADS-C 1) 1.9 (0.6) N=282) 2.2 (0.8) N=51p = NR

SADS-C 1) 2.0 (0.7) N=28

2) 2.2 (0.8) N=51

p = NRp=ns for treatmentp=0.05 for test of differences between treatment groups over time at 12 months 

p=0.007 for test of differences between treatment groups over time at 24 months (15 months posttreatment)

Relapse 1) 8/31 (26%) 2) 27/70 (39%)p=NR ITT analysisSurvival (no relapse) 1) 71%2) 47%p=0.04Drop-outs excluded

Relapse (24 months or 15 months posttreatment)1) 11/31 (35%) (3 patients terminated early)2) 38/70 (54%) (16 patients terminated early) p<0.005ITT analysisMean survival without relapse (24 months or 15 months post-treatment)1) 73.5 wks2) 53.2 wks Hazard Ratio=0.37 (95%CI 0.19-0.72)ITT analysis
161

reatments for Adult Mental Health

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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

 

Recovery (based on SADS-C)1) 20/26 (77%) (HR relative to 4 = 

1.87)

2) 40/62 (65%) (HR=1.48)3) 45/75 (60%) (HR=1.34)4) 67/130 (52%)No differences 1, 2, 3 (1, 2, & 3 

combined vs. 4, p=0.01)

1 vs 4, p=0.02Confidence intervals not reported for HRsTime to recovery (median among those who 

recovered, N=172)

1) 103 days2) 128 days3) 112 days4) 146 daysNo differences 1, 2, 3Recovery (in subsample with family availability, N=159)1) 20/26 (77%) (HR=1.40)2) 17/30 (57%) (HR=1.16)3) 23/39 (59%) (HR=0.98)4) 37/64 (58%)No differences 1, 2, 31 vs. 4, p=0.10

Recovery (2 consecutive months with BRMS < 6 and MHRSD < 7)1) 16/33 (48%)2) 21/30 (70%)3) 16/29 (55%)p=0.21 (at 28 months – final)

 

RecoveryLow family impairment (N=27)1) 2/5 (40%)2) 7/9 (78%)3) 11/13 (85%)High family impairment (N=55)1) 12/24 (50%)2) 14/18 (78%)3) 5/13 (39%)p=ns for main effects (family impairment or treatment condition)Interaction p=ns (at 28 months – final)
162

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

Relapse after recoveryLow family impairment (N=20)1) 1/2 (50%)2) 4/7 (57%)3) 7/11 (64%)High family impairment (N=31)1) 8/12 (67%)2) 9/14 (64%)3) 3/5 (60%)p=ns for main effects (family impairment or treatment condition)Interaction p=nsSignificant (all p<0.05) family impairment by tx interaction for:a) # depressive episodes/yrb) % time in any mood episodec) % time in depressive episodeHigh impairment families: 1) significant differences - MFG vs. 

medication only for a), b), and c)

2) significant difference between FT vs. 

medication only for a)

Low impairment families:No difference between tx groups(at 28 months – final)

HAM-D1) 15.6 (10.3) N=222) 14.9 (5.7) N=18p=0.26

HAM-D1) 5.6 (6.1) N=222) 11.2 (9.1) N=18p=0.025, d=0.67

YMRS1) 8.8 (9.7) N=222) 9.2 (9.2) N=18p=0.15

YMRS1) 1.6 (2.4) N=222) 5.8 (9.0) N=18p=0.037, d=0.34
163

reatments for Adult Mental Health

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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up



Relapse (% with at least 1 

relapse based on BPRS and supplementary items from SADS-C)

1) 46%2) 52%p>0.10 Interaction with premorbid adjustment – family treatment reduced risk of relapse in patients with poorer premorbid adjustment, p=0.06

Relapse (% with at least 1 relapse)1) 28%2) 60%p<0.05Interaction with premorbid adjustment, p=ns

Rehospitalization (% with at 

least 1 rehospitalization):

1) 29%2) 40%p>0.10 Interaction with premorbid adjustment, p=ns

Rehospitalization1) 12%2) 60%p<0.01Interaction with premorbid adjustment, p<0.03Frequency of mood episode recurrence (MHRSD > 15 or BRMS > 5)1) 11/16 (69%)2) 13/21 (62%)3) 10/16 (63%)p=0.90 (at 28 months – final)

GAS1) 64.4 N=182) 64.7 N=15

GAS1) 73.0 N=182) 65.7 N=15p<0.03 (test of treatment group differences over time)

 

LIFE-RIFT Total ScoreDifference (9 month and baseline)1) -3.2 (3.1)2) -1.6 (4.4)3) -1.1 (4.7)4) -0.9 (3.5)1, 2, & 3 combined vs. 4, p=0.04(more negative score = greater improvement)
164

reatments for Adult Mental Health

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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

Hospitalization frequency1) 5/16 (31%)2) 1/21 (5%)3) 6/16 (38%)p=0.04 (MFG significantly lower)(at 28 months – final)

ard deviation) unless otherwise noted. 

st-treatment, unless otherwise noted; Long term=12 months post-treatment, unless otherwise noted. If an outcome had a final measure reported 

ong term follow up column and noted. 

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

RMS = Bech-Rafaelsen Mania Scale; GAS = Global Assessment Scale; HAM-D = Hamilton Depression Rating Scale; HR = hazard ratio; LIFE

Up Evaluation – Range of Impaired Functioning Tool; MFG = multiple family group; MHRSD = Modified Hamilton Rating Scale for Depression; 

sorders and Schizophrenia-Change Version
165

reatments for Adult Mental Health

dence Evidence-based Synthesis Program

ipolar Disorder Studies

Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

ACTION

 

LIFE-RIFT Relationship 

Functioning Domain

Difference (9 month and baseline)1) -0.5 (1.6)2) -0.3 (2.1)3) -0.2 (1.3)4) 0.1 (1.5)1, 2, and 3 combined vs. 4, 

p=0.02

(more negative score = greater 

improvement)

LIFE-RIFT Satisfaction DomainDifference (9 month and baseline)1) -0.9 (0.9)2) -0.3 (1.4)3) -0.1 (1.2)4) 0.0 (1.3)1, 2, and 3 combined vs. 4,p=0.048

ard deviation) unless otherwise noted. 

st-treatment, unless otherwise noted; Long term=12 months post-treatment, unless otherwise noted. If an outcome had a final measure reported 

ong term follow up column and noted. 

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

FE-RIFT = Longitudinal Interval Follow-Up Evaluation – Range of Impaired Functioning Tool
166

reatments for Adult Mental Health

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es - Bipolar Disorder Studies

Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

 

Attendance mean sessions/# of 

sessions

1) 11.5/30 (38%)2) 16.7/30 (56%)3) 13.3/30 (44%)4) 2.2/3 (73%)

p=ns (1 vs. 2 vs. 3)

T)

oup 

Pharmacotherapy sessions 

attended (ITT analysis)

1) 15 (10)2) 12 (8)3) 12 (8)p=ns(at 28 months – final)Pharmacotherapy sessions 

attended (N=53 who recovered)

1) 20 (9)2) 14 (7)3) 16 (6)p<0.05 (group 1 vs. group 2)(at 28 months – final)

Study designed med adherence scale1) NR N=182) NR N=17scale of 1=poor, 6=excellent

Study designed med adherence scale1) 5.7 N=182) 5.2 N=17p=0.008

1) 2.8 (0.4)2) 2.6 (0.5)p=0.04scale of 1=fully non-adherent, 

3=fully adherent
167

reatments for Adult Mental Health

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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

n

Physicians’ rating of medication compliance(7-point Likert-type scale)1) 6.2 (1.6)2) 5.6 (1.9)p=ns

ard deviation) unless otherwise noted. 

st-treatment, unless otherwise noted; Long term=12 months post-treatment, unless otherwise noted. If an outcome had a final measure reported 

ong term follow up column and noted. 

 = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

ormation - Schizophrenia Spectrum Disorder Studies

e

istics

Inclusion/Exclusion

Criteria Treatment Groups Intervention Characteristics Outcomes Assessed Quality

% male

ears

ty:

s:

%

 87%

NR

R

m 

nrolled 

y 

h 

 living 

y.

cs: NR

MH Condition: Schizophrenia or schizoaffective disorderAssessed by: structured clinical interview for DSMIV criteria diagnosisInclusions:In addition to diagnosis; age 18-45; enrolled in outpatient community mental health services in Spokane, WA, reside with family of origin, or have regular contact with family; family member and patient agree to consent; minimum attendance by one family member for at least five face to face contacts. [Subjects then stratified by medication status – atypical vs conventional antipsychotic use.]Family member or SO:Any family member 

1) Multiple Family Group (MFG) N=552) Standard Care (SC) N = 51No statistical differences at baseline – frequency of substance abuse, use of atypical antipsychotics, or severity of positive or negative symptoms Analysis:Baseline (pre and post): N=106

1) Format: Usual care + 1) three weekly sessions with clinicians and families (individually) without patient; 2) then a multiple family educational workshop (again without patient); then 3) biweekly multiple family group sessions with patient present. Manualized: YesSessions: NR2 yearsApproach: multi-disciplinary; psychoeducational, develop a supportive network, formal problem solving techniques.2) Format: Mental Health multidisciplinary treatment team delivered medication management, case management, some patients therapeutic and rehabilitation services.Manualized: N/ASessions: N/ATxt Length: N/AApproach: Multidisciplinary 

Patient Outcomes:Utilization:a. Hospitalization rateb. Crisis care usedc. Outpatient service utilization Outcome timeframe:Pre-treatment (year before baseline)During -treatment (1 year after baseline)

Allocation concealment:NRBlinding: NRIntention to treat analysis: YesWithdrawals adequately described: YesTreatment integrity:Study supervisors do systematic review of videotapes for engagement sessions and multiple family group settings; weekly phone consultations, and annual on-site visits. Study Quality:Good
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e

istics

Inclusion/Exclusion

Criteria Treatment Groups Intervention Characteristics Outcomes Assessed Quality

% male

rs

ty:

%

s: NR

R

Same as Dyck, 2002102 1) MFG N=32

2) SC N=31Analysis:1) MFG N=212) SC N=21(42 participants that received treatment for full 12 months)

Same as Dyck, 2002102 Patient Outcomes:

Symptoms:a. MSANSOutcome timeframe:BaselineDuring -treatment (1 year after baseline)

Same as Dyck, 2002102

% male

ears

ty:

merican 

n 

%s: NR

R

Same as Dyck, 2002,102

2000101

1) MFG N=532) SC N = 44Analysis:Baseline: N=97Final: N = 97

Same as Dyck, 2002,102 2000101 Patient Outcomes:

Utilization:a. Hospitalization rate (overall psychiatric, community, state, overall)b. Outpatient service utilization Outcome timeframe:Pre-treatment (year before baseline)Post-treatment (2 years)Final (3 years post baseline, 1 year after post-treatment)

Same as Dyck, 2002,102 2000101
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e

istics

Inclusion/Exclusion

Criteria Treatment Groups Intervention Characteristics Outcomes Assessed Quality

% male

ears

ty:

%

 1%

s:

ed 84%

vorced/

%

 1%

NR

R

ected 

sion 

ervice 

ial 

n 

sis 

acute 

isode.

cs: NR

MH Condition: Schizophrenia or schizoaffective/schizophreniform disordersAssessed by: Structured clinical interview DSM-III-R criteriaInclusions: In addition to diagnosis, subjects also needed to have one or more complicating factors:lack of consistent treatment participation; history of violence or suicidality, frequent hospitalization, homelessness, arrests/convictions, moderate to severe substance use; at least one family member required to participate and give informed consent.Family member or SO:Any family memberExclusions: Acutely violent or suicidal; major medical illness or physical addiction requiring immediate hospitalization (excluded only until subject was stabilized)

1) Multi-family group N=37*2) Crisis only N = 31**Both groups are in Assertive community treatment (ACT); ACT consists of manualized program covering eight areas (includes family education and engagement); and one home visit. Analysis:Baseline: N=68 Post-treatment (2 years): N = 68Family outcomes only:Baseline: N=46Post-treatment (2 years): N = 46

1) Format: ACT + initial workshop for family only; then multi-family group meetings (6 families and patient is present)Manualized: YesSession: every 2 wks Txt Length: 2 yearsApproach: Psychoeducational; Treatment decisions guided by group. Group provides social support, learn formal problem solving technique.2) Format: ACT+ interaction between treatment team and family members only in crisis. No multi-family groups. Manualized: YesSession: N/AApproach: Psychoeducational

Patient OutcomesGlobal functioning: a. Employment ratesSymptoms:a. PANSS (positive, negative, general)Health Care Utilizationa. Re-HospitalizationFamily Outcomes:Global Functioning:a. SAS-FV IIIDissatisfaction with patient Friction between pt and others Well being of family Outcome timeframe:BaselinePost-treatment

Allocation concealment: NoBlinding: NRIntention to treat analysis: No, on family measures.Withdrawals adequately described: NoStudy Quality:Fair
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e

istics

Inclusion/Exclusion

Criteria Treatment Groups Intervention Characteristics Outcomes Assessed Quality

% male

ears

s: 

ed 63%

 37%

ty: 

R

HS 

plete

R

nts 

vices 

ng 

h 

igible 

e 

for 

o 

cs: NR

MH condition: Dual disorder; either schizophrenia, schizoaffective or bipolar disorder AND active substance use or dependence within past 6 monthsAssessed by: Structured clinical interview DSM IV (for both)Family member or SO:a relative, close friend, or other person with a ‘caring but non-professional relationship’ to subject (e.g. clergy)Inclusions: In addition to diagnosis; ≥18 yrs old; ≥4 hours per week contact with the family member; diagnosis of active substance abuse or dependence within the past six months (based on SCID); subject currently receiving services at one of three mental health agencies participating in studyExclusions:None

1) FIDD - Family Intervention for Dual Disorders N=522) FPE – Family Psychoeducation N = 56Analysis:ITT N=108 up to 36 months. 

1) Format: Family member(s) and patient presentManualized: NRSessions: 20–30 sessions, 1-1.5 hours Txt Length: 9-18 mos Approach: Psycho educational/behavioral family therapy; education, communication and problem solving, tailored strategies, encouraged attendance at multiple family support groups between end of treatment & 36 months.2) Format: Family member and patient present Manualized: NRSessions: 6-8, 1 hourTxt Length: 6-8 weeks Approach: Psychoeducational; basic information about disorders and treatment; encouraged attendance at multiple family support groups between end of treatment & 36 months.

Intermediate OutcomesAdherence:a. Engagement (participation rate in ≥2 sessions)b. Exposure (attended at least 3 problem solving sessions for FIDD or 6 educational sessions for FPE)Outcome timeframe:Post-treatment only 

AllocationConcealment: NRBlinding: Yes (assessors)Intention-to-treat analysis: YesWithdrawals adequately described: YesTreatment integrity:Interviews wererandomly selected and rated by a third interviewer to check on reliabilityStudy Quality:Good
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e

istics

Inclusion/Exclusion

Criteria Treatment Groups Intervention Characteristics Outcomes Assessed Quality

eser, 

Same as Mueser, 200999 Same as Mueser, 

200999

Same as Mueser, 200999 Patient Outcomes

Symptom improvement: a. BPRS – totalb. BPRS psychosis scale c. TLFB Days Drinkingd. TLFB Days using drugsGlobal functioning: a. GAS b. % stable days in communityIntermediate OutcomesAdherenceb. Days medication nonadherenceOutcome timeframe:BaselinePost-treatmentFinal (36 months post baseline – 18 months post-treatment for FIDD group; 33 months posttreatment for FPE group)

Same as Mueser, 200999
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reatments for Adult Mental Health

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e

istics

Inclusion/Exclusion

Criteria Treatment Groups Intervention Characteristics Outcomes Assessed Quality

 then 

ted a 

phase s);e 

cs 

N=313

% male

ears

ty: NR

s: NR

NR

R

ring 

on 

ute 

 

cs: NR

MH Condition: Schizophrenia, schizoaffective/schizophreniform disordersAssessed by: Structured clinical interview for DSMIII-R diagnosisFamily member or SO: Any family member.Inclusions: In addition to diagnosis; age 18-55; willingness to take fluphenazine decanoate injections and not receive other neuroleptic, antidepressant, or mood stabilizing medications; in contact with family of origin or legal guardian > 4 hours per week; subject and family member consent; psychiatric hospitalization or symptom relapse in the past three months.Exclusions: Current physical dependence on alcohol, stimulants, barbiturates, or narcotics, current hospitalization precipitated by substance abuse; current pregnancy; Liver damage, epilepsy or acute brain syndrome, unequivocal liver damage.

Two stage:Assigned to familytreatment N = 5281) Applied family management(AFM) N = 2722) SupportiveFamily management(SFM) N = 256Note: Assigned to atreatment group,then stabilized (stabilization phase for 16-24 weeks); then 2 year maintenance phase.After stabilization,further dividedbetween 3 doseregimens ofFluphenazine.Stabilized, and on tomaintenance phaseN = 313: 1) AFM N = 1572) SFM N = 156Analysis:Baseline: N=313Post-treatment (2 years)N = 313

1) Format:* Individual family meeting in home, then sessions in home (individual) with patient present; monthly family group meetings and case management that paralleled SFM.Manualized: YesSessions: weekly then biweekly then monthly; max of 32 sessions Txt Length: > 2 yearsApproach: behavioral family therapy, in addition to SFM model - psychoeducational (communication, problem solving, social support)2) Format*: Monthly group meetings (with patient present), with case management / consultation with treatment team for problem solving (if initiated by family). Manualized: NRSessions: Monthly Txt Length: > 2 years Approach: psychoeducational (communication, problem solving, social support). Families relied on to initiate contacts with treatment team as needed. 

Patient OutcomesUtilization:a. Time to rehospitalizationb. % rehospitalizedc. Time to first rescue medicationd. Time to psychotic relapseOutcome timeframe:Final (24 months post)Intermediate OutcomesTreatment attendancea.% attended initial workshop b.% attended monthly support meetingsOutcome timeframe:BaselinePost-treatment 

Allocation concealment:NRBlinding:Medication blindedIntention to treat analysis: No; only those who stabilized shownWithdrawals adequately described: YesTreatment Integrity: Certification in AFM required for study clinicians based on video sessions; ongoing competency monitored through audio taped sessions & supervisory telephone calls.Study Quality:Fair
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e

istics

Inclusion/Exclusion

Criteria Treatment Groups Intervention Characteristics Outcomes Assessed Quality

 as 

9724

Same Study as Schooler 199724

Same Study as Schooler 199724Analysis of those who stabilized and went to maintenance phaseN = 3131) AFM, N = 1572) SFM, N = 156Analysis:Baseline: N=313Post-treatment (2 years)N = 313

Same Study as Schooler 199724 Family Outcomes

Family Functioning a. SAS-PT Social functioning Family relationship Patient Rejection Scaleb. SAS-Interim Patient: Family friction scaleCouple functioning: a. SAS-PT Romancesexual Outcome timeframe:BaselinePost-treatment 

Same Study as Schooler 199724Treatment Integrity: Additional information provided: all sessions audio taped, and select sessions evaluated by independent rater.

 DSM=Diagnostic and Statistical Manual of Mental Disorders; SO=significant other or family member included; MFG=Multiple Family Group; 

d; N/A=not applicable; SO=significant other; MANS=Modified Scale for Assessment of Negative Symptoms; ACT=Assertive community 

gative Syndrome Scale; SAS-FV=Social Adjustment Scale – Family Version; FIDD=Family Intervention for Dual Disorders; FPE=Family 

anagement=AFM; Supportive Family Management=SFM; SAS-PT=Social Adjustment Scale Patient; TLFB = Time Line Follow Back; BPRS = 

 = Global Assessment Scale

ucational workshop.
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Schizophrenia Spectrum Disorder Studies

Pre-treatment (baseline) During-treatment Post-Treatment Long-term follow up

MSANS 

1) 7.9 (3.1) N=212) 8.7 (3.3) N=21p=NR (ns)

MSANS1

1) 7.2 (2.0) N=212) 8.4 (3.1) N=21

p<0.05

Brief Psychiatric Rating Scale BPRS (Total) 

1) 2.0 (0.6) N=522) 2.0 (0.5) N=56p=NR 

BPRS Total at month 12

1) 1.9 (0.5) N=392) 2.0 (0.6) N=45p=NR 

BPRS Total at month 18

1) 1.7 (0.4) N=282) 1.9 (0.5) N=34p=NR 

BPRS Total at month 36(FINAL)

1) 1.9 (0.5) N=232) 1.9 (0.5) N=25p=NR

Linear regression, ANCOVA models (differences between groups 1) and 2) over time: F 3.8, df 1,86 p=0.05Effects over time, groups 1) and 2) combined:F 8.0, df 1,390 p=0.005

Brief Psychiatric Rating Scale BPRS (Psychosis) 

1) 2.1 (1.0) N=522) 2.1 (1.4) N=56p=NR 

BPRS Psychosis at month 12

1) 1.9 (1.0) N=392) 2.1 (0.1) N=45p=NR 

BPRS Psychosis at month 18

1) 1.8 (0.8) N=282) 1.6 (0.7) N=34p=NR 

BPRS Psychosis at month 36FINAL)1) 1.9 (0.8) N=232) 1.9 (0.9) N=25p=NRLinear regression, ANCOVA models (differences between groups 1) and 2) over time: F 7.1, df 1,86 p=0.009Effects over time, groups 1) and 2) combined:F 3.4, df 1,390 p=0.07

Days drinking, past 6 months

) 45.5 (50.2) N=52

2) 37.1 (37.8) N=56

p=NR 

Days drinking, past 6 monthsat month 121) 16.7 (28.2) N=392) 32.8 (47.0) N=45

p=NR 

Days drinking, past 6 months at month 181) 25.1 (40.2) N=282) 22.3 (32.3) N=34

p=NR 

Days drinking, past 6 months at month 36 (FINAL)1) 36.0 (45.4) N=232) 32.3 (55.7) N=25p=NR Effects over time, groups 1) and 2) combined:F 0.24, df 1,283 p=0.63
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reatments for Adult Mental Health

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Pre-treatment (baseline) During-treatment Post-Treatment Long-term follow up

Days drug use, past 6 months

1) 49.9 (55.8) N=522) 50.0 (47.9) N=56

p=NR 

Days drug use, past 6 months at month 12

1)25.0 (45.9) N=392)44.2 (59.4 ) N=45

p=NR 

Days drug use, past 6 months at month 18

1) 28.4 (46.8) N=282) 32.3 (49.3) N=34

p=NR 

Days drug use, past 6 months at month 36 (FINAL)

1) 43.4 (67.6) N=232) 30.6 (57.1) N=25

Effects over time, groups 1) and 2) combined:F 3.05, df 1,290 p=0.08

Employment rate during 2 year study period1) 32% N=372) 19% N=31p<0.07

lobal Assessment Scale

) 43.4 (10.1) N=52

2) 42.7 (8.2) N=56p=NR 

Global Assessment Scaleat month 12

1) 49.0 (12.6) N=392) 47.2 (10.9 ) N=45p=NR 

Global Assessment Scaleat month 18

1) 49.8 (12.9) N=282) 48.4 (11.2) N=34p=NR 

Global Assessment Scaleat month 36 (FINAL)

1) 48.3 (12.0) N=232) 47.5 (9.0) N=25

p=NR

Effects over time, groups 1) and 2) combined:F 11.9, df 1,388 p<0.001Linear regression, ANCOVA models (differences between groups 1) and 2) over time: F 2.9, df 1,86 p=0.08

% stable days in community, 

ast 6 months) 84% N=52) 87% N=56=NR 

% stable days in community, past 6 months at month 12

1) 86% N=392) 85% N=45p=NR 

% stable days in community, past 6 months

at month 181) 97% N=282) 89% N=34p=NR 

% stable days in community, past 6 months at 

month 36 (FINAL)

1) 92% N=232) 93% N=25

p=NREffects over time, groups 1) and 2) combined:F 5.68, df 1,387 p=0.02
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reatments for Adult Mental Health

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Pre-treatment (baseline) During-treatment Post-Treatment Long-term follow up

% hospitalized in year prior3

) 29% N=16/55) 38% N=19/51=0.15

% hospitalized in year prior1

1) 9% N=5/552) 22% N=11/51p=0.035% received crisis/urgent care in year prior11) 13% N=7/552) 22% N=11/51p=0.09

utpatient Service Utilization

ours) in year prior3

) 16.0 (24.7) N=55

2) 23.3 (34.4) N=51p=0.21

Outpatient Service Utilization(hours) in year prior1

1) 15.8 (27.4) N=552) 14.1 (21.8) N=51p=0.40

% hospitalized (all psychiatric) 

 year prior3

) 31% N=16/53) 37% N=16/44=NR (ns)

% hospitalized (all psychiatric)in year prior1

1) 8% N=4/532) 21% N=9/44p=NR (ns)

% hospitalized (all psychiatric) in year prior4

1) 23% N=12/532) 16% N=7/44p=NR (ns)

% hospitalized (all psychiatric)in year prior6

1) 8% N=4/532) 19% N=8/44p=NR (ns)

% hospitalized (community 

ospitals) in year prior3

) 25% N=13/53) 33% N=14/44=NR (ns)

% hospitalized (community hospitals) in year prior1

1) 4% N=2/532) 19% N=8/44p<0.05

% hospitalized (community hospitals) in year prior4

1) 21% N=11/532) 12% N=5/44p=NR (ns)

% hospitalized (community hospitals) in year prior6

1) 8% N=4/532) 14% N=6/44p=NR (ns)

% hospitalized (state hospitals) 

 year prior3

) 8% N=4/53) 9% N=4/44=NR (ns)

% hospitalized (state hospitals)in year prior1

1) 4% N=2/532) 7% N=3/44p=NR (ns)

% hospitalized (state hospitals) in year prior4

1) 6% N=3/532) 9% N=4/44p=NR (ns)

% hospitalized (state hospitals) in year prior6

1) 2% N=1/532 )14% N=6/44p<0.05

utpatient Service Utilization

ours) in year prior3,7

) 55.8 (88.1) N=53) 57.6 (85.3) N=44=NR (ns)

Outpatient Service Utilization(hours) in year prior1

1) 79.3 (94.6) N=552) 53.6 (74.2) N=51p<0.05

Outpatient Service Utilization(hours) in year prior4

1) 39.9 (71.0) N=532) 27.2 (51.9) N=44

p<.05

Outpatient Service Utilization(hours) in year prior6

1) 14.0 (15.8) N=532) 25.2 (33.5) N=44p=NR (ns)
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Pre-treatment (baseline) During-treatment Post-Treatment Long-term follow up

Days to re-hospitalization1) 515 N=157 2) 504 N=156p=NR (ns)% re-hospitalized1) 29% N=157 2) 35% N=156p=0.28Days to first rescue medication1) 323 N=157 2) 351 N=156p=NR (ns)Days to psychotic relapse1) 524 N=157 2) 544 N=156p=NR (ns)

ard deviation) unless otherwise noted. 

st-treatment, unless otherwise noted; Long term=12 months post-treatment, unless otherwise noted. If an outcome had a final measure reported 

ong term follow up column and noted. Measures listed in the study descriptive tables but not reported here if either 1) the authors did not report 

hey did not test for differences between conditions on these measures.

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

SANS = Modified Scale for Assessment of Negative Symptoms; 

rvention.

8 months; FPE = 3 months. 

ne.

rvention.

ated with hospitalization year after baseline. Cochran-Mantel-Haenszel procedure that controlled for hospitalization year before randomization, 

ween group membership and hospitalization (p<0.04). 

r intervention.

ck (2002); however, crisis utilization services were not included in estimate of outpatient utilization in Dyck, but were included in McDonell figures. 

ease during utilization period due to addition of 24 90 minute MFG sessions in year 1, and 12 in year 1 (post baseline). When these sessions 

observed. 
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Schizophrenia Spectrum Disorder Studies 

Baseline Mid-treatment (one year)1 Post-treatment (two years)1

in 

SAS: Social/leisure factor1) 2.8 (0.6) N=1572) 2.7 (0.6) N=156p=NR

SAS: Social/leisure factor1) 2.7 (0.7) N=1572) 2.6 (0.6) N=156p=NR

SAS: Social/leisure factor1) 2.8 (0.7) N=1572) 2.6 (0.6) N=156Mixed effects model:2

Test of differences between groups over time: F(2,299)=0.29p=NR (ns)

SAS: Family relationships factor1) 1.8 (0.7) N=1572) 1.9 (0.6) N=156p=NR

SAS: Family relationships factor1) 1.9 (0.6) N=1572) 1.8 (0.6) N=156p=NR

SAS: Family relationships factor1) 1.9 (0.6) N=1572) 1.9 (0.6) N=156Mixed effects model:2

Test of differences between groups over time: F(2,299)=0.92p=NR (ns)

Patient Rejection Scale3

1) 61.0 (22.1) N=1572) 57.3 (19.6) N=156p=NR

Patient Rejection Scale3

1) 59.2 (21.5) N=1572) 58.9 (21.7) N=156p=NR

Patient Rejection Scale31) 61.2 (23.0) N=1572) 60.2 (23.0) N=156Mixed effects model: 2Test of differences between groups over time: F(2,288)=3.07p<0.01Effect size (r): 0.30 SAS Family friction4Β=-0.187 SE 0.063p<0.01Effect size (r): 0.24

in 

SAS: romance / sexual factor1) 2.8 (1.1) N=1572) 2.9 (0.9) N=156p=NR

SAS: romance / sexual factor1) 2.7 (1.0) N=1572) 2.6 (1.0) N=156p=NR

SAS: romance / sexual factor1) 2.7 (1.1) N=1572) 2.6 (1.0) N=156Mixed effects model: 2Test of differences between groups over time: F(2,236)=0.71p=NR (ns)

rd deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

f an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. Measures listed in the study 

ere if either 1) the authors did not report findings from these measures or 2) they did not test for differences between conditions on these measures.

R = not reported; N/A = not applicable; SAS = Social Adjustment Scale

ulated at baseline, year 1, and year 2 of two year treatment.

ded covariates diagnosis, gender, site, Brief Psychiatric Rating scale.

h scores indicate more negative family attitudes toward the patient.

models; effects sizes computed by averaging outcomes for months 18-24.
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reatments for Adult Mental Health

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mes - Schizophrenia Spectrum Disorder Studies

Baseline / Short Term During treatment During treatment/post-treatment Final

orders 

Engagement in treatment(> 2 sessions, either arm)1) 88% N=46/522) 84% N=47/56p=NR (ns)Exposed to treatment(> 3sessions FIDD; >6 sessions FPE)1) 62% N=32/522) 55% N=31/56p=NR (ns)

Relatives attending family support group (between end of treatment and month 36)1) 15% N=6/402) 11% N=5/46p=NR (ns)

t

Attendance, initial workshop1

1) 75.2% N=2722) 79.2% N=256 p=NR (ns)Attendance, monthly treatment 1

1) 53.5% N=2722) 60.3% N=256 p=NR (ns)

Attendance, monthly treatment2

1) 60.4% N=1572) 66.2% N=156 p=NR (ns)

% Attendance, monthly treatment3

1) 50.2% N=1572) 50.9% N=156 p=NR (ns)

Attendance, monthly treatment4

1) 39.3%N=1572) 33.3% N=156 p=NR (ns)

orders 

Days medication nonadherence (in past 30) at baseline

1) 4.5 (8.1) N=522) 2.6 (6.4) N=56p=NR (ns)

Days medication nonadherence (in past 30) at month 12

1) 2.6 (8.1) N=392) 5.2 (9.0) N=45p=NR (ns)

Days medication non-adherence (in past 30) at month 18

1) 4.0 (6.9) N=282) 3.1 (7.8) N=34p=NR (ns)

Days medication nonadherence (in past 30) at month 36 (FINAL)

1) 2.5 (3.0) N=232) 1.2 (1.9) N=25p=NR (ns)Time effects, combined groups:

F 3.34, df 1,350 p=0.07

eviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post-treatment, unless otherwise noted. If 

 beyond 12 months, it is reported in long term follow up column and noted. 

ot reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses using an intent-to-treat approach.

 

e during months 1-6 of maintenance phase. e during months 7-12 of maintenance phase. e during months 18-24 of maintenance phase (final). 

onths; FPE = 3 months. 
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nformation - Post Traumatic Stress Disorder (PTSD) Studies

s

Inclusion and Exclusion 

Criteria

Treatment 

Groups Intervention Outcomes Assessed Quality

n: 

s): 

ts 

rs 

nt 

os 

a.

MH Condition: PTSDAssessed by: ClinicianAdministered PTSD ScaleSO: Any family memberInclusions: 1) military service during the Vietnam conflict, 2) clinical diagnosis of combat PTSD, 3) stable psychiatric medication regimen at randomization, 4) willingness to provide informed consentExclusions:1) medical condition contraindicating use of exposure therapy (e.g., severe cardiovascular disease), 2) history or present evidence of an organic brain, psychotic, or severe dissociative disorder, 3) current substance dependence, 4) evidence of overt physical aggression to self or others within preceding year

1) Exposure 

Therapy + Behavioral Family Therapy (BFT)

N = 17 (11 completed)2) Exposure 

Therapy

N = 12(12 completed)3) 2 month wait 

list + BFT if desired

N = 13 (13 completed)Randomized: N=42Analysis:Baseline N=36Post-treatment 

N=36

Short term (final) 

6 months

N=20

1) Format: Exposure Therapy + BFTManualized: YesSessions: 18 exposure sessions followed by 16 sessions of BFTTxt Length: 9 weeks for exposure therapy then 11-12 weeks of BFT weekly, then 2 biweekly BFT meetings, then 2 monthly BFT meetingsApproach: Repeated exposure to trauma memory followed by cognitive restructuring + skills training in BFT for education on the disorder, communication training, anger management, and problem-solving skills.2) Format: Exposure TherapyManualized: YesSessions: 18Txt Length: 9 weeksApproach: Exposure therapy with cognitive restructuring3) Format: wait list + BFT if desiredManualized: YesSessions: 16Txt Length: 11-12 weeks of BFT weekly, then 2 biweekly BFT meetings, then 2 monthly BFT meetingsApproach: Psychoeducation, communication training, anger management, problem-solving skills training

Patient OutcomesSymptom 

Improvement

a. M-PTSDb. Impact of 

Events Scale 

c. CAPS

Global functioning

a. SAS-SR

Family Outcomes

Family functioning:a. SPSI

Intermediate 

OutcomeAttendancea. # dropouts

Outcome timeframe:

BaselinePost-treatmentShort term (Final)– 6 months

Allocation concealment:NRBlinding: NRIntention to treat analysis: NoWithdrawals adequately described: Yes Treatment Integrity: Therapists met weekly with supervisors; supervisors reviewed progress notes; sessions audiotaped and PI listened to random 20% for protocol adherence (then provided feedback to therapists) Study Quality: Fair
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s

Inclusion and Exclusion 

Criteria

Treatment 

Groups Intervention Outcomes Assessed Quality

ale

 

%

%

d 

MH Condition: PTSDAssessed by: PTSD Symptoms ScaleSO: Any family member(s) >17 age living in same householdInclusions: Bosnian refugees who screened positive for PTSD; not currently receiving mental health services. Exclusions: Those who screened positive for an acute confusional state, active psychosis, or substance intoxication or withdrawal

1) Coffee and Family Education and Support (CAFES)N = 110 2) No treatment control groupN = 87 Analysis:Baseline N=197Short term (6 months)N=197 Long term (12 months)N=197 Final (18 months)N=197 

1) Format: Groups for the patient and family members (all family members > 17 yrs old invited; 7 families/group)Manualized: YesSessions: 9Txt Length: 16 weeksApproach: Community-based, family focused program aimed at improving access to mental health services by impacting family processes intervention included support, psychoeducation, and communication training among other topics2) No treatment

Patient OutcomeHealth Care 

Utilization 

a. # of mental 

health visits

Intermediate OutcomeAttendancea. attrition rateOutcome timeframe:BaselineShort term: 

6 months

Long term:

12 months

Final: 18 months 

Allocation concealment:NRBlinding: NRIntention to treat analysis: NRWithdrawals adequately described: Yes Treatment Integrity: 20 hrs implementation training, weekly group and individual supervision, monthly videotaping of CAFÉS sessionsStudy Quality: Fair

vestigator; HS = high school; SO = significant other or family member included; M-PTSD = Mississippi Scale for Combat-Related PTSD; CAPS = 

 SAS-SR = Social Adjustment Scale-Self-report; SPSI = Social Problem-Solving Inventory
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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

Positive symptoms1) 0.03 (0.10) N=112) -0.03 (0.15) N=123) 0.01 (0.14) N=13p=ns

Positive symptomsa

1) -0.06 (0.15) N=112) -0.07 (0.12) N=123) 0.02 (0.09) N=13p < 0.05*Groups 1) & 2) significantly < 3)

Positive symptomsa

1) -0.07 (0.12) N=102) -0.09 (0.16) N=103) NRp=ns

Negative symptomsa

1) -0.04 (0.12) N=112) -0.05 (0.12) N=123) 0.01 (0.11) N=13p=ns

Negative symptomsa

1) -0.11 (0.23) N=112) -0.15 (0.17) N=123) -0.02 (0.17) N=13p=ns

Negative symptomsa

1) -0.10 (0.21) N=102) -0.15 (0.21) N=103) NRp=ns

Social Adjust Scale (SAS-SR)b

1) 2.64 (0.47) N=112) 2.73 (0.25) N=123) 2.84 (0.71) N=13p=ns

Social Adjust Scale (SAS-SR)b

1) 2.40 (0.61) N=112) 2.48 (0.43) N=123) 2.72 (0.69) N=13p=ns

Social Adjust Scale (SASSR)b

1) 2.32 (0.55) N=102) 2.55(0.61) N=103) NRp=ns

# mental health visits in prior 6 months1) 0.1 N=1102) 0.1 N= 87 p=NR

# mental health visits in prior 6 months1) 5.2 N=1102) 2.2 N=87 p=NR(6months)

# mental health visits in prior 6 months1) 6.3 N=1102) 2.3 N=87 p=NR (12 months)# mental health visits in prior 6 months1) 6.0 N=1102) 1.7 N=87 p=NR(18 months- final) Random effects regression model:Significant between group differences: β = 3.17, p<0.005

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. 

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

d PTSD Scale (CAPS) scores; Mississippi Scale for Combat-Related PTSD scale scores; and Impact of Events Scale; Higher score indicates 

cial adjustment.

e symptoms or worse social adjustment.
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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

 Problem-Solving Inventory (SPSI)

Social Problem-Solving Inventory(SPSI)No group comparisons on family functioning outcomesSubgroup comparison(change scores from baseline to post )(a) BFT completers: 

6.00 (22.61) N=NR

(b) No BFT participation

-9.10 (21.70) N=NR

p<0.05

d deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post-treatment, 

e had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. 

mes - Post Traumatic Stress Disorder Studies 

Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

Family 

esired

# of dropoutsN/A

# of dropouts1) 6 N=172) 0 N=123) 0 N=13p < 0.01

d Support 

Attrition RateN/A

Attrition RateNR

Attrition Rate1) 17%2) 14% p=NR

Attrition Rate1) 6%2) 10% p=NR(12 months)Attrition Rate1) 4%2) 1% p=NR(18 months - final)

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. 

able; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses using an intent-to-treat approach
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nformation - Sexual Functioning Disorders Studies

cs

Inclusion and Exclusion 

Criteria

Treatment 

Groups Intervention Outcomes As- sessed Quality

 

%

r 

s

ol

r 

:

rs 

rs

, 

MH Condition: Erectile dysfunction (ED)Assessed by: NRSO: Female intimate partnerInclusions: 20-80 yrs old; ED for ≥6 months (due to a medical condition or not); absence of medical condition that prohibits Sildenafil intake or compromises study completion; stable heterosexual relationship ≥1 year; men consent to pre-tx medical evaluation to establish level of organic involvement of ED and safety of Sildenafil dosage; both partners read, write, and speak English fluently; provide informed consentExclusions: Fair-tosevere mood disorders (BDI-II > 19), substancerelated disorders (≥3 drinks a day), lifetime female sexual dysfunction except pain related to lubrication; inability to interrupt psychotherapy during study; spousal abuse; extra-marital affair in last year; recent discussion of or separation plans; gender identity disorder in last 5 years

1) Medication (Sildenafil) + sex therapyN = 27 (24 completed)2) Medication (Sildenafil) onlyN = 24 

(20 completed) Randomized:N =51Analysis:Baseline N= 44Post-treatment:N = 44Short term (Final-2 months): 

N = 44

1) Format: medication + couple sex therapy Manualized: YesSessions: 8 sex therapy sessions (weekly for weeks 1-4; biweekly thereafter)Txt Length: 12 weeksApproach: “Sessions included an amalgam of existing couple and sex therapy strategies such as communication and emotional skills training, sensate focus, sexual fantasy training, and cognitive restructuring” with homework2) Format: medication only with brief, typically individual, pick-up visits to assess side effects and medical concerns Manualized: NRSessions: 8 (15 minute) sessions; weekly for weeks 1-4 and then biweekly Txt Length: 12 weeksApproach: NR 

Patient Outcomes:Symptom Improvementa. International Index for Erectile Function (IIEF)Family Outcomes:Couple functioning:a. Dyadic Adjustment scale (DAS)b. Personal Assessment of Intimacy in Relationships (PAIR) Intermediate OutcomesSatisfaction with carea. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)Attendance:a. RetentionOutcome timeframe:BaselinePost-treatmentShort term (final): 2 months

Allocation concealment:NRBlinding: NRIntention to treat analysis: NoWithdrawals adequately described:Yes Treatment Integrity: all couples need by same therapist (Principal Investigator)Study Quality: Poor
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cs

Inclusion and Exclusion 

Criteria

Treatment 

Groups Intervention Outcomes As- sessed Quality

 

s

:

, 

MH Condition: Erectile dysfunction without previously diagnosed medical etiologyAssessed by: Psychologist telephone interviewSO: Intimate partner of at least 6 monthsInclusions: Heterosexual couples in the same relationship ≥6 months; Patient diagnosis of predominantly psychogenic ED confirmed by a urologist.Exclusions: Patient: diabetes mellitus, multiple sclerosis, spinal cord injury, prostate surgery or radiation, Peyronie’s disease, or significant mental health problems requiring psychotropic drugs or hospitalization, or receiving medication for hypertension, heart disease/angina (especially nitrates) or vascular disease. Female partner: diagnosis of dyspareunia, primary anorgasmia or vaginimus.

1) Medication (Sildenafil) + cognitive behavioral sex therapyN = 30 (29 completed)2) Medication (Sildenafil) only + sex therapy for non-responders after week 4N = 27 (24 completed)Randomized:N = 57Analysis:Baseline: N = 53Post-treatment (4 weeks):N = 53Final (8 weeks):N = 53

1) Format: Medication (Sildenafil) + cognitive behavioral sex therapyManualized: NRSessions: WeeklyTxt Length: 4-8 weeksApproach: medication + cognitive-behavioral sex therapy2) Format: Sildenafil + couple sex therapy for treatment nonrespondersManualized: NRSessions: 3-6Txt Length: 4-8 weeksApproach: 1 pretreatment information session; follow-up visits with a psychologist at 4 and 8 weeks; 4 weeks of cognitivebehavioral sex therapy if non-responsive to medication at week 4; only 1 couple met the ‘success’ criteria after 4 weeks of medication only and all other couples (N = 23) we assigned to 4 weeks of sex therapy

Patient Outcomes:Symptom Improvement a. IIEF Patient Global functioninga. BDIFamily Outcomes:Couple functioning:a. Revised DAS (Patient) Sexual satisfactiona. IIEF – sexual satisfaction (Patient)Intermediate OutcomesAttendance:a. Retention

Allocation concealment:NRBlinding: NRIntention to treat analysis: NoWithdrawals adequately described: Yes Treatment Integrity: NRStudy Quality: Poor 

mber included; NR = not reported; HS = high school; BDI = Beck Depression Inventory
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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

 Total Score

 (17) N=24 (16) N=20

IIEF - Total Score1) 50.3 (16.4) N=24 2) 55 (13.7) N=20 p=ns

IIEF - Total Score1) 47.7 (19.6) N=24 2) 46.2 (14.2) N=20 (at 2 months - final)p=ns

erectile function 

7 (7.2) N=29

 (7.2) N=24

IIEF erectile function 1) 17.4 (7.6) N = 29 2) 13.7 (8.4) N = 24 p = 0.10(week 4)Clinical ‘success’1) 48%2) 29%p=NR

erectile function 

atients with score ≥ 19 - clinical ess)

% (4/29) p=ns% (4/24) p=ns

IIEF erectile function 1) 48% (14/29) p=ns2) 29% (7/24) p=nsp=NR(week 4)

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. Measures listed in the 

rted here if either 1) the authors did not report findings from these measures or 2) they did not test for differences between conditions on these 

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

EF = International Index for Erectile Function 

le Sex Therapy was added to treatment group 2 non-responders.
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Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

PAIR–Sexual Intimacy (Patient)1) 68.3 (22.3) N=242) 67.6 (21.4) N=20p=NR

PAI –Sexual Intimacy (Patient1) 74.2 (23.7) N=242) 73.3 (20.0) N=20 p=NR

PAIR–Sexual Intimacy (Patient)1) 73.0 (23.1) N=242) 71.6 (20.1) N=20 p=NR (at 2 months – final)

PAIR Emotional Intimacy (Patient)1) 73.0 (18.0) N=24 2) 74.0 (18.0) N=20 p=NR

PAIR–Emotional Intimacy (Patient)1) 73.0 (18.0) N=24 2) 70.0 (19.0) N=20 p=NR

PAIR–Emotional Intimacy (Patient) 1) 71.2 (20.6) N=24 2) 70.0 (23.2) N=20 p=NR (at 2 months - final)

DAS (Patient) 1) 113.8 (14.2) N=24 2) 113.4 (16.3) N=20 p=NR

DAS (Patient)1) 115.2 (16.5) N=24 2) 115.2 (16.5) N=20 p=NR

DAS (Patient)1) 112.4 (17.5) N=24 2) 112.4 (17.5) N=20 p=NR (at 2 months – final)

IIEF Sexual Satisfaction (Patient) 1) 4.8 (2.7) N=292) 4.2 (1.9) N=24p=NR

IIEF Sexual Satisfaction (Patient)1) 6.0 (1.9) N=29 2) 4.9 (2.0) N=24 p=NR (week 4)

IIEF Sexual Satisfaction (% patients with score ≥6 - clinical success)1) 45% (13/29) 2) 29% (7/24)p=NR

IIEF Sexual Satisfaction (% patients with score ≥6 - clinical success)1) 65.5% (19/29) 2) 37.5% (9/24) p=NR (week 4)

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. Measures listed in 

reported here if either 1) the authors did not report findings from these measures or 2) they did not test for differences between conditions on 

 (at 5% level); NR = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = 

-to-treat approach; IIEF = International Index for Erectile Function; DAS = Dyadic Adjustment Scale; PAIR = Personal Assessment of Intimacy in 

le Sex Therapy was added to treatment group 2 non-responders. 
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mes - Sexual Functioning Disorders Studies

Outcome

Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

tion

reatment - randomization)

2427

RetentionNR

Retention1) N=20 2) N=24 (at 2 months - final)p=NR

tion

reatment -randomization)

3027

Retention1) N=29 2) N=24 p=NR

 (Patient)

EDITS (Patient)1) 77.6 (12.8) N=24 2) 73.2 (17.5) N=20 p=ns

EDITS (Patient) 1) 71.9 (16.4) N=24 2) 56.5 (22.8) N=18 * 1) vs. 2) p ≤0.01(at 2 months - final)

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. 

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

DITS = Erectile Dysfunction Inventory of Treatment Satisfaction
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eristics Inclusion and Exclusion Criteria Treatment Groups Intervention Outcomes Assessed Quality

male 

%

s 32%

4%

stics:

od:

 TV, 

lets at 

MH Condition: Depression in heterosexual womenAssessed by: SCI for DSM-IV Axis I Disorders SO: Male partnerInclusions: Married or living together for 1+ yrs; both partners 21+ yrs; fluent in English; score ≥21 on BDI-II; women met diagnostic criteria and, if taking concurrent medication for depression, were in individual psychotherapy for ≥12 wks or taking stable dose of medication for ≥8 wks; male partners could not meet diagnostic criteria for depressionExclusions: Severely discordant couples (DAS of ≤75); act of infidelity in preceding 6 months or more than 2 acts of physical aggression in preceding year by 1 or both partners; already receiving couples therapy; male partners in individual psychotherapy or on antidepressant medication

1) Treatment (Brief Couple Therapy, BCT) (N = 18 couples)2) Wait list control (N = 17 couples)Randomized: N = 35 couplesAnalysis:Post-treatment:N = 30Final: N = 27

Format: Brief Couple therapyManualized: YesSessions: 5 (weekly for 2 hours)Txt Length: 5 weeks with 3 month follow-up evaluationApproach: combination of psychoeducational and cognitivebehavioral marital therapy

Patient Outcomes:Symptom improvement:a. BDI-IIb. HAM-DIntermediate Outcomes:NoneFamily Outcomes:Relationship satisfaction a. DASOutcome timeframe:BaselinePost-treatmentShort term (Final): 3 months

Allocation concealment: unclearBlinding: Yes (treating clinicians and outcome assessors)Intention to treat analysis: NoWithdrawals adequately described:YesTreatment Integrity: session audiotapes coded for therapy adherence and therapist competenceStudy quality: Fair
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e

6% 

R

stics:

ing 

per 

MH Condition: Binge eating disorderAssessed by: DSM-IV research criteria for binge eating disorderSO: spouse or cohabiting partnerInclusions: women; 18-65 yrs, BMI≥25; spouse or cohabitating partner willing to participateExclusions: engaged in purging behaviors more than 1x/month; met DSM-IV criteria for anorexia nervosa, bulimia nervosa or EDNOS; receiving concurrent treatment for weight loss; currently taking appetite suppressants; pregnancy

1) Standard group cognitive behavioral therapy (CBT-SD) (N = 32)2) Group CBT with spouse involvement (CBT-SI) (N = 31)3) Wait-list control group (N = 31)Randomized:N =94Analysis:N = 62 (completed all assessments; no additional information about when withdrawals occurred) 

1) Format: Group therapy (patients only)Manualized: YesSessions: 12, 90 min eachTxt Length: 12 weeksApproach: cognitive behavioral therapy2) Format: Group therapy (patient and spouse)Manualized: Yes (modified to actively include spouses)Sessions: 12, 90 min eachTxt Length: 12 weeksApproach: cognitive behavioral therapy with spouse involvement (attend all group meetings)

Patient Outcomes:Symptom improvement:a. 7-day calendar recall of binges b. EDEQPatient global functioninga. BDIIntermediate Outcomesa. Attendance at weekly meetingsFamily Outcomes:Couple functioning:a. DASb. Author-developed 7-point Likert scale - understanding of binge eating, level of agreement about reducing binge eatingOutcome timeframe:BaselinePost-treatmentShort term (Final): 6 months

Allocation concealment: UnclearBlinding: UnclearIntention to treat analysis: completed ITT and found results did not differ from treatment completer analysis; only completer analysis reportedWithdrawals adequately described: 34% of entire sample failed to complete assessments (groups comparable); unclear if other withdrawalsTreatment Integrity: Adherence checklist completed by therapist at the end of each group meetingStudy quality: Fair
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eristics Inclusion and Exclusion Criteria Treatment Groups Intervention Outcomes Assessed Quality

e 

t 

arried 

stics: 

ods:

 sent to 

led for 

MH Condition: smoking Assessed by: self-report via screening survey (telephone) of all women with scheduled first prenatal visitSO: intimate partnerInclusions: ≤20 weeks pregnant, age ≥18 yrs, current smoker or recent quitter (smoker in 30 days prior to pregnancy), living with intimate partner, willing to have partner contacted for participationExclusions: no additional criteria reported

1) Woman-only (WO) – usual care + latepregnancy relapse prevention kit, 6 health advisor counseling calls 2) Partner-assisted (PA) – WO + booklet and videos about support behaviors, 6 calls to partner from health advisor, written agreement regarding support behaviors, stop smoking assistance to partner (if appropriate)3) Usual care – provider advice at first prenatal visit; self-help guide mailed to patientRandomized:N = 625Analysis:N = 583 (all randomized except women who miscarried) at all assessment times

1) Format: individual therapy via telephoneManualized: standard protocolSessions: 6 calls (3 in pregnancy, 3 in postpartum)Txt Length: from first prenatal visit through 4 months post-partumApproach: motivational interviewing2) Format: individual therapy via telephone (separate calls to woman and partner)Manualized: standard protocolSessions: 6 calls (3 in pregnancy, 3 in postpartum)Txt Length: not statedApproach: motivational interviewing3) Format: individualManualized: not stated (standard self-help guide provided)Sessions: 1Txt Length: first prenatal visitApproach: provider advice

Patient Outcomes:a. Smoking status:self report of smoking in past 7 daysIntermediate Outcomes: a. Smoking-specific support:Partner interaction Questionnaire (10 item version)b. General interpersonal support: 1. emotional support 2. instrumental support Family/Couple Outcomes: NROutcome timeframe:Baseline (first prenatal visit)Post-treatment: 2-months postpartumShort term: 6-months post-partumLong terms – 12 months post-partum*Treatment continued to 4 months postpartum

Allocation concealment: UnclearBlinding: NRIntention to treat analysis: Yes after excluding patients who miscarried – missing values imputed to be “smoker”Withdrawals adequately described: YesTreatment Integrity: NRStudy quality: Poor

 clinical interviews; SO = significant other or family member included; DSM = Diagnostic and Statistical Manual of Mental Disorders; BDI-II = 

on; DAS = Dyadic Adjustment Scale; HAM-D = Hamilton Rating Scale for Depression; EDEQ = Eating Disorder Examination Questionnaire; ED

wise Specified
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Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

PRESSION

DI-II

 31.4 (9.3) N=18 30.2 (11.1) N=17

=ns

BDI-II1) 20.3 (13.5) N=162) 25.3 (13.9) N=14p=ns

BDI-II1) 14.4 (10.6) N=152) 26.9 (17.2) N=12All univariate comparisons: p=nsHierarchical linear modeling:Effect size d=0.54β=-0.41, p<0.01 Improvement (>50% reduction from baseline)1) 67% 2) 20% p<0.01Recovery (BDI-II<11)1) 40% 2) 8% p<0.01

AM-D

 26.9 (6.8) N=18 28.5 (6.9) N=17

=ns

HAM-D1) 18.4 (10.8) N=162) 26.3 (10.6) N=14p=ns

HAM-D1) 13.6, (11.4) N=152) 26.4 (12.3) N=12Univariate: p<0.01Hierarchical linear modeling:Effect size d=0.72 β=-0.47, p<0.001Improvement (>50% reduction from baseline)1) 67% 2) 17% p<0.01Recovery (HAM-D<6)1) 47% 2) 8% p<0.01
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Baseline Post-Treatment Short-term Follow-up Long-term Follow-up

TING DISORDERS

ays Binged (7-day recall)

 3.4 (2.1) 3.8 (1.7) 3.8 (1.8)l comparisons: p=ns

Days Binged (7-day recall)1)1.2 (1.8)2) 1.8 (2.0)3) 3.0 (1.8)All comparisons: p=ns

Days Binged (7-day recall)1) 0.7 (0.9)2) 1.1 (1.4)All comparisons: p=ns

ays Binged (EDEQ)

 9.6 (6.1) 7.6 (5.7) 8.5 (5.2)

l comparisons: p=ns

Days Binged (EDEQ)1) 3.3 (4.4)2) 2.4 (2.8)3) 5.9 (4.6)All comparisons: p=ns

Days Binged (EDEQ)1) 3.5 (4.6)2) 1.6 (2.1)All comparisons: p= ns

OKING CESSATION

urrent Smoker

 46%  45%  46%l comparisons: p=ns

Abstinence1) 42% 2) 37% 3) 38%All comparisons: p=ns

Abstinence1) 37% 2) 36% 3) 33%All comparisons: p=ns

Abstinence1) 35% 2) 32% 3) 29%All comparisons: p=ns

G DISORDERS

DI

 20.4 (10.0) 18.7 (8.9) 17.4 (9.9)l comparisons: p=ns

BDI1) 11.8 (9.4)2) 14.8 (9.3)3) 16.8 (9.5)All comparisons: p=ns

BDI1) 12.2 (9.2)2) 12.9 (8.1)All comparisons: p=ns

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. 

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

DI-II = Beck Depression Inventory – Second Edition; CBT = Cognitive Behavioral Therapy; EDEQ = Eating Disorder Examination Questionnaire; 

 Depression
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Baseline Post-treatment Short-term Follow-up

ESSION

DAS1) 96.6 (17.4) N=182) 90.3 (18.4) N=17p=ns

DAS1) 100.6 (20.5) N=162) 91.9 (23.5) N=14p=ns

DAS1) 102.1,(22.7) N=152) 92.9 (19.8) N=12All univariate comparisons: p= nsHierarchical linear modeling:Effect size d= 0.43, β=0.55, p<0.01

G DISORDERS

rapy 

DAS1) 95.1 (28.02) 98.4 (21.0)3) 99.0 (19.8)All comparisons: p=ns

DAS1) 99.1 (24.7)2) 101.4 (26.0)3) 100.0 (20.1)All comparisons: p=ns

DAS1) 99.1 (22.8)2) 99.2 (23.5)All comparisons: p=ns

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. 

R = not reported; N/A = not applicable; Completers = findings for analyses conducted only with treatment completers; ITT = findings for analyses 

BT = Cognitive Behavioral Therapy; DAS = Dyadic Adjustment Scale

mes - Depression, Eating Disorders, and Smoking Cessation Studies 

Baseline Short-term Follow-up Long-term Follow-up

DERS

At Weekly MeetingsCompleters (N=62)1) 9/12 2) 9/12 3) Not applicablep=0.45

CESSATION

 care

No differences between groups - results not reported by treatment groupFor all participantsSignificant linear decline over time for:1) Smoking-specific support (Positive)2) Instrumental support3) Emotional supportSignificant U-shaped function for:Smoking-specific support (Negative)

ard deviation) unless otherwise noted. Short-term follow up = 6 months post-treatment, unless otherwise noted; Long term=12 months post

If an outcome had a final measure reported beyond 12 months, it is reported in long term follow up column and noted. 

conducted only with treatment completers; CBT = Cognitive Behavioral Therapy
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Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

APPENDIX E. Forest Plots from Pooled Analyses

for Alcohol and Drug Use Studies

Figure 1a. Percent Days Abstinent, Differences between BCT and ICBT: Studies Not Conducted 

with Data from Fals-Stewart. 

Study or Subgroup

1.15.1 Post-treatment

McCrady 2009

O'Farrell 2010

Subtotal (95% CI)

Heterogeneity: Tau2 = 96.93; Chi2 = 1.76, df = 1 (P = 0.18); I2 = 43%

Test for overall effect: Z = 1.31 (P = 0.19)

1.15.2 Short-term followup (6 months)

McCrady 2009

O'Farrell 2010

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.04, df = 1 (P = 0.85); I2 = 0%

Test for overall effect: Z = 2.12 (P = 0.03)

1.15.3 Long-term followup (12 months)

McCrady 2009

Subtotal (95% CI)

Heterogeneity: Not applicable

Test for overall effect: Z = 1.72 (P = 0.09)

Test for subgroup differences: Chi2 = 0.02, df = 2 (P = 0.99), I2 = 0%

Mean

80.5

71.1

75.7

57.7

75.4

SD

27.7

37

34.3

40.4

34.7

Total

50

15

65

50

15

65

50

50

Mean

74.2

43.6

61.4

46.4

63.1

SD

35

41.9

39.5

32

37.6

Total

52

14

66

52

14

66

52

52

Weight

69.8%

30.2%

100.0%

77.3%

22.7%

100.0%

100.0%

100.0%

IV, Random, 95% CI

6.30 [-5.92, 18.52]

27.50 [-1.35, 56.35]

12.71 [-6.37, 31.79]

14.30 [-0.04, 28.64]

11.30 [-15.14, 37.74]

13.62 [1.01, 26.22]

12.30 [-1.73, 26.33]

12.30 [-1.73, 26.33]

Couple/Marital Individual Mean Difference Mean Difference

IV, Random, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy
196

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 1b. Percent Days Abstinent, Differences between BCT and ICBT: Studies Conducted with 

Data from Fals-Stewart. 

Study or Subgroup

1.13.1 Post-treatment

Fals-Stewart 1996

Fals-Stewart 2006

Fals-Stewart 2008

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.54, df = 6 (P = 1.00); I2 = 0%

Test for overall effect: Z = 3.56 (P = 0.0004)

1.13.2 Short-term followup (6 months)

Fals-Stewart 1996

Fals-Stewart 2006

Fals-Stewart 2008

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.61, df = 6 (P = 1.00); I2 = 0%

Test for overall effect: Z = 5.03 (P < 0.00001)

1.13.3 Long-term followup (12 months)

Fals-Stewart 1996

Fals-Stewart 2003

Fals-Stewart 2006

Fals-Stewart 2008

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 3.00, df = 7 (P = 0.89); I2 = 0%

Test for overall effect: Z = 5.42 (P < 0.00001)

Test for subgroup differences: Chi2 = 13.78, df = 2 (P = 0.001), I2 = 85.5%

Mean

95.4

96.3

94.1

85.9

90.2

92.3

94.2

81.5

85.9

84.1

77.6

80.6

85.1

81.9

73.2

59.6

79.3

74.1

66.9

70.9

77.8

74.2

SD

15.4

16.3

13.4

22.7

21.9

15.2

6.4

28.6

18.1

26.5

25.8

27.2

20.7

16.3

29.8

26.4

29.7

25.8

35.6

25.6

20.2

22.2

Total

40

46

46

22

25

10

36

225

40

46

46

22

25

10

31

220

40

62

46

46

22

25

10

33

284

Mean

91.1

93.6

88.3

81.8

86.6

88.3

90.2

70.4

75

70.3

63.6

71.4

78.2

71.9

65.1

49.3

60.2

60.2

53.4

60.4

70.2

65.4

SD

14.1

17.7

13

26.2

17.4

16.7

8

24.5

20.3

27.1

42.3

26.2

22.6

17.9

26.9

28.4

20.9

27.3

24.8

22.4

18.6

26.1

Total

40

46

46

21

22

10

36

221

40

46

46

21

22

10

32

217

40

62

46

46

21

22

10

35

282

Weight

12.9%

11.1%

18.5%

2.5%

4.3%

2.7%

48.0%

100.0%

13.3%

29.3%

15.1%

4.1%

7.8%

5.0%

25.4%

100.0%

11.9%

19.8%

16.8%

15.7%

5.5%

9.8%

6.4%

14.0%

100.0%

IV, Random, 95% CI

4.30 [-2.17, 10.77]

2.70 [-4.25, 9.65]

5.80 [0.40, 11.20]

4.10 [-10.58, 18.78]

3.60 [-7.65, 14.85]

4.00 [-10.00, 18.00]

4.00 [0.65, 7.35]

4.21 [1.89, 6.53]

11.10 [-0.57, 22.77]

10.90 [3.04, 18.76]

13.80 [2.85, 24.75]

14.00 [-7.06, 35.06]

9.20 [-6.08, 24.48]

6.90 [-12.09, 25.89]

10.00 [1.55, 18.45]

10.93 [6.67, 15.19]

8.10 [-4.34, 20.54]

10.30 [0.65, 19.95]

19.10 [8.61, 29.59]

13.90 [3.05, 24.75]

13.50 [-4.77, 31.77]

10.50 [-3.22, 24.22]

7.60 [-9.42, 24.62]

8.80 [-2.70, 20.30]

11.89 [7.59, 16.19]

Couple/Marital Individual Mean Difference Mean Difference

IV, Random, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy; EtOH = alcohol
197

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 2. Percent Days Abstinent, Differences between BCT and ICBT: Alcohol Use Disorder 

Studies Only

Study or Subgroup

1.2.1 Post-treatment

Fals-Stewart 2006

Kelley 2002 (EtOH)

Lam 2009

McCrady 2009

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.25, df = 3 (P = 0.97); I2 = 0%

Test for overall effect: Z = 1.43 (P = 0.15)

1.2.2 Short-term followup (6 months)

Fals-Stewart 2006

Kelley 2002 (EtOH)

Lam 2009

McCrady 2009

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.43, df = 3 (P = 0.93); I2 = 0%

Test for overall effect: Z = 3.56 (P = 0.0004)

1.2.3 Long-term followup (12 months)

Fals-Stewart 1996

Fals-Stewart 2006

Kelley 2002 (EtOH)

Lam 2009

McCrady 2009

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 2.68, df = 4 (P = 0.61); I2 = 0%

Test for overall effect: Z = 4.07 (P < 0.0001)

Test for subgroup differences: Chi2 = 5.97, df = 2 (P = 0.05), I2 = 66.5%

Mean

96.3

90.2

92.3

80.5

85.9

80.6

85.1

75.7

77.4

79.3

70.9

77.8

75.4

SD

16.3

21.9

15.2

27.7

18.1

27.2

20.7

34.3

34.9

29.7

25.6

20.2

34.7

Total

46

25

10

50

131

46

25

10

50

131

40

46

25

10

50

171

Mean

93.6

86.6

88.3

74.2

75

71.4

78.2

61.4

71.6

60.2

60.4

70.2

63.1

SD

17.7

17.4

16.7

35

20.3

26.2

22.6

39.5

33.6

20.9

22.4

18.6

37.6

Total

46

22

10

52

130

46

22

10

52

130

40

46

22

10

52

170

Weight

51.2%

19.6%

12.6%

16.6%

100.0%

57.6%

15.2%

9.9%

17.3%

100.0%

16.2%

33.2%

19.4%

12.6%

18.6%

100.0%

IV, Random, 95% CI

2.70 [-4.25, 9.65]

3.60 [-7.65, 14.85]

4.00 [-10.00, 18.00]

6.30 [-5.92, 18.52]

3.64 [-1.34, 8.61]

10.90 [3.04, 18.76]

9.20 [-6.08, 24.48]

6.90 [-12.09, 25.89]

14.30 [-0.04, 28.64]

10.83 [4.87, 16.80]

5.80 [-9.21, 20.81]

19.10 [8.61, 29.59]

10.50 [-3.22, 24.22]

7.60 [-9.42, 24.62]

12.30 [-1.73, 26.33]

12.56 [6.51, 18.61]

Couple/Marital Individual Mean Difference Mean Difference

IV, Random, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy; EtOH = alcohol
198

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 3. Percent Days Heavy Drinking, Differences between BCT and ICBT: Alcohol Use 

Disorder Studies Only

Study or Subgroup

1.9.1 Post-treatment

Fals-Stewart 2005

McCrady 2009

Subtotal (95% CI)

Heterogeneity: Chi2 = 1.44, df = 1 (P = 0.23); I2 = 31%

Test for overall effect: Z = 0.78 (P = 0.43)

1.9.2 Short-term followup (6 months)

Fals-Stewart 2005

McCrady 2009

Subtotal (95% CI)

Heterogeneity: Chi2 = 0.06, df = 1 (P = 0.81); I2 = 0%

Test for overall effect: Z = 2.62 (P = 0.009)

1.9.3 Long-term followup (12 months)

Fals-Stewart 2005

McCrady 2009

Subtotal (95% CI)

Heterogeneity: Chi2 = 1.03, df = 1 (P = 0.31); I2 = 3%

Test for overall effect: Z = 3.13 (P = 0.002)

Test for subgroup differences: Chi2 = 4.66, df = 2 (P = 0.10), I2 = 57.1%

Mean

5.2

10.5

14.1

12.3

19.2

12.8

SD

14.3

22.2

19.3

27.4

21.3

26.2

Total

25

50

75

25

50

75

25

50

75

Mean

4.9

18.7

23.6

23.8

38.2

22.7

SD

15.1

34.6

15

37.6

25.6

34.2

Total

25

52

77

25

52

77

25

52

77

Weight

65.5%

34.5%

100.0%

63.8%

36.2%

100.0%

44.9%

55.1%

100.0%

IV, Fixed, 95% CI

0.30 [-7.85, 8.45]

-8.20 [-19.44, 3.04]

-2.63 [-9.23, 3.97]

-9.50 [-19.08, 0.08]

-11.50 [-24.23, 1.23]

-10.22 [-17.88, -2.57]

-19.00 [-32.05, -5.95]

-9.90 [-21.70, 1.90]

-13.99 [-22.74, -5.24]

Couple/Marital Individual Mean Difference Mean Difference

IV, Fixed, 95% CI

-20 -10 0 10 20

Favors couple Favors individual

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences.

Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy
199

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 4. Percent Days Abstinent, Differences between BCT and ICBT: Drug Use Disorder Studies 

Only

Study or Subgroup

1.3.1 Post-treatment

Fals-Stewart 1996

Fals-Stewart 2008

Kelley 2002 (Drug)

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.31, df = 3 (P = 0.96); I2 = 0%

Test for overall effect: Z = 3.41 (P = 0.0007)

1.3.2 Short-term followup (6 months)

Fals-Stewart 1996

Fals-Stewart 2008

Kelley 2002 (Drug)

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.35, df = 3 (P = 0.95); I2 = 0%

Test for overall effect: Z = 4.13 (P < 0.0001)

1.3.3 Long-term followup (12 months)

Fals-Stewart 1996

Fals-Stewart 2003

Fals-Stewart 2008

Kelley 2002 (Drug)

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.91, df = 4 (P = 0.92); I2 = 0%

Test for overall effect: Z = 3.97 (P < 0.0001)

Test for subgroup differences: Chi2 = 7.90, df = 2 (P = 0.02), I2 = 74.7%

Mean

95.4

94.1

85.9

94.2

84.4

84.1

77.6

81.9

76.6

59.6

74.1

66.9

74.2

SD

15.4

13.4

22.7

6.4

25.3

26.5

25.8

16.3

27.7

26.4

25.8

35.6

22.2

Total

40

46

22

36

144

40

46

22

31

139

40

62

46

22

33

203

Mean

91.1

88.3

81.8

90.2

73.2

70.3

63.6

71.9

69.4

49.3

60.2

53.4

65.4

SD

14.1

13

26.2

8

23.3

27.1

42.3

17.9

22.1

28.4

27.3

24.8

26.1

Total

40

46

21

36

143

40

46

21

32

139

40

62

46

21

35

204

Weight

15.7%

22.6%

3.0%

58.7%

100.0%

26.4%

25.0%

6.8%

41.9%

100.0%

21.8%

28.2%

22.3%

7.9%

19.9%

100.0%

IV, Random, 95% CI

4.30 [-2.17, 10.77]

5.80 [0.40, 11.20]

4.10 [-10.58, 18.78]

4.00 [0.65, 7.35]

4.46 [1.89, 7.02]

11.20 [0.54, 21.86]

13.80 [2.85, 24.75]

14.00 [-7.06, 35.06]

10.00 [1.55, 18.45]

11.53 [6.06, 17.01]

7.20 [-3.78, 18.18]

10.30 [0.65, 19.95]

13.90 [3.05, 24.75]

13.50 [-4.77, 31.77]

8.80 [-2.70, 20.30]

10.38 [5.26, 15.51]

Couple/Marital Individual Mean Difference Mean Difference

IV, Random, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size. 

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy
200

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 5. Relationship Adjustment using Dyadic Adjustment Scale, Difference in Mean Scores 

between BCT and ICBT: Alcohol Use Disorder Studies Only

Study or Subgroup

1.18.1 Post-treatment

Fals-Stewart 2005

Fals-Stewart 2006

Kelley 2002 (EtOH)

Lam 2009

Walitzer 04 CAF+BCT

Subtotal (95% CI)

Heterogeneity: Chi2 = 2.84, df = 4 (P = 0.59); I2 = 0%

Test for overall effect: Z = 6.35 (P < 0.00001)

1.18.2 Short-term followup (6 months)

Fals-Stewart 2005

Fals-Stewart 2006

Kelley 2002 (EtOH)

Lam 2009

Walitzer 04 CAF+BCT

Subtotal (95% CI)

Heterogeneity: Chi2 = 4.45, df = 4 (P = 0.35); I2 = 10%

Test for overall effect: Z = 6.87 (P < 0.00001)

1.18.3 Long-term followup (12 months)

Fals-Stewart 2005

Fals-Stewart 2006

Kelley 2002 (EtOH)

Lam 2009

Walitzer 04 CAF+BCT

Subtotal (95% CI)

Heterogeneity: Chi2 = 11.56, df = 4 (P = 0.02); I2 = 65%

Test for overall effect: Z = 4.37 (P < 0.0001)

Test for subgroup differences: Chi2 = 1.27, df = 2 (P = 0.53), I2 = 0%

Mean

119.3

123

115.4

114.6

108.4

112.6

117.2

103.9

105.9

107.8

109.3

112.4

91.4

99.8

101.2

SD

11.9

12.1

18.2

16.8

14.4

16.2

13.7

16.2

19.6

12.7

17.2

14

19.9

20.3

15.9

Total

25

46

25

10

19

125

25

46

25

10

16

122

25

46

25

10

17

123

Mean

104.6

111.2

102.2

98.1

105.4

98.4

102.2

86.7

93.9

108.3

96

98

82.1

88.9

113.6

SD

11.6

18.6

19.1

17.9

26.2

11.6

14.4

19.2

20.2

25.6

19.3

18.8

20.7

22

23

Total

25

46

22

10

21

124

25

46

22

10

15

118

25

46

22

10

14

117

Weight

35.2%

36.4%

13.0%

6.5%

8.9%

100.0%

25.5%

47.1%

14.8%

5.1%

7.5%

100.0%

20.8%

46.6%

15.8%

6.2%

10.6%

100.0%

IV, Fixed, 95% CI

14.70 [8.19, 21.21]

11.80 [5.39, 18.21]

13.20 [2.49, 23.91]

16.50 [1.28, 31.72]

3.00 [-9.94, 15.94]

12.52 [8.66, 16.39]

14.20 [6.39, 22.01]

15.00 [9.26, 20.74]

17.20 [6.97, 27.43]

12.00 [-5.44, 29.44]

-0.50 [-14.87, 13.87]

13.80 [9.86, 17.75]

13.30 [3.17, 23.43]

14.40 [7.63, 21.17]

9.30 [-2.35, 20.95]

10.90 [-7.65, 29.45]

-12.40 [-26.62, 1.82]

10.32 [5.69, 14.94]

Couple/Marital Individual Mean Difference Mean Difference

IV, Fixed, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy; EtOH = alcohol
201

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 6. Relationship Adjustment using Dyadic Adjustment Scale, Difference in Mean Scores 

between BCT and ICBT: Drug Use Disorder Studies Only

Study or Subgroup

1.19.1 Post-treatment

Fals-Stewart 2001

Fals-Stewart 2008

Kelley 2002 (Drug)

Winters 2002

Subtotal (95% CI)

Heterogeneity: Chi2 = 2.87, df = 3 (P = 0.41); I2 = 0%

Test for overall effect: Z = 6.03 (P < 0.00001)

1.19.2 Short-term followup (6 months)

Fals-Stewart 2008

Kelley 2002 (Drug)

Winters 2002

Subtotal (95% CI)

Heterogeneity: Chi2 = 1.05, df = 2 (P = 0.59); I2 = 0%

Test for overall effect: Z = 5.79 (P < 0.00001)

1.19.3 Long-term followup (12 months)

Fals-Stewart 2008

Kelley 2002 (Drug)

Winters 2002

Subtotal (95% CI)

Heterogeneity: Chi2 = 5.18, df = 2 (P = 0.07); I2 = 61%

Test for overall effect: Z = 5.61 (P < 0.00001)

Test for subgroup differences: Chi2 = 1.28, df = 2 (P = 0.53), I2 = 0%

Mean

97.9

114.2

103.6

105.3

109.8

93.6

93.4

106.9

90.7

86.2

SD

16.4

15.1

22.1

13.2

16

17.2

22.7

16.5

22.3

25.2

Total

17

46

22

36

121

46

22

31

99

46

22

33

101

Mean

79.2

101.9

88.7

97.2

94.1

77.8

84.3

87.3

75.8

82.8

SD

18.1

13.6

16.4

16.1

14.8

18.7

23.6

17.2

20.4

25.9

Total

19

46

21

36

122

46

21

32

99

46

21

35

102

Weight

11.9%

44.0%

11.3%

32.8%

100.0%

60.7%

20.8%

18.4%

100.0%

62.0%

18.1%

19.9%

100.0%

IV, Fixed, 95% CI

18.70 [7.43, 29.97]

12.30 [6.43, 18.17]

14.90 [3.30, 26.50]

8.10 [1.30, 14.90]

11.98 [8.09, 15.87]

15.70 [9.40, 22.00]

15.80 [5.05, 26.55]

9.10 [-2.33, 20.53]

14.50 [9.60, 19.41]

19.60 [12.71, 26.49]

14.90 [2.13, 27.67]

3.40 [-8.75, 15.55]

15.52 [10.10, 20.95]

Couple/Marital Individual Mean Difference Mean Difference

IV, Fixed, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy
202

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 7. Percent Days Abstinent, Differences between BCT and ICBT: Studies with Female 

Subjects Only

Study or Subgroup

1.7.1 Post-treatment

Fals-Stewart 2006

McCrady 2009

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.27, df = 2 (P = 0.88); I2 = 0%

Test for overall effect: Z = 2.61 (P = 0.009)

1.7.2 Short-term followup (6 months)

Fals-Stewart 2006

McCrady 2009

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.26, df = 2 (P = 0.88); I2 = 0%

Test for overall effect: Z = 4.04 (P < 0.0001)

1.7.3 Long-term followup (12 months)

Fals-Stewart 2006

McCrady 2009

Winters 2002

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 1.75, df = 2 (P = 0.42); I2 = 0%

Test for overall effect: Z = 4.02 (P < 0.0001)

Test for subgroup differences: Chi2 = 10.36, df = 2 (P = 0.006), I2 = 80.7%

Mean

96.3

80.5

94.2

85.9

75.7

81.9

79.3

75.4

74.2

SD

16.3

27.7

6.4

18.1

34.3

16.3

29.7

34.7

22.2

Total

46

50

36

132

46

50

31

127

46

50

33

129

Mean

93.6

74.2

90.2

75

61.4

71.9

60.2

63.1

65.4

SD

17.7

35

8

20.3

39.5

17.9

20.9

37.6

26.1

Total

46

52

36

134

46

52

32

130

46

52

35

133

Weight

17.7%

5.7%

76.5%

100.0%

46.2%

13.9%

40.0%

100.0%

41.8%

23.4%

34.8%

100.0%

IV, Random, 95% CI

2.70 [-4.25, 9.65]

6.30 [-5.92, 18.52]

4.00 [0.65, 7.35]

3.90 [0.97, 6.83]

10.90 [3.04, 18.76]

14.30 [-0.04, 28.64]

10.00 [1.55, 18.45]

11.01 [5.67, 16.35]

19.10 [8.61, 29.59]

12.30 [-1.73, 26.33]

8.80 [-2.70, 20.30]

13.92 [7.14, 20.71]

Couple/Marital Individual Mean Difference Mean Difference

IV, Random, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy
203

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 8. Relationship Adjustment using Dyadic Adjustment Scale, Difference in Mean Scores 

between BCT and ICBT: Studies with Female Subjects Only

Study or Subgroup

1.22.1 Post-treatment

Fals-Stewart 2006

Winters 2002

Subtotal (95% CI)

Heterogeneity: Chi2 = 0.60, df = 1 (P = 0.44); I2 = 0%

Test for overall effect: Z = 4.23 (P < 0.0001)

1.22.2 Short-term followup (6 months)

Fals-Stewart 2006

Winters 2002

Subtotal (95% CI)

Heterogeneity: Chi2 = 0.82, df = 1 (P = 0.37); I2 = 0%

Test for overall effect: Z = 5.27 (P < 0.00001)

1.22.3 Long-term followup (12 months)

Fals-Stewart 2006

Winters 2002

Subtotal (95% CI)

Heterogeneity: Chi2 = 2.40, df = 1 (P = 0.12); I2 = 58%

Test for overall effect: Z = 3.91 (P < 0.0001)

Test for subgroup differences: Chi2 = 1.12, df = 2 (P = 0.57), I2 = 0%

Mean

123

105.3

117.2

93.4

112.4

86.2

SD

12.1

13.2

13.7

22.7

14

25.2

Total

46

36

82

46

31

77

46

33

79

Mean

111.2

97.2

102.2

84.3

98

82.8

SD

18.6

16.1

14.4

23.6

18.8

25.9

Total

46

36

82

46

32

78

46

35

81

Weight

52.9%

47.1%

100.0%

79.8%

20.2%

100.0%

76.3%

23.7%

100.0%

IV, Fixed, 95% CI

11.80 [5.39, 18.21]

8.10 [1.30, 14.90]

10.06 [5.39, 14.72]

15.00 [9.26, 20.74]

9.10 [-2.33, 20.53]

13.81 [8.68, 18.94]

14.40 [7.63, 21.17]

3.40 [-8.75, 15.55]

11.79 [5.87, 17.71]

Couple/Marital Individual Mean Difference Mean Difference

IV, Fixed, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy
204

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 9. Percent Days Abstinent, Differences between BCT and ICBT: Studies with Male Subjects 

Only

Study or Subgroup

1.6.1 Post-treatment

Fals-Stewart 1996

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.01, df = 3 (P = 1.00); I2 = 0%

Test for overall effect: Z = 1.64 (P = 0.10)

1.6.2 Short-term followup (6 months)

Fals-Stewart 1996

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.28, df = 3 (P = 0.96); I2 = 0%

Test for overall effect: Z = 2.61 (P = 0.009)

1.6.3 Long-term followup (12 months)

Fals-Stewart 1996

Fals-Stewart 2003

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Subtotal (95% CI)

Heterogeneity: Tau2 = 0.00; Chi2 = 0.31, df = 4 (P = 0.99); I2 = 0%

Test for overall effect: Z = 3.29 (P = 0.001)

Test for subgroup differences: Chi2 = 2.93, df = 2 (P = 0.23), I2 = 31.7%

Mean

95.4

85.9

90.2

92.3

81.5

77.6

80.6

85.1

73.2

59.6

66.9

70.9

77.8

SD

15.4

22.7

21.9

15.2

28.6

25.8

27.2

20.7

29.8

26.4

35.6

25.6

20.2

Total

40

22

25

10

97

40

22

25

10

97

40

62

22

25

10

159

Mean

91.1

81.8

86.6

88.3

70.4

63.6

71.4

78.2

65.1

49.3

53.4

60.4

70.2

SD

14.1

26.2

17.4

16.7

24.5

42.3

26.2

22.6

26.9

28.4

24.8

22.4

18.6

Total

40

21

22

10

93

40

21

22

10

93

40

62

21

22

10

155

Weight

57.5%

11.2%

19.0%

12.3%

100.0%

44.1%

13.5%

25.7%

16.6%

100.0%

22.3%

37.1%

10.3%

18.3%

11.9%

100.0%

IV, Random, 95% CI

4.30 [-2.17, 10.77]

4.10 [-10.58, 18.78]

3.60 [-7.65, 14.85]

4.00 [-10.00, 18.00]

4.11 [-0.80, 9.01]

11.10 [-0.57, 22.77]

14.00 [-7.06, 35.06]

9.20 [-6.08, 24.48]

6.90 [-12.09, 25.89]

10.30 [2.56, 18.05]

8.10 [-4.34, 20.54]

10.30 [0.65, 19.95]

13.50 [-4.77, 31.77]

10.50 [-3.22, 24.22]

7.60 [-9.42, 24.62]

9.85 [3.98, 15.73]

Couple/Marital Individual Mean Difference Mean Difference

IV, Random, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy; EtOH = alcohol
205

Family Involved Psychosocial Treatments for Adult Mental Health 

Conditions: A Review of the Evidence Evidence-based Synthesis Program

Figure 10. Relationship Adjustment using Dyadic Adjustment Scale, Difference in Mean Scores 

between BCT and ICBT: Studies with Male Subjects Only

Study or Subgroup

1.21.1 Post-treatment

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Subtotal (95% CI)

Heterogeneity: Chi2 = 0.13, df = 2 (P = 0.94); I2 = 0%

Test for overall effect: Z = 4.07 (P < 0.0001)

1.21.2 Short-term followup (6 months)

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Subtotal (95% CI)

Heterogeneity: Chi2 = 0.25, df = 2 (P = 0.88); I2 = 0%

Test for overall effect: Z = 4.55 (P < 0.00001)

1.21.3 Long-term followup (12 months)

Kelley 2002 (Drug)

Kelley 2002 (EtOH)

Lam 2009

Subtotal (95% CI)

Heterogeneity: Chi2 = 0.41, df = 2 (P = 0.81); I2 = 0%

Test for overall effect: Z = 2.93 (P = 0.003)

Test for subgroup differences: Chi2 = 0.63, df = 2 (P = 0.73), I2 = 0%

Mean

103.6

115.4

114.6

93.6

103.9

105.9

90.7

91.4

99.8

SD

22.1

18.2

16.8

17.2

16.2

19.6

22.3

19.9

20.3

Total

22

25

10

57

22

25

10

57

22

25

10

57

Mean

88.7

102.2

98.1

77.8

86.7

93.9

75.8

82.1

88.9

SD

16.4

19.1

17.9

18.7

19.2

20.2

20.4

20.7

22

Total

21

22

10

53

21

22

10

53

21

22

10

53

Weight

36.3%

42.6%

21.1%

100.0%

40.3%

44.5%

15.3%

100.0%

37.4%

44.9%

17.7%

100.0%

IV, Fixed, 95% CI

14.90 [3.30, 26.50]

13.20 [2.49, 23.91]

16.50 [1.28, 31.72]

14.51 [7.53, 21.50]

15.80 [5.05, 26.55]

17.20 [6.97, 27.43]

12.00 [-5.44, 29.44]

15.84 [9.02, 22.66]

14.90 [2.13, 27.67]

9.30 [-2.35, 20.95]

10.90 [-7.65, 29.45]

11.68 [3.87, 19.48]

Couple/Marital Individual Mean Difference Mean Difference

IV, Fixed, 95% CI

-20 -10 0 10 20

Favors Individual Favors Couple/Marital

*Horizontal bars for each study represent the study’s confidence interval. Confidence intervals extending below 0 

indicate non-significant differences. Size of box or diamond reflects sample size.

BCT = Behavioral Couple or Marital Therapy; ICBT = Individual Cognitive-Behavioral Therapy; EtOH = alcohol