Couples Therapy for Alcoholic Patients
Condition: Alcoholism
MeSH terms: Alcoholism
Study type: Interventional
Phase: Phase 2

Summary: 
      In treating alcoholism, many studies show Behavioral Couples Therapy (BCT) is more effective
      than typical counseling, but BCT is not widely used because standard BCT delivered one couple
      at a time is costly to deliver and does not fit with the primary group therapy focus of most
      community clinics. The proposed study will test with married or cohabiting alcoholic patients
      whether a group format for BCT will produce similar positive outcomes as standard BCT, and
      deliver these results at a lower cost. If outcomes are favorable, this could prompt clinics
      to start using group BCT and improve outcomes for alcoholic patients and their families.
    

Detailed description: 
      Multiple studies indicate that participation in Behavioral Couples Therapy (BCT) is
      associated with robust positive outcomes for alcoholic and drug-abusing patients, in terms of
      reduced substance use and improved relationship functioning. Yet, community-based treatment
      programs rarely offer BCT to incoming eligible patients. As reported by providers and
      administrators in a national survey of treatment programs in the U.S., BCT was viewed as
      prohibitively labor intensive, due in large measure to its standard conjoint
      one-couple-at-a-time delivery format. Given the public policy climate that is now emphasizing
      not only clinical effectiveness, but also economic accountability, an intervention's
      efficiency (i.e., the ratio of effectiveness to program resources used to provide the
      service) is a critical factor in decisions by treatment programs to adopt new interventions.
      Although BCT has well-proven efficacy, the consensus of providers and administrators is that
      BCT is not efficient.

      To address these issues, we have studied couples group formats to deliver BCT. First, in
      earlier work the PI developed a 10-week BCT group with a number of conjoint sessions added
      before to prepare couples and afterwards to prevent relapse. While the outcomes were
      favorable, the added conjoint sessions and the closed group that once begun did not add
      additional members made it a hard sell for community agencies looking for briefer treatments
      and typically running ongoing groups with new members added regularly. Second, to overcome
      these problems, the PI and Co-PI developed a 10-session ongoing BCT group format that has
      rotating content and rolling admissions in which couples join the group, complete 10
      sessions, and "graduate". A major advantage of this ongoing group format for BCT is that it
      fits with the way other types of groups generally are run in substance abuse programs. It got
      favorable reviews in provider focus groups and showed promise in a pilot study.

      The pilot study with married or cohabiting male drug-abusing patients examined the efficacy
      of a multi-couple group therapy version of BCT (G-BCT) compared to standard conjoint BCT
      (S-BCT), and individual-based treatment (group and individual counseling) for the patient
      only. Results showed G-BCT yielded equivalent outcomes when compared to S-BCT, in terms of
      reduction in substance use and improved relationship adjustment, but GBCT was less costly to
      deliver and had superior cost-benefit and cost-effectiveness. Both G-BCT and S-BCT yielded
      better clinical and cost-outcomes than individual-based treatment. Also, a small-scale
      evaluation study indicated G-BCT was more likely to be used in community-based treatment
      programs than S-BCT.

      Thus, this proposed study will conduct a randomized clinical trial to examine the clinical
      effectiveness, in terms of substance use, relationship functioning, and psychosocial
      adjustment, of Group BCT (G-BCT) versus Standard BCT (S-BCT) for 160 alcoholic patients and
      their nonsubtance-abusing partners. Given the likely differences in cost of treatment
      delivery between the 2 interventions, we will also examine the comparative cost-benefit and
      cost-effectiveness of the 2 intervention packages.
    

Intervention name(s): Group Couples Counseling; One-on-One Couples Counseling
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Alcoholism; Couples