Brief Relationship Therapy for Alcoholism: A Randomized Clinical Trial Examining Clinical Efficacy and Cost-Effectiveness.

The purpose of this study was to examine the clinical efficacy and cost effectiveness of brief relationship therapy (BRT), a shortened version of standard behavioral couples therapy (S-BCT), with alcoholic male patients (N = 100) and their nonsubstance-abusing female partners. Participants were randomly assigned to 1 of 4 treatment conditions: (a) BRT, (b) S-BCT, (c) individual-based treatment (IBT), or (d) psychoeducational attention control treatment (PACT). Equivalency testing revealed that, compared with those assigned to S-BCT, participants who were randomly assigned to BRT had equivalent posttreatment and 12-month follow-up heavy drinking outcomes. Moreover, at 12-month follow-up, heavy drinking and dyadic adjustment outcomes for patients who received BRT were superior to those of patients who received IBT or PACT. BRT was significantly more cost effective than the S-BCT, IBT, or PACT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples- versus individual-based therapy for alcohol and drug abuse: Effects on children's psychosocial functioning.

The study compared the effect of couples-based vs individual-based therapy for men who entered outpatient substance abuse treatment on the psychosocial functioning of children in their homes. Men were randomly assigned to (1) behavioral couples therapy (BCT), (2) individual-based treatment (IBT) or (3) couples-based psychoeducational attention control treatment (PACT). For both children of alcohol (N=71) and drug-abusing men (N=64), parents' ratings of children's psychosocial functioning was higher for children whose fathers participated in BCT at posttreatment and at 6- and 12-mo follow-up than for children whose fathers participated in IBT or PACT. BCT resulted in greater improvements in parents' dyadic adjustment and fathers' substance use. Thus, couples-based intervention that addresses both issues may have greater benefits for children in these homes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral couples therapy for female substance-abusing patients: Effects on substance use and relationship adjustment.

Married or cohabiting female drug-abusing patients (N=75) were randomly assigned to either a behavioral couples therapy condition (BCT, n=37), which consisted of group, individual, and behavioral couples therapy sessions, or to an equally intensive individual-based treatment condition (IBT; n=38), which consisted of group and individual counseling. During most of the 1-yr follow-up, compared with participants who received IBT, those who received BCT reported (1) fewer days of substance use, (2) longer periods of continuous abstinence, (3) lower levels of alcohol, drug, and family problems, and (4) higher relationship satisfaction. However, differences in relationship satisfaction and number of days of substance use dissipated over the course of the posttreatment follow-up period and were not significantly different by the end of 1 yr. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral couples therapy for male substance-abusing patients: Effects on relationship adjustment and drug-using behavior.

Married or cohabitating substance-abusing patients (n?=?80) who were entering individual outpatient treatment, most of whom were referred by the criminal justice system (n?=?68; 85%), were randomly assigned to a no-couples-treatment control group (n?=?40) or to 12 weekly sessions of adjunctive behavioral couples therapy (BCT; n?=?40) . Drug use and relationship adjustment measures were collected at pretreatment, posttreatment, and at 3-, 6-, 9-, and 12-month follow-ups. Couples who received BCT as part of individual-based treatment had better relationship outcomes, in terms of more positive dyadic adjustment and less time separated, than couples in which husbands received individual-based treatment only. Husbands in the BCT condition also reported fewer days of drug use, longer periods of abstinence, fewer drug-related arrests, and fewer drug-related hospitalizations through the 12-month follow-up period than husbands receiving individual-based treatment only. However, some of the drug use and relationship adjustment differences between these groups dissipated over the course ofthe follow-up period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral couples therapy for male substance-abusing patients: A cost outcomes analysis.

The cost outcomes for married or cohabiting substance-abusing male patients (N?=?80) who were randomly assigned to receive either behavioral couples therapy (BCT) or individual-based treatment (IBT) were compared. Social costs incurred by patients in several areas (e.g., cost of substance abuse treatment, support from public assistance) during the year before and the year after treatment were estimated. BCT was more cost-beneficial than IBT; although the monetary outlays for delivering IBT and BCT were not different, the average reduction in aggregate social costs from baseline to follow-up was greater for patients who received BCT (i.e., $6,628) than for patients who received IBT (i.e., $1,904). BCT was also more cost-effective than IBT; for each $100 spent on treatment, BCT produced greater improvements than IBT on several indicators of treatment outcome (e.g., fewer days of substance use, fewer legal problems). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating intimate partner violence among substance-abusing dyads: The effect of couples therapy.

This study examined whether participation in couples therapy, compared with individual therapy, had a differential effect on the day-to-day relationship between substance use and occurrences of intimate partner violence (IPV) among married or cohabiting substance-abusing men. Patients (N = 207) were randomly assigned to either partner-involved behavioral couples therapy (BCT; included non-substance-abusing female partners in conjoint sessions) or individual-based treatment (IBT; male partners only). Couples in BCT reported lower levels of IPV and substance use at a 12-month posttreatment follow-up compared with couples with male partners in IBT. Moreover, treatment assignment was a significant moderator of the day-to-day relationship between substance use and IPV. Likelihood of nonsevere and severe male-to-female partner violence on days of male partners’ substance use was lower among couples who received BCT compared with IBT. These findings indicate couples therapy may play an important role in the treatment of IPV among substance-abusing couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral family counseling and naltrexone for male opioid-dependent patients.

Men (N=124) entering treatment for opioid dependence who were living with a family member were randomly assigned to one of two 24-week treatments: (a) behavioral family counseling (BFC) plus individual treatment (patients had both individual and family sessions and took naltrexone daily in presence of family member) or (b) individual-based treatment only (IBT; patients were given naltrexone and were asked in counseling sessions about their compliance, but there was no family involvement). BFC patients, compared with their IBT counterparts, ingested more doses of naltrexone, attended more scheduled treatment sessions, had more days abstinent from opioids and other drugs during treatment and during the year after treatment, and had fewer drug-related, legal, and family problems at 1-year follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drinking outcomes following drink refusal skills training: Differential effects for African American and non-Hispanic White clients.

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Alcohol-Focused Spouse Involvement and Behavioral Couples Therapy: Evaluation of Enhancements to Drinking Reduction Treatment for Male Problem Drinkers.

This study evaluated the effects of alcohol-focused spouse involvement and behavioral couples therapy (BCT) in group drinking reduction treatment for male problem drinkers. Sixty-four male clients and their female partners were randomly assigned to 1 of 3 conditions: treatment for problem drinkers only (PDO), couples alcohol-focused treatment, or the latter combined with BCT. Clients whose partners were included in treatment evidenced fewer heavy drinking days and more abstinent/light drinking days in the year following treatment, relative to PDO clients. The combination of alcohol-focused spouse involvement and BCT yielded no better outcomes than alcohol-focused spouse involvement alone. Drinking consequences, spouse behavioral support for drinking reduction, and relationship satisfaction showed no effects of treatment condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized motivational enhancement prevention group reduces drinking and alcohol consequences in first-year college women.

Alcohol consumption among college students has become an increasing problem that requires attention from college administrators, staff, and researchers. Despite the physiological differences between men and women, college women are drinking at increasingly risky rates, placing them at increased risk for negative consequences. The current study tested a group motivational enhancement approach to the prevention of heavy drinking among 1st-year college women. Using a randomized design, the authors assigned participants either to a group that received a single-session motivational enhancement intervention to reduce risky drinking that focused partly on women's specific reasons for drinking (n = 126) or to an assessment-only control group (n =94). Results indicated that, relative to the control group participants, intervention participants drank fewer drinks per week, drank fewer drinks at peak consumption events, and had fewer alcohol-related consequences over a 10-week follow-up. Further, the intervention, which targeted women's reasons for drinking, was more effective in reducing consumption for participants with high social and enhancement motivations for drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men.

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderating effects of a craving intervention on the relation between negative mood and heavy drinking following treatment for alcohol dependence.

Objective: Negative affect is a significant predictor of alcohol relapse, and the relation between negative affect and drinking has been shown to be strongly mediated by alcohol craving. Thus, targeting craving during treatment could potentially attenuate the relation between negative affect and drinking. Method: The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. Our goal in the current study was to examine whether a treatment module that targeted craving would predict changes in negative mood during the 16-week combined behavioral intervention (n = 776) and the relation among changes in mood, craving, and changes in heavy drinking during treatment and 1 year posttreatment. Results: Changes in negative mood were significantly associated with changes in heavy drinking during treatment (f2 = 0.78). Participants (n = 432) who received the craving module had significantly fewer heavy drinking days during treatment (d = 0.31), and receiving the module moderated the relation between negative mood and heavy drinking during treatment (f2 = 0.92) and 1 year posttreatment (f2 = 0.03). Moderating effects of the craving module were mediated by changes in craving during treatment. Within-subject analyses indicated significant pre- to postmodule reductions in negative mood. Additionally, postmodule craving significantly mediated the association between negative mood and heavy drinking during treatment and at posttreatment. Conclusions: The craving module of the combined behavioral intervention may weaken the relation between negative affect and heavy drinking by fostering greater decreases in craving during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity.

A randomized clinical trial evaluated the efficacy of multisystemic therapy (MST) versus usual community services (UCS) for 48 juvenile sexual offenders at high risk of committing additional serious crimes. Results from multiagent assessment batteries conducted before and after treatment showed that MST was more effective than UCS in improving key family, peer, and academic correlates of juvenile sexual offending and in ameliorating adjustment problems in individual family members. Moreover, results from an 8.9-year follow-up of rearrest and incarceration data (obtained when participants were on average 22.9 years of age) showed that MST participants had lower recidivism rates than did UCS participants for sexual (8% vs. 46%, respectively) and nonsexual (29% vs. 58%, respectively) crimes. In addition, MST participants had 70% fewer arrests for all crimes and spent 80% fewer days confined in detention facilities than did their counterparts who received UCS. The clinical and policy implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of group motivational interviewing (GMI) for psychiatric inpatients with chemical dependence.

Dually diagnosed patients with chemical dependency and a comorbid psychiatric disorder typically show poor compliance with aftercare treatment, which may result in costly and pervasive individual and societal problems. In this study, the authors investigated the effect of adding motivational interviewing in a group format to standard treatment for dually diagnosed psychiatric inpatients. The patients (n = 101) all received standard care and in addition were assigned to either group motivational interviewing (GMI) or a therapist attention activity control group (TAAC). Of patients who attended aftercare and who used alcohol or drugs, those who participated in GMI attended significantly more aftercare treatment sessions, consumed less alcohol, and engaged in less binge drinking at follow-up compared with those in TAAC. Differences between conditions in the overall percentage of participants who achieved complete abstinence or who attended aftercare treatment were not significant, possibly because of a lack of power. These results provide preliminary evidence for the efficacy of GMI when added at the outset to an inpatient program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal change in cognitive performance among individuals with mild cognitive impairment.

The authors used mixed-effects growth models to examine longitudinal change in neuropsychological performance over a 4-year period among 197 individuals who were either normal or had mild cognitive impairment (MCI) at baseline. At follow-up, the participants were divided into 4 groups: (a) controls: participants who were normal at both baseline and follow-up (n = 33), (b) stables: participants with MCI whose Clinical Dementia Rating-Sum of Boxes (CDR-SB) score did not differ between the first and last evaluations (n = 22), (c) decliners: participants with MCI whose CDR-SB score declined between the first and last evaluations (n = 95), and (d) converters: participants who received a clinical diagnosis of Alzheimer's disease during the follow-up period (n = 47). Only the Episodic Memory factor showed a significantly greater rate of decline over the follow-up period among the converters. Two other factors were significantly lower in converters at baseline in comparison with other groups (the executive function factor and the general knowledge factor), but the rate of decline over time did not differ. Individuals with an APOE ε4 allele scored lower on the episodic memory and executive function factors at baseline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating paternal alcoholism with learning sobriety together: Effects on adolescents versus preadolescents.

The purpose of this study was to determine whether Learning Sobriety Together, a treatment for substance abuse that combines behavioral couples therapy and individual counseling, had comparable secondary benefits on the internalizing and externalizing behaviors of adolescent versus preadolescent siblings living in homes with their alcoholic fathers (N = 131) and their non-substance-abusing mothers. During a 17-month assessment period, the association between parents' functioning (i.e., fathers' drinking as determined by percentage of days abstinent and parents' dyadic adjustment) and children's adjustment (as rated by mothers, fathers, and children's teachers) was stronger for preadolescents than for their adolescent siblings, particularly in terms of children's externalizing behaviors. Interventions that reduce paternal drinking and improve couple functioning may serve as an important preventative intervention for preadolescents in these homes, whereas adolescents may need more intensive interventions to address internalizing and externalizing symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Broad-spectrum behavioral treatment for chronic alcoholics: Effects of training controlled drinking skills.

Evaluated drinking skills training for 62 male chronic alcoholic veterans (mean age 46.1 yrs) by assigning 10 successive cohorts to trained or untrained conditions in a randomized block experimental design. All Ss received broad-spectrum behavioral treatment consisting of alcohol education, group therapy, individual therapy, self-management training, job-seeking and interpersonal-skills training, drink-refusal-skills training, and relaxation training. Cohorts assigned to the controlled drinking skills condition received 15 hrs of blood-alcohol-level discrimination training, responsible-drinking-skills training, and social-drinking practice sessions. Six-month posttreatment follow-up revealed that Ss in the drinking skills condition had significantly fewer abstinent days and more abusive drinking days than Ss in the untrained condition. Differences between groups were not significant in follow-up Months 7–22, although trends continued. No differences were obtained on moderate drinking days or any adjunctive measures of psychosocial adjustment. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personalized mailed feedback for college drinking prevention: A randomized clinical trial.

The current study was designed to evaluate the efficacy of a mailed feedback and tips intervention as a universal prevention strategy for college drinking. Participants (N = 1,488) were randomly assigned to feedback or assessment-only control conditions. Results indicated that the mailed feedback intervention had a preventive effect on drinking rates overall, with participants in the feedback condition consuming less alcohol at follow-up in comparison with controls. In addition, abstainers in the feedback condition were twice as likely to remain abstinent from alcohol at follow-up in comparison with control participants (odds ratio = 2.02), and feedback participants were significantly more likely to refrain from heavy episodic drinking (odds ratio = 1.43). Neither gender nor severity of baseline drinking moderated the efficacy of the intervention in these analyses, but more conservative analyses utilizing last-observation carryforward suggested women and abstainers benefited more from this prevention approach. Protective behaviors mediated intervention efficacy, with participants who received the intervention being more likely to use strategies such as setting limits and alternating alcohol with nonalcoholic beverages. Implications of these findings for universal prevention of college drinking are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mother and child interpretations of threat in ambiguous situations: Relations with child anxiety and autonomic responding.

This study examined maternal and child interpretive bias to threat (IBT) during dyadic conversation, child physiological reactivity and regulation during dyadic conversation, and maternal report of child anxiety in a community sample of 35 mothers and their 8- to 10-year-old children. Mothers and children discussed one neutral and six ambiguous scenarios, which were subsequently coded for frequency of maternal and child initiation, minimization, and expansion of threat-related themes. Child electrocardiogram data were collected during these conversations and maternal reports of child anxiety and internalizing problems were obtained. Across the sample, children initiated threat-related discussion more often than mothers. Maternal threat expansions were significantly positively correlated with child anxiety and internalizing behaviors. Maternal minimizations of threat were significantly associated with augmented child vagal tone throughout the IBT paradigm. Implications for prevention of child anxiety and directions for extending IBT research within the context of the mother–child dyad are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)