Objective: Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually-based therapy (IBT) for substance use and relationship outcomes among men with alcohol use disorder (AUD). The present study compared BCT with IBT for women with AUD. Method: Participants were women with AUD (N = 105) and their male partners without SUD. Participants were mostly White and in their forties. Women were randomized to equally intensive treatments consisting of either BCT plus 12-step-oriented IBT or IBT only. Primary outcomes included: Timeline Followback Interview percentage days abstinent (PDA) and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcomes included: Dyadic Adjustment Scale (DAS), Relationship Happiness Scale (RHS), and Revised Conflict Tactics Scales measure of intimate partner violence (IPV). Outcome data were collected at baseline, post-treatment, and quarterly for 1-yr follow-up. Results: Compared to IBT only, BCT plus IBT had significantly better primary outcomes of higher PDA and fewer substance-related problems during the 1-yr follow-up period. Compared to IBT only, BCT had significantly higher male RHS during the 1-yr follow-up. Women with lower pretreatment DAS had significantly higher DAS following BCT versus IBT, and there was an increasing advantage for BCT on female DAS over the follow-up. IPV was significantly reduced from pretreatment to follow-up, with no differences between treatment conditions. Conclusion: Results showed that BCT for women with AUD was more efficacious than IBT in reducing substance use and substance-related problems and improving partner relationships.

Objective Behavioral couples therapy (BCT) is more efficacious than individually-based therapy (IBT) for substance and relationship outcomes among patients with substance use disorder (SUD). This study compared BCT with IBT for drug-abusing women. Method Sixty-one women, mostly White, late thirties, with primary SUD other than alcohol (74% opioid diagnosis), and male partners were randomized to 26 sessions over 13-weeks of BCT plus 12-step-oriented IBT (i.e. BCT+IBT) or IBT. Substance-related outcomes: percentage days abstinent (PDA), percentage days drug use (PDDU), Inventory of Drug Use Consequences. Relationship outcomes: Dyadic Adjustment Scale (DAS) and days separated. Data were collected at baseline, post-treatment, and quarterly for 1-yr follow-up. Results On PDA, PDDU, and substance-related problems, both BCT+IBT and IBT patients showed significant (p < .01) large effect size improvements throughout the 1-yr follow-up (d > .8 for most time periods). BCT+IBT showed a significant (p < .001) large effect size (d = −.85) advantage versus IBT on fewer substance-related problems, while BCT+IBT and IBT did not differ on PDA or PDDU (p’s > .47). On relationship outcomes, compared to IBT, BCT+IBT had significantly higher male-reported DAS (p < .001, d = .57) and fewer days separated (p = .01, d = −.47) throughout the 1-yr follow-up. Conclusion BCT+IBT for drug-abusing women was more efficacious than IBT in improving relationship satisfaction and preventing relationship break-up. On substance use and substance-related problems, women receiving both treatments substantially improved, and women receiving BCT+IBT had fewer substance-related problems than IBT.

We report here on the feasibility of implementing a semiautomated performance improvement system-Patient Feedback (PF)-that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4 weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at postintervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness.

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ABSTRACT. Objective: Despite extensive intimate partner violence (IPV) among women in substance use disorder treatment, few studies have investigated IPV risk factors within this population. Conceptual models, which have received support in other populations, propose that antisociality and generalized violence, alcohol and drug use, and relationship adjustment may be interrelated pathways that infl uence IPV. The purpose of this study was to test a conceptual model that integrates these individual and relationship pathways to explain IPV among women entering substance use disorder treatment. Method: Women entering substance use disorder treatment (N = 277) who had a male relationship partner completed measures of the following domains about themselves and their male partners: antisociality/generalized violence, heavy alcohol use, drug use, relationship adjustment, and psychological and physical IPV. Results: Structural equation modeling analyses showed that the antisociality/generalized violence of each partner had direct and indirect effects on IPV. Each partner's antisociality/generalized violence was directly related to her or his physical IPV. Female antisociality/ generalized violence was indirectly related to female physical IPV via female drug use and female psychological IPV. Male antisociality/generalized violence was indirectly associated with male physical IPV via male drinking, relationship adjustment, and male psychological IPV. A reciprocal relationship was found between partners' psychological IPV but not physical IPV. When accounting for other individual and relational IPV predictors, male partners' physical IPV infl uenced women's physical IPV, but women's physical IPV did not infl uence their male partner's physical IPV. Conclusions: Both partners' antisociality/generalized violence, substance use, and overall relationship adjustment are important in understanding IPV among women entering substance use disorder treatment. (J. Stud. Alcohol Drugs, 72, 933-942, 2011)