A randomized clinical trial of behavioral couples therapy versus individually-based treatment for drug-abusing women.

Abstract

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.

Efficacy of Behavioral Couples Therapy Versus Individual Recovery Counseling for Addressing Posttraumatic Stress Disorder Among Women With Drug Use Disorders

“…As previously reported in O'Farrell et al. (), a Cohen's f effect size difference of 0.25–0.26 was anticipated between BCT+IBT versus IBT on substance‐related and relationship outcomes. To achieve a statistical power of 0.80 or higher with an alpha value of .05, the target sample size was 84 to 104 participants.…”

“…There were no significant differences between BCT+IBT and IBT on these and other pretreatment variables reported in O'Farrell et al. ().…”

“…Participants were 51 drug‐abusing women who endorsed a lifetime PTSD Criterion A traumatic event according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM‐IV ; American Psychiatric Association, ). Women and their male partners were recruited from an SUD treatment program as part of a larger study to compare BCT+IBT to IBT (see O'Farrell et al., ). Eligibility criteria included: (a) denial of severe (i.e., likely to cause serious injury or death) intimate partner violence (IPV) in the past 3 years and no fear that couples therapy might increase IPV risk, as reported on brief IPV items in the study screening interview; (b) both partners were over 18 years old; (c) couple was married or living together for at least 1 year, lived apart for no more than 4 of past 12 months, and had no immediate plans to separate or divorce; (d) woman met Structured Clinical Interview for DSM‐IV (SCID; First, Spitzer, Gibbons & Williams, ) criteria for a current (past 12 months) SUD, and had a substance other than alcohol or nicotine as the primary substance according to a diagnostic algorithm; (e) woman agreed to goal of abstinence from drugs and alcohol and was willing to forgo other non‐study‐related SUD counseling during study‐based treatment; (f) male partner agreed that if randomized to BCT, he would work in BCT to help the female partner achieve abstinence from drugs and alcohol (see O'Farrell et al., , for additional study criteria details).…”

“…Women were randomly assigned to equally intensive treatments: (a) BCT plus 12‐step‐oriented IBT (BCT+IBT) or (b) IBT. Outcome data were collected at baseline, posttreatment, and quarterly through 1‐year follow‐up (see O'Farrell et al., for more details on study methods).…”

“…According to the SCID (First et al, 1996), 32.8% of male partners exhibited substance dependence, and 45.9% were more broadly defined as having a substance use problem. To be classified as having a substance use problem, male partners needed to meet SCID criteria for dependence or abuse or to report heavy alcohol or drug use on the Drug Use Frequency measure (for review, see O'Farrell et al, 2017). There were no significant differences between BCT+IBT and IBT on these and other pretreatment variables reported in O'Farrell et al (2017).…”