Adapting Behavioral Marital Therapy to Treat Drug Abuse (Epstein, PI)

This second revision of R01DA10835-01, originally submitted 2/96 (score was 225) then 2/97 (score was 179), is a 3 year, Stage I research plan is in response to the NIDA Behavioral Therapies Development Program. It develops a marital therapy model of treatment for drug abusing or dependent males and their female partners, by modifying a similar model currently used to treat alcohol dependence. The assessment/treatment manual will be developed by treating three cohorts of 8 couples each. Changes in the protocol based on experiences with each cohort will be incorporated into the treatment manual for the subsequent cohort. Broad objectives of the study are to begin programmatic development of a promising behavioral couples treatment for drug addiction (BCTD), and to generate a treatment manual, related materials, and descriptive data for Stage II research. Specific primary goals are: (1) to develop a feasible, manualized treatment protocol for stand-alone, outpatient cognitive- behavioral couples therapy for drug addiction; (2) to develop baseline (BL) and follow-up (FU) assessment batteries for both partners, to study the effects of psychopathology, substance use, and quality of the marital relationship, on response to BCTD, and (3) to generate self-report, interview, and observational data on each couple, so that we can carefully describe the sample in terms of BL and post-treatment characteristics, and marital interaction specifically related our model of change. These descriptive data will facilitate development of a treatment protocol that is applicable to wide range of drug abusing individuals, and of hypotheses related to change, that can be tested in later Stage II studies. Specific secondary goals are: (4) to develop selection and training protocols for therapists; (5) to develop a measure of therapist adherence/competence; (6) to develop a measure of treatment integrity, and (7) to evaluate the feasibility of following up this sample. Research Design and Methods: First, we will prepare a BCTD treatment manual for drug misuse, BL and FU assessment batteries, a training protocol for therapists, and a battery of treatment and therapist process measures. The assessment/treatment package will include BL assessment 24 outpatient conjoint sessions, post-treatment FU and exit interview, and a 3 month FU and exit interview. The initial version of the protocols will be developed in the first six months, by modifying existing protocols for alcohol behavioral couples therapy. During the second half of the first year, 8 couples will be recruited and the initial protocol will be piloted and revised. Eight more couples will comprise the second cohort and will be administered the revised assessment/treatment protocol during the second year of the grant. The manual will then be revised again, and the final cohort of 8 couples will pilot the "closest to final" version of the assessment/treatment/ follow-up package during the last year of the grant. Final revisions will be made based on results from the third cohort pilot, and the manual and protocols will be prepared for used in subsequent tests of the treatment.