| Conditions: |
|
Behavioral Couples Therapy |
| Purpose: |
|
As they move from preadolescence to adolescence and adulthood, children need nurturing and
supportive environments to realize their potential. Unfortunately, many children reside in
destructive families that often result in negative short and long-term outcomes. As
well-chronicled in the scientific and lay press, an all-too-common example involves parental
substance abuse. Indeed, children living with a parent who abuses substances often have
significant emotional, behavioral, and social problems. It has long been recognized that
interventions are needed to address the clinical needs of these youth and to help prevent
the development of problems that may emerge in early adulthood. To date, the majority of
treatments have focused on either treating the children individually, or in the context of
family therapy. Although directly involving these youth in treatment may be ideal, the
majority of custodial parents who enter treatment for substance abuse are very reluctant to
allow their children to engage in individual or family therapy. Thus, interventions for
substance-abusing parents that do not directly involve children, but serve to improve the
family environment as a whole, may have the greatest potential for reaching the most
children and thereby positively influencing their overall adjustment and well-being.
From this vantage, a promising approach is Learning Sobriety Together (LST; the "brand" name
of Behavioral Couples Therapy [BCT] for alcoholism and drug abuse), a comprehensive
psychosocial intervention for substance abuse that focuses both on reducing addiction
severity, improving couple adjustment, reducing interparental conflict and intimate partner
violence (IPV), and improving the family environment and psychological functioning. In a
series of preliminary studies, the PI found that children whose substance-abusing fathers
and nonsubstance-abusing mothers participated in LST displayed higher psychosocial
adjustment at posttreatment and during an extended follow-up than youth whose
substance-abusing fathers participated in individual-based treatment (IBT) or whose parents
participated in a couples-based attention control treatment. These findings indicate that
LST may extend beyond the couple to their children and may provide an entry point into the
family system from which to improve the adjustment of these youth.
The present randomized clinical trial provides the next important step for this line of
research. First, the present study is a far more developed examination of the potential
effects of LST on multiple dimensions of youth functioning, taken from multiple
perspectives. Second, we do not know "how" LST works. The positive effects of LST on parents
(reduced addition severity, improved dyadic adjustment, reduced partner violence, improved
parenting, and improved parental psychological adjustment) may have positive "trickle down"
effects on youth; however, we have not undertaken an empirical examination of these
potential mechanisms of action. If we can understand how it works, we will be able to use
that information to refine LST to enhance the mechanisms that benefit youth. Thus, the
present study will examine possible curative mechanisms. Third, we have a very limited
understanding for "whom" it works. Thus, we will examine whether LST may operate differently
for children of different stages of development. If we can understand this moderating
effect, we may be able to develop and refine LST to meet the needs of families with children
of different ages.
To address these issues, the present study is a randomized clinical trial (RCT) to compare
the emotional and behavioral adjustment, beliefs, and behaviors, including serious problem
behaviors, of youth ages 6 to 18 (as rated by mothers, fathers, teachers, and the children
themselves) whose mothers or fathers are randomly assigned to participate in LST with their
nondrug using partners as compared to parents who are assigned to IBT. We will also focus on
potential mechanisms of action that are positively influenced by LST.
|
| Study Summary: |
|
The present randomized clinical trial provides the next important step for this line of
research. First, the present study is a far more developed examination of the potential
effects of LST on multiple dimensions of youth functioning, taken from multiple
perspectives. Second, we do not know "how" LST works. The positive effects of LST on parents
(reduced addition severity, improved dyadic adjustment, reduced partner violence, improved
parenting, and improved parental psychological adjustment) may have positive "trickle down"
effects on youth; however, we have not undertaken an empirical examination of these
potential mechanisms of action. If we can understand how it works, we will be able to use
that information to refine LST to enhance the mechanisms that benefit youth. Thus, the
present study will examine possible curative mechanisms. Third, we have a very limited
understanding for "whom" it works. Thus, we will examine whether LST may operate differently
for children of different stages of development. If we can understand this moderating
effect, we may be able to develop and refine LST to meet the needs of families with children
of different ages.
To address these issues, the present study is a randomized clinical trial (RCT) to compare
the emotional and behavioral adjustment, beliefs, and behaviors, including serious problem
behaviors, of youth ages 6 to 18 (as rated by mothers, fathers, teachers, and the children
themselves) whose mothers or fathers are randomly assigned to participate in LST with their
nonsubstance-abusing partners as compared to parents who are assigned to IBT. We will also
focus on potential mechanisms of action that are positively influenced by LST.
We intend to use the information collected from the proposed investigation to refine and
modify LST to enhance its positive effects on children. This process of (a) examining
multiple dimensions of functioning and (b) evaluating theoretically and empirically
identified mediators and moderators to inform intervention development and refinement has
been used successfully for over a decade with LST, resulting in empirically informed LST
variants for alcoholic patients, drug-abusing patients, patients who engage in domestic
violence, female substance-abusing patients, and so on. Thus, this project provides the next
critical step for LST refinement and interventions for couples entering LST who have
custodial children, the latter of whom we may only be able to help by helping their parents.
|
| Criteria: |
|
Inclusion Criteria:
- couples must be married or cohabiting in a stable relationship for at least 2 years
- both partners must be at least 18 years of age
- men must be residing in the home for the last 2 years
- women or men must meet DSM-IV criteria for current alcohol or drug dependence (DSM-IV
4th ed., American Psychiatric Association, 1994)
- women or men must have medical clearance to engage in abstinence-oriented outpatient
treatment
- women or men must agree to refrain from the use of alcohol or illicit drugs for the
duration of treatment
- women or men must refrain from seeking additional substance abuse treatment except
for self-help meetings (e.g., Narcotics Anonymous) for the duration of treatment
unless recommended by his primary individual therapist.
- the randomly selected target child cannot have cognitive or physical limitations that
would preclude interview (e.g., mental retardation, blindness).
- children in the study must be fluent in English.
Exclusion Criteria:
- if either partner has perpetrated severe levels of violence against the other as
assessed by the Timeline Followback Spousal Violence or CTS-2
- if either parent meets DSM-IV criteria for an organic mental disorder, schizophrenia,
delusional (paranoid) disorder, or other psychotic disorders
- if either partner participates in other substance abuse treatment (except for
self-help groups)
- one or both partners are fearful of participating in couples treatment
- one or both partners want to leave the relationship, in whole or in part, due to IPV
|
| NCT ID: |
|
NCT01172587 |
| Primary Contact: |
|
Principal Investigator
Michelle L Kelley, Ph.D.
Old Dominion University
|
| Backup Contact: |
|
N/A |
| Location Contact: |
|
Niagara Falls, New York 14301
United States
Daniel Shubsda
Phone: 716-282-1228
Email: dshubsda@northpointecouncil.org
Site Status: Recruiting |