Cost-effectiveness of individual versus group female-specific cognitive behavioral therapy for alcohol use disorder.

OBJECTIVE: To determine the relative cost-effectiveness of individual female-specific cognitive behavioral therapy (I-FS-CBT) versus group female-specific cognitive behavioral therapy (G-FS-CBT). METHODS: This cost-effectiveness study is based on a randomized controlled trial in which 155 women seeking treatment for alcohol use disorder at an academic outpatient clinic were randomized to 12 manual-guided sessions of I-FS-CBT (n = 75) or G-FS-CBT (n = 80). The primary patient outcomes were the number of drinking days and the number of heavy drinking days during the 12-week treatment and 1-year follow-up periods. All cost data (including resource utilizations) were collected prospectively alongside the trial. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to determine the cost-effectiveness of I-FS-CBT relative to G-FS-CBT. Results are presented from the provider perspective. RESULTS: During the 12-week treatment period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $141 (or $258), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $141 (or $258). During the 1-year follow-up period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $54 (or $169), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $54 (or $169). The results are robust to sensitivity analyses on several key cost parameters. CONCLUSIONS: Compared to I-FS-CBT, G-FS-CBT holds promise as a cost-effective approach, in both the short run and the long run, for improving drinking outcomes of women with alcohol use disorder.

Nonlinear Associations Between Co-Rumination and Both Social Support and Depression Symptoms.

Co-ruminating about one's problems appears to involve both beneficial self-disclosure and harmful rumination, suggesting that moderate levels may be the most adaptive. This study used nonlinear regression to determine whether moderate levels of self-reported co-rumination in relationships with a sibling, parent, friend, and romantic partner are linked to the highest levels of self-perceived social support and lowest levels of self-reported depression symptoms in 175 emerging adults (77% female; M = 19.66 years). As expected, moderate co-rumination was associated with high social support across all four relationship types, but, somewhat unexpectedly, high levels of co-rumination were also associated with high social support. As predicted, moderate levels of co-rumination with friends and siblings were associated with low levels of depression. Contrary to hypotheses, high levels of co-rumination were associated with high depression within romantic relationships. Co-rumination with a parent did not have a linear or quadratic association with depression. These findings suggest that high co-ruminating in supportive relationships and to a lesser extent low co-ruminating in unsupportive relationships are maladaptive interpersonal processes but that co-rumination's relation to depression depends on the co-ruminating partner. Psychotherapies for depression may target these maladaptive processes by supporting clients' development of balanced self-focused negative talk.