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

Behavioral couples therapy (BCT) for substance use disorder shares similar intervention strategies with empirically supported couples therapies for posttraumatic stress disorder (PTSD). Like couples-based PTSD therapies, BCT includes interventions that may help to improve PTSD, such as increasing positive behavioral exchanges and improving communication. Studies have yet to examine whether BCT, which has demonstrated efficacy for improving substance-related outcomes, is efficacious for reducing PTSD. We conducted a secondary analysis of a randomized clinical trial comparing individually based treatment (IBT) to BCT plus IBT (BCT+IBT) for women with drug use disorders. Women in both conditions received 26 therapy sessions over 13 weeks. Women completed the PTSD Diagnostic Scale at baseline, posttreatment, and quarterly during the 1-year follow-up. Of the 61 women who were randomized to treatment, 51 (83.6%) reported a lifetime traumatic event. Of the 50 women who endorsed a "worst traumatic event," 25 (50.0%) had a baseline PTSD diagnosis. The treatments did not differ on baseline PTSD severity or diagnosis. Women who received BCT+IBT had significant reductions in PTSD severity from baseline to each of four posttreatment follow-ups, ds = 0.34-0.80; there were no changes in the IBT group. Generalized estimating equation results showed that women who received BCT+IBT had significantly lower PTSD severity during follow-up versus those who received IBT, d = 0.35. There were no differences in the proportion of participants diagnosed with PTSD following treatment. This was the first study to show that BCT+IBT is efficacious for reducing PTSD among women with drug use disorders.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Eficacia de la Terapia conductual de pareja frente a la Consejería de recuperación individual para tratar el TEPT entre las mujeres con Trastornos de Uso de Drogas. ABUSO DE DROGAS EN MUJERES Y TEPT La terapia conductual de pareja (TCP) para el trastorno por consumo de sustancias comparte estrategias de intervención con apoyo empírico similares a la terapia de pareja para el trastorno de estrés postraumático (TEPT). Al igual que las terapias de pareja basadas en TEPT, la TCP incluye intervenciones que pueden ayudar a mejorar el TEPT, como el aumento de los intercambios conductuales positivos y la mejora de la comunicación. Los estudios aún no han examinado si la TCP, la cual ha demostrado ser eficaz para mejorar los resultados relacionados con sustancias, es eficaz para reducir el TEPT. Se realizó un análisis secundario de un ensayo clínico aleatorio que comparó el tratamiento individualizado (TI) con la TCP más la TI (TI+ TCP) para las mujeres con trastornos por el consumo de drogas. Las mujeres en ambas condiciones recibieron 26 sesiones de terapia durante 13 semanas. Las mujeres completaron la Escala de Diagnóstico del TEPT al inicio, después del tratamiento y trimestralmente durante el seguimiento de un año. De las 61 mujeres que fueron asignadas al azar al tratamiento, 51 (83.6%) reportaron un evento traumático en la vida. De las 50 mujeres que señalaron un "peor evento traumático", 25 (50.0%) tuvieron un diagnóstico inicial de TEPT. Los tratamientos no difirieron según la gravedad o el diagnóstico inicial del TEPT. Las mujeres que recibieron TCP +TI tuvieron reducciones significativas en la gravedad del TEPT desde el inicio hasta cada uno de los cuatro seguimientos posteriores al tratamiento, ds = 0.34 - 0.80; no hubo cambios en el grupo de TI. Los resultados de la ecuación de estimación generalizada mostraron que las mujeres que recibieron TCP+TI tuvieron una gravedad de TEPT significativamente menor durante el seguimiento en comparación con las que recibieron TI, d = 0.35. No hubo diferencias en la proporción de participantes diagnosticados con TEPT después del tratamiento. Este fue el primer estudio en mostrar que la TCP +TI es eficaz para reducir el TEPT entre las mujeres con trastornos por el uso de drogas.

Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder: Pilot Results From U.S. Military Veterans and Their Partners.

We studied 13 U.S. male military veterans and their female partners who consented to participate in an uncontrolled trial of couple treatment for alcohol use disorder and posttraumatic stress disorder (CTAP). CTAP is a 15-session, manualized therapy, integrating behavioral couples therapy for alcohol use disorder (AUD) with cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Due to ineligibility (n = 1) and attrition (n = 3), 9 couples completed the study, and 7 completed 12 or more sessions. There were 8 veterans who showed clinically reliable pre- to posttreatment reduction of PTSD outcomes. There were also significant group-level reductions in clinician-, veteran-, and partner-rated PTSD symptoms (d = 0.94 to 1.71). Most veterans showed clinically reliable reductions in percentage days of heavy drinking. Group-level reduction in veterans' percentage days of heavy drinking was significant (d = 1.01). There were 4 veterans and 3 partners with clinically reliable reductions in depression, and group-level change was significant for veterans (d = 0.93) and partners (d = 1.06). On relationship satisfaction, 3 veterans and 4 partners had reliable improvements, and 2 veterans and 1 partner had reliable deterioration. Group-level findings were nonsignificant for veteran relationship satisfaction (d = 0.26) and for partners (d = 0.52). These findings indicate that CTAP may be a promising intervention for individuals with comorbid PTSD and AUD who have relationship partners.

A comparison of psychosocial adjustment among children of women who received behavioral couples therapy versus individually based therapy for substance use disorder.

BACKGROUND: Children of women with substance use disorder (SUD) exhibit elevated risk for psychosocial adjustment problems. However, little research has examined whether women's SUD treatment is beneficial for their children. In comparison to individually based therapy (IBT), behavioral couples therapy (BCT) is superior for reducing women's SUD problems and improving their intimate partner relationships. The current study sought to examine whether BCT is more efficacious than 12-step-oriented IBT for reducing psychosocial adjustment problems among the children of women with SUD. METHODS: The study obtained the data from two larger randomized clinical trials, both of which compared BCT plus IBT versus IBT alone for women with SUD. Participants were women (N = 75) and their male partners who had an identified target child between the ages of 6 and 16 years old (M = 10.63). Most (62%) were the biological child of both partners, and 92% lived with the couple. Both partners completed the Child Behavior Checklist (CBCL) in relation to the target child at baseline, post-treatment, and 6-month follow-up. RESULTS: Comparisons of CBCL scores from baseline to following treatment mostly showed significant improvement in BCT + IBT but not IBT. Generalized estimating equations, which controlled for baseline CBCL, showed better retainment of treatment gains for mother-reported internalizing CBCL scores in BCT + IBT, but the study found no other between treatment differences. CONCLUSION: These findings suggest that BCT + IBT produces more consistent improvements for children of women with SUD versus IBT.

Colonic lavage in treatment of refractory Clostridium difficile infection: an adaptation of the Pittsburgh protocol.

Clostridium difficile infection (CDI) is a common nosocomial sequela in patients treated with antibiotics. Surgical intervention is indicated in fulminant cases. However, the mortality associated with total colectomy and end ileostomy is high. Previous reports have indicated that surgical intervention for severe complicated CDI with formation of a loop ileostomy leading to the diversion of fecal stream followed by colonic lavage can be beneficial in treating severe CDI. This procedure is known as the Pittsburgh protocol and has been reported to decrease the mortality and the need for a total colectomy in patients with severe complicated CDI. In this case, we present a 75-year-old female with refractory CDI. In her treatment, we adapted the Pittsburgh protocol and utilized a 20-French MIC gastrostomy tube to recreate the ileocecal valve and control the colonic lavage without retrograde flow.

The runaway kidney: a rare case of a parastomal hernia with partial kidney herniation.

Although parastomal hernias are a common complication of ostomy formation, herniation of intra-abdominal organs, aside from intestine, is infrequent. Furthermore, herniation of retroperitoneal organs, such as the kidney, is an extremely rare finding. We report the case of a 59-year-old male with a right ileostomy who presented with an acute kidney injury with suggestive urinary tract infection. A computed tomography scan revealed a left proximal ureteral stone with left hydronephrosis and a prominent right parastomal hernia with herniation of the mesenteric/retroperitoneal fat, portion of the right kidney, right proximal ureter and some bowel. The patient was taken to the operating room for a left cystourethroscopy with stent placement and made a full recovery. Due to the patient's extensive surgical history, high risk of postoperative infection and lack of evidence demonstrating functional impairment of the right kidney, surgical intervention was not recommended at the present time.

Group Versus Standard Behavioral Couples' Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness.

OBJECTIVE: The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners--group behavioral couples' therapy plus individual-based treatment (G-BCT), or standard behavioral couples' therapy plus individual-based treatment (S-BCT). METHOD: We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS: The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS: As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples' therapy.

Prevention of intimate partner violence in substance-using populations.

Although the prevention of intimate partner violence is a major public health priority for the United States, little is known about how to prevent this form of violence. The strong cross-sectional and longitudinal association between substance misuse and partner violence suggests that substance-misusing populations may be an ideal audience for implementing partner violence prevention programs. This approach is reviewed from the perspective of universal, selective, and indicated prevention programs.

Review of the association between treatment for substance misuse and reductions in intimate partner violence.

A substantial body of research supports a strong cross-sectional and longitudinal association between substance misuse and perpetration of intimate partner violence (IPV). This article briefly addresses the theoretical connection between substance use and intimate partner violence and research on the association between substance misuse and IPV. Studies examining the effect of individual and couples-based addiction treatments on IPV are reviewed. The implications of this work and future directions for research are discussed.

Brief family treatment intervention to promote continuing care among alcohol-dependent patients in inpatient detoxification: a randomized pilot study.

Alcohol-dependent patients in inpatient detoxification were randomized to treatment-as-usual (TAU) intervention or brief family treatment (BFT) intervention to promote continuing care postdetoxification. BFT consisted of meeting with the patient and an adult family member (in person or over the phone) with whom the patient lived to review and recommend potential continuing care plans for the patient. Results showed that BFT patients (n = 24) were significantly more likely than TAU patients (n = 21) to enter a continuing care program after detoxification. This was a medium to large effect size. In the 3 months after detoxification, days using alcohol or drugs (a) trended lower for treatment-exposed BFT patients who had an in-person family meeting than for TAU counterparts (medium effect), and (b) were significantly lower for patients who entered continuing care regardless of treatment condition (large effect).

Poisson regression for modeling count and frequency outcomes in trauma research.

The authors describe how the Poisson regression method for analyzing count or frequency outcome variables can be applied in trauma studies. The outcome of interest in trauma research may represent a count of the number of incidents of behavior occurring in a given time interval, such as acts of physical aggression or substance abuse. Traditional linear regression approaches assume a normally distributed outcome variable with equal variances over the range of predictor variables, and may not be optimal for modeling count outcomes. An application of Poisson regression is presented using data from a study of intimate partner aggression among male patients in an alcohol treatment program and their female partners. Results of Poisson regression and linear regression models are compared.

Behavioral couples therapy for comorbid substance use disorders and combat-related posttraumatic stress disorder among male veterans: an initial evaluation.

Outcomes after behavioral couples therapy (BCT) were compared for 19 dually diagnosed veterans with combat-related PTSD and a substance use disorder (SUD, primarily alcohol dependence) and 19 veterans with SUD only. Clients with and without comorbid PTSD had very similar pre-treatment clinical profiles on dimensions of substance misuse, relationship functioning, and psychological symptoms. Further, both PTSD and non-PTSD clients showed good compliance with BCT, attending a high number of BCT sessions, taking Antabuse, and going to AA. Finally, both PTSD and non-PTSD groups improved from before BCT to immediately after and 12 months after BCT. Specific improvements noted were increased relationship satisfaction and reductions in drinking, negative consequences of drinking, male-to-female violence, and psychological distress symptoms. Extent and pattern of improvement over time were similar whether the client had PTSD or not. The present results suggest that BCT may have promise in treating clients with comorbid SUD and combat-related PTSD.

Brief family treatment intervention to promote aftercare among substance abusing patients in inpatient detoxification: transferring a research intervention to clinical practice.

Two earlier studies showed that a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification increased aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member with whom the patient lived to review aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Based on the earlier research results, we trained a newly hired staff person to continue providing BFT. We monitored key process benchmarks derived from the earlier research studies to ensure ongoing fidelity in delivering BFT. This method proved successful in transferring BFT from delivery in a research study to ongoing delivery in routine clinical practice after the research ended. It also ensured that a high proportion of patients had their families contacted and included in planning the patients' aftercare.

Intra-operative identification of a De Garengeot hernia: a rare finding and discussion of operative approach.

The presence of an incarcerated vermiform appendix within a femoral hernia defect, a De Garengeot hernia, is distinctly different than an inguinal hernia containing the appendix, an Amyand hernia. The De Garengeot hernia is a rare finding with few reported cases. We present a 35-year-old female with a painful groin mass palpable below the inguinal ligament. An ultrasound of the groin revealed a thin-walled fluid collection medial to the femoral vessels. No additional imaging at the time was obtained. Intra-operatively, the patient was found to have her distal appendix incarcerated within the transected hernia sac thus altering the planned surgical procedure. We present a unique operative approach for managing a De Garengeot hernia.

Patient with Lynch syndrome with subsequent development of small bowel adenocarcinoma.

Small bowel adenocarcinoma (SBA) is a rare cancer in the general population, but the incidence increases in patients with Lynch syndrome. The present case describes a 57-year-old white woman with a history of colon cancer status posthemicolectomy and diagnosis of Lynch syndrome. Twenty years after her operation, the patient presented with vague abdominal discomfort and constipation, and underwent an exploratory laparotomy which revealed a stage 3A SBA. Genetic testing of the specimen provided evidence of microsatellite instability and faulty DNA repair supporting aetiology of Lynch syndrome. This case is unique in that SBA, if present in patients with Lynch syndrome, is usually a presenting symptom and has not been widely described in literature as an occurrence so many years after. As a result, this case highlights the importance of a low threshold for a thorough evaluation in patients with Lynch syndrome who present with signs of small bowel obstruction.

Partner violence among drug-abusing women receiving behavioral couples therapy versus individually-based therapy.

INTRODUCTION: Studies have found reductions in female-to-male (F-to-M) and male-to-female (M-to-F) intimate partner violence (IPV) following alcohol-related treatment. Despite high prevalence of IPV among drug-abusing women, there are no controlled studies examining IPV following drug-related treatment for women. This is a secondary analysis of a randomized clinical trial comparing behavioral couples therapy plus individually-based treatment (BCT + IBT) versus individually-based treatment (IBT) for drug-abusing women and their male partners (N = 61; see O'Farrell, Schumm, Murphy, & Muchowski, 2017). We hypothesized that both treatments would have reductions in F-to-M and M-to-F IPV, but reductions would be greater in BCT + IBT. MATERIAL AND METHODS: Women were mostly White, and all exhibited drug use disorders (74% opioid use disorder). Forty-five percent had a male partner with a current substance problem. The Revised Conflict Tactics Scales (CTS2) were administered at baseline and 12-months after treatment (85% follow-up rate). RESULTS: Psychological aggression frequency and F-to-M physical assault declined in both treatments. M-to-F physical assault, M-to-F sexual coercion, and female and male injury declined in IBT. However, these outcomes did not change in BCT + IBT. Thus, results showed that IBT, but not BCT + IBT, reduced M-to-F physical assault and M-to-F sexual coercion. Contrary to our hypothesis, IBT was lower than BCT + IBT on F-to-M and M-to-F physical assault, M-to-F sexual coercion, and female injury. M-to-F physical assault frequency was lower at follow-up if the male partner had versus did not have a current substance problem. CONCLUSIONS: BCT + IBT and IBT are viable interventions for reducing both partners' psychological aggression and F-to-M physical assault frequency among drug-abusing women and their male partners. IBT is promising for reducing M-to-F physical assault and female physical injury. There appears to be greater risk of M-to-F physical assault when the female but not male partner is substance-abusing.

Longitudinal associations between fathers' heavy drinking patterns and children's psychosocial adjustment.

Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.

Brief family treatment intervention to promote aftercare among male substance abusing patients in inpatient detoxification: A quasi-experimental pilot study.

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Results indicated that male substance abusing patients who received BFT (N=14), as compared with a matched treatment as usual (TAU) comparison group (N=14) that did not, showed a trend toward being more likely to enter an aftercare program and to attend more days of aftercare in the 3 months after detoxification. The magnitude of these differences favoring BFT over TAU was midway between a medium and a large effect size. Days using alcohol or drugs in the 3 months after detox were lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (trend, medium effect), and for patients who entered aftercare regardless of treatment condition (significant large effect).

Psychosocial problems in children of women entering substance use disorder treatment: A longitudinal study.

BACKGROUND: While parental substance use disorder (SUD) has been recognized as a risk factor for child outcomes, past research seldom focused specifically on children whose mothers suffer from alcohol and drug use disorders. Are these children at risk for elevated psychosocial problems, and would such risk be reduced if maternal substance use was reduced? AIMS: Children of substance-abusing mothers (COSAM, N=130) were compared to a demographically matched comparison sample, and examined soon after their mothers entered SUD treatment and in the 18months after treatment entry. We expected to observe elevated symptomatology among COSAM at baseline assessment, followed by a decreasing trend after maternal treatment in general, and remission in particular. RESULTS: Children's psychosocial problems were assessed through maternal reports on the Pediatric Symptom Checklist. Soon after their mothers entered SUD treatment, COSAM exhibited significantly greater overall and clinical-level psychosocial problems than the children from the matched comparison sample. However, at the end of the 18-months study period, these two groups no longer differed in terms of problems. Results from the longitudinal growth models revealed reductions in COSAM's overall and clinical-level problems following their mothers' SUD treatment. However, these reductions were similar for all COSAM, regardless of whether their mothers relapsed or remitted. CONCLUSION: Psychosocial problems were significantly reduced in COSAM following maternal SUD treatment, such that COSAM did not significantly differ from children from the matched comparison sample by the end of the 18-month study period.

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

OBJECTIVE: Behavioral couples therapy (BCT) is more efficacious than individually-based therapy (IBT) for substance and relationship outcomes among substance use disorder patients. This study compared BCT with IBT for drug-abusing women. METHOD: Sixty-one women, mostly White, late 30s, with primary substance use disorder other than alcohol (74% opioid), 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 were percentage days abstinent (PDA), percentage days drug use (PDDU), Inventory of Drug Use Consequences. Relationship outcomes were Dyadic Adjustment Scale (DAS), days separated. Data were collected at baseline, posttreatment, and quarterly for 1-year 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 1-year 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 (ps > .47). On relationship outcomes, compared to IBT, BCT + IBT had significantly higher male-reported Dyadic Adjustment Scale (p < .001, d = .57) and fewer days separated (p = .01, d = -.47) throughout 1-year follow-up. CONCLUSION: BCT + IBT for drug-abusing women was more efficacious than IBT in improving relationship satisfaction and preventing relationship breakup. 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. (PsycINFO Database Record

Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment.

Psychosocial adjustment in children of alcoholics (COAs; N=125) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment. Before their fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sample, but they improved significantly following their fathers' treatment. Children of stably remitted fathers were similar to their demographic counterparts from the comparison sample and had fewer adjustment problems than children of relapsed fathers, even after accounting for children's baseline adjustment. Thus, COAs' adjustment improved when their fathers received treatment for alcoholism, and fathers' recovery from alcoholism was associated with clinically significant reductions in child problems.