Assessing Treatment Integrity in Alcohol Behavioral Couple Therapy.

OBJECTIVES: Alcohol Behavioral Couple Therapy (ABCT) is an efficacious treatment for alcohol use disorders. Coding treatment integrity can shed light on the active ingredients of ABCT, but there are no published studies of treatment integrity instruments for ABCT. The present study describes the development and initial reliability of the Treatment Integrity Rating System - Couples Version (C-TIRS) for ABCT. METHODS: The C-TIRS was used to rate 284 first- and mid-treatment ABCT sessions of 188 couples in four randomized clinical trials. RESULTS: Average inter-rater reliability for distinguishing ratings between C-TIRS items was fair-to-good for quantity items (intraclass correlation [ICC] = 0.64) and poor-to-fair for quality items (ICC = 0.41). Five C-TIRS subscales were defined a priori to measure treatment components involving cognitive-behavioral therapy, spouse involvement, couple therapy, common therapeutic factors, and overall adherence to the treatment protocol and had adequate internal reliability (α = 0.74-0.89). Inter-rater reliability was fair to good on seven of ten scales but poor on three scales (ICC range = 0.17-0.72). CONCLUSIONS: The C-TIRS was designed to provide information about quantity and quality of the delivery of ABCT components; however, further refinement of the C-TIRS is warranted before it should be used in frontline practice. Clinical implications and recommendations for future research are discussed.

Nucleus Accumbens Volume Is Associated with Frequency of Alcohol Use among Juvenile Justice-Involved Adolescents.

Differential neural development of structures associated with reward and control systems may underlie risky behavior in adolescence. The nucleus accumbens and orbitofrontal cortex (OFC) have been implicated in substance use behavior, although structural studies have yet to explore specific relationships between nucleus accumbens and OFC volumes and alcohol use in adolescence. High resolution structural MRI scans and assessments of recent alcohol use and lifetime substance use were collected in a sample of 168 juvenile justice-involved adolescents to explore whether gray matter volumes were associated with past 3-month quantity and frequency of alcohol use. Gray matter volumes were not associated with average quantity of alcohol use. Accumbens volume was positively associated with past 3-month frequency of drinking, and OFC volume was negatively associated with drinking frequency. Results may suggest that structural differences in regions related to reward and control processing may contribute to risk behavior in adolescence.