title: Assessing Treatment Integrity in Alcohol Behavioral Couple Therapy.
abstract: OBJECTIVE
  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 defineda priorito 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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hallgren
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico.
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Crotwell
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico.
authors.forename: Rosa E
authors.initials: RE
authors.lastname: Muñoz
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico.
authors.forename: Becky K
authors.initials: BK
authors.lastname: Gius
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: McCrady
authors.affiliation: Department of Psychology, Washington State University Vancouver.
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Ladd
authors.affiliation: Department of Psychiatry, University of Massachusetts Medical School.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Epstein
keywords: alcohol behavioral couple therapy; behavioral coding; treatment fidelity; treatment integrity