Behavioral Couples Therapy for Alcoholics & Addicts
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Behavioral Couples Therapy for Alcoholics & Addicts
“FAMILY THERAPY FOR ADDICTIONS
Meta-analyses and reviews of studies on family oriented treat¬ment approaches have shown superior rates of engagement, treatment outcome, and participation in aftercare when compared with individual oriented care (63—66). The evidence from the Stanton and Shadish (66) meta-analysis of 1,571 cases involving an estimated 3,500 patients and family members favored family therapy over individual counseling or therapy, peer group therapy, and family psychoeducation. It was effective for adolescents and adults. It can also enhance methadone maintenance and other medication assisted treatments. It promotes higher treatment retention, which improves outcome.
Approaches for Adults with Addiction Problems
Behavioral couples therapy (BCT) is the most extensively researched family approach in the treatment of substance abuse and has been shown effective (64—67). In an extensive review of the literature, Epstein and McCrady (67, 68) found empirical support for the effectiveness of behavioral couple therapy; however, Fals-Stewart and Birchler (69) have shown that fewer than 30% of the addiction treatment programs surveyed use BCT. Couples therapy has been shown to be effective in a variety of formats. Based on their extensive review of the literature, Thomas and Corcoran (70) report that overall, all treatment conditions showed reduced substance use for up to 2 years after treatment had ended, although drinking tended to increase as time elapsed. There is limited research on drug-using couples, minority groups, and low-income couples. Although there are numerous other approaches to family therapy in addiction, much can be said for having empirical evidence of efficacy.
BCT works with couples who cohabitate where one of the partners suffers from an addiction disorder. It uses a recovery contract to clearly set out the goals of the treatment and conditions that would indicate relapse. Partners learn to go over the recovery contract daily with a trust discussion about intent to remain sober and verbal reinforcement for doing so. Arguing about past or future relapses is avoided and can be saved for therapy sessions. Providing clean urine drug screens and taking medications to assist in maintaining sobriety (e.g., methadone, buprenorphine, modafinil, disulfiram, naltrexone, acamprosate) in the presence of the partner are used, and progress is recorded on a calendar. Urges and triggers to urges are discussed openly. Relapses are identified by either partner and must be interrupted as soon as possible as specified in the recovery contract.
Once continuing abstinence is maintained, the focus of the therapy shifts to improving the dyadic relationship. Resentments over past mistakes, disloyalties, dishonesties and the like must be resolved without triggering a relapse. These include increasing 'positive feeling, goodwill and commitment to the relationship . . . and teaching communication skills to resolve conflicts . . .' (53, p. 206). The positive feelings are enhanced by three procedures: 1) catch your partner doing something nice (noticing the positive behaviors and reinforcing progress); 2) planning shared rewarding experiences (often leisure time activities that had been neglected or supplanted by the addiction behaviors and fighting); and 3) Caring Day assignment (to perform special acts for each other to demonstrate their love; taking the initiative rather than waiting for the partner to initiate). Communication is enhanced by teaching: good listening skills; directly expressing feelings; daily times to communicate with one another, without aggression or passivity, on feelings, events and problems; and negotiating skills for satisfying desires and needs.
Efficacy of BCT has been established for alcoholism and for drug abuse by two meta-analyses (64, 66). It had a moderate effect size indicating a robust advantage over individual oriented treatments in the following areas: frequency and duration of abstinence, happiness in relationships, fewer separations, reduced domestic violence, benefit to the children, improved adherence to recovery medications, and 5:1 benefit:cost ratio. However, Longabaugh et al. (71) found that patients diagnosed with antisocial-personality disorder had better outcomes with individual approaches. The work of Holtzworth-Munroe et al. (72) illustrates the need for individual treatment in intimate partner violence. Fichter et al. (73) found that alcoholism relapse was predicted by excessive critical comments by significant others, low warmth, and lesser involvement. These skills can be altered by family relationship enhancement training.” Principles of Addiction Medicine, Fourth Edition (2009 American Society of Addiction Medicine), page 864 (numbers in parentheses are the footnote numbers).
In this PDF whitepaper (Google behavioral couples therapy; it's the first PDF listing), one can find some of the guidelines for and details of BCT in addiction care:
http://www.bhrm.org/guidelines/couples%20therapy.pdf
What are your thoughts about or experiences with BCT?
Meta-analyses and reviews of studies on family oriented treat¬ment approaches have shown superior rates of engagement, treatment outcome, and participation in aftercare when compared with individual oriented care (63—66). The evidence from the Stanton and Shadish (66) meta-analysis of 1,571 cases involving an estimated 3,500 patients and family members favored family therapy over individual counseling or therapy, peer group therapy, and family psychoeducation. It was effective for adolescents and adults. It can also enhance methadone maintenance and other medication assisted treatments. It promotes higher treatment retention, which improves outcome.
Approaches for Adults with Addiction Problems
Behavioral couples therapy (BCT) is the most extensively researched family approach in the treatment of substance abuse and has been shown effective (64—67). In an extensive review of the literature, Epstein and McCrady (67, 68) found empirical support for the effectiveness of behavioral couple therapy; however, Fals-Stewart and Birchler (69) have shown that fewer than 30% of the addiction treatment programs surveyed use BCT. Couples therapy has been shown to be effective in a variety of formats. Based on their extensive review of the literature, Thomas and Corcoran (70) report that overall, all treatment conditions showed reduced substance use for up to 2 years after treatment had ended, although drinking tended to increase as time elapsed. There is limited research on drug-using couples, minority groups, and low-income couples. Although there are numerous other approaches to family therapy in addiction, much can be said for having empirical evidence of efficacy.
BCT works with couples who cohabitate where one of the partners suffers from an addiction disorder. It uses a recovery contract to clearly set out the goals of the treatment and conditions that would indicate relapse. Partners learn to go over the recovery contract daily with a trust discussion about intent to remain sober and verbal reinforcement for doing so. Arguing about past or future relapses is avoided and can be saved for therapy sessions. Providing clean urine drug screens and taking medications to assist in maintaining sobriety (e.g., methadone, buprenorphine, modafinil, disulfiram, naltrexone, acamprosate) in the presence of the partner are used, and progress is recorded on a calendar. Urges and triggers to urges are discussed openly. Relapses are identified by either partner and must be interrupted as soon as possible as specified in the recovery contract.
Once continuing abstinence is maintained, the focus of the therapy shifts to improving the dyadic relationship. Resentments over past mistakes, disloyalties, dishonesties and the like must be resolved without triggering a relapse. These include increasing 'positive feeling, goodwill and commitment to the relationship . . . and teaching communication skills to resolve conflicts . . .' (53, p. 206). The positive feelings are enhanced by three procedures: 1) catch your partner doing something nice (noticing the positive behaviors and reinforcing progress); 2) planning shared rewarding experiences (often leisure time activities that had been neglected or supplanted by the addiction behaviors and fighting); and 3) Caring Day assignment (to perform special acts for each other to demonstrate their love; taking the initiative rather than waiting for the partner to initiate). Communication is enhanced by teaching: good listening skills; directly expressing feelings; daily times to communicate with one another, without aggression or passivity, on feelings, events and problems; and negotiating skills for satisfying desires and needs.
Efficacy of BCT has been established for alcoholism and for drug abuse by two meta-analyses (64, 66). It had a moderate effect size indicating a robust advantage over individual oriented treatments in the following areas: frequency and duration of abstinence, happiness in relationships, fewer separations, reduced domestic violence, benefit to the children, improved adherence to recovery medications, and 5:1 benefit:cost ratio. However, Longabaugh et al. (71) found that patients diagnosed with antisocial-personality disorder had better outcomes with individual approaches. The work of Holtzworth-Munroe et al. (72) illustrates the need for individual treatment in intimate partner violence. Fichter et al. (73) found that alcoholism relapse was predicted by excessive critical comments by significant others, low warmth, and lesser involvement. These skills can be altered by family relationship enhancement training.” Principles of Addiction Medicine, Fourth Edition (2009 American Society of Addiction Medicine), page 864 (numbers in parentheses are the footnote numbers).
In this PDF whitepaper (Google behavioral couples therapy; it's the first PDF listing), one can find some of the guidelines for and details of BCT in addiction care:
http://www.bhrm.org/guidelines/couples%20therapy.pdf
What are your thoughts about or experiences with BCT?
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