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Behavioral couples and family therapy for substance abusers

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Abstract

Behavioral couples therapy (BCT) sees the substanceabusing patient with the spouse to arrange a daily "sobriety contract" in which the patient states his or her intent not to drink or use drugs, and the spouse expresses support for the patient’s efforts to stay abstinent. For patients taking a recovery-related medication (eg, disulfiram, naltrexone), daily medication ingestion witnessed and verbally reinforced by the spouse also is part of the contract. Behavioral couples therapy also teaches communication and increases positive activities. Findings of the past few years have added considerably to the evidence base showing that BCT produces greater abstinence and better relationship functioning than typical individual-based treatment; BCT also reduces social costs and domestic violence. Noteworthy recent advances have extended the positive effects of BCT to women drug abusers, showed the indirect benefits of BCT for the couple’s children, expanded BCT to include family members other than spouses, integrated BCT with pharmacotherapy, and started to address barriers to technology transfer.

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References and Recommended Reading

  1. Keller M: Trends in treatment of alcoholism. In Second Special Report to the U.S. Congress on Alcohol and Health. Washington, DC: Department of Health, Education, and Welfare; 1974:145–167.

    Google Scholar 

  2. O’Farrell TJ, Fals-Stewart W: Family-involved alcoholism treatment: an update. In Recent Developments in Alcoholism, vol 15: Services Research in the Era of Managed Care. Edited by Galanter M. New York: Plenum; 2001:329–356. A comprehensive review of research on family-involved treatment for alcoholism.

    Google Scholar 

  3. Stanton MD, Shadish WR: Outcome, attrition, and familycouple treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies. Psych Bull 1997, 122:170–191.

    Article  CAS  Google Scholar 

  4. O’Farrell TJ: Treating Alcohol Problems: Marital and Family Interventions. New York: Guilford Press; 1993.

    Google Scholar 

  5. O’Farrell TJ, Fals-Stewart W: Behavioral couples therapy for alcoholism and drug abuse. J Subst Abuse Treat 2000, 18:51–54. Reviews studies of behavioral couples therapy that were done before the past few years. The present article updates this paper with more recent findings.

    Article  PubMed  CAS  Google Scholar 

  6. Azrin NH, Sisson RW, Meyers R, Godley M: Alcoholism treatment by disulfiram and community reinforcement therapy. J Behav Ther Exp Psychiatry 1982, 13:105–112.

    Article  PubMed  CAS  Google Scholar 

  7. Bowers TG, Al-Redha MR: A comparison of outcome with group/marital and standard/individual therapies with alcoholics. J Stud Alc 1990, 51:301–309.

    CAS  Google Scholar 

  8. Hedberg AG, Campbell L: A comparison of four behavioral treatments of alcoholism. J Behav Ther Exp Psychiatry 1974, 5:251–256.

    Article  Google Scholar 

  9. McCrady B, Stout R, Noel N, et al.: Comparative effectiveness of three types of spouse involved alcohol treatment: outcomes 18 months after treatment. Brit J Addiction 1991, 86:1415–1424.

    Article  CAS  Google Scholar 

  10. O’Farrell TJ, Cutter HSG, Choquette KA, et al.: Behavioral marital therapy for male alcoholics: marital and drinking adjustment during the two years after treatment. Behav Ther 1992, 23:529–549.

    Article  Google Scholar 

  11. Fals-Stewart W, Birchler GR, O’Farrell TJ: Behavioral couples therapy for male substance-abusing patients: effects on relationship adjustment and drug-using behavior. J Consult Clin Psychol 1996, 64:959–972.

    Article  PubMed  CAS  Google Scholar 

  12. O’Farrell TJ, Choquette KA, Cutter HSG, et al.: Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment. J Subst Abuse 1996, 8:145–166.

    Article  PubMed  CAS  Google Scholar 

  13. O’Farrell TJ, Choquette KA, Cutter HSG, et al.: Cost-benefit and cost-effectiveness analyses of behavioral marital therapy with and without relapse prevention sessions for alcoholics and their spouses. Behav Ther 1996, 27:7–24.

    Article  Google Scholar 

  14. Fals-Stewart W, O’Farrell TJ, Birchler GR: Behavioral couples therapy for male substance abusing patients: a cost outcomes analysis. J Consult Clin Psychol 1997, 65:789–802.

    Article  PubMed  CAS  Google Scholar 

  15. O’Farrell TJ, Murphy CM: Marital violence before and after alcoholism treatment. J Consult Clin Psychol 1995, 63:256–262.

    Article  PubMed  CAS  Google Scholar 

  16. O’Farrell TJ, Van Hutton V, Murphy CM: Domestic violence after alcoholism treatment: a two-year longitudinal study. J Stud Alc 1999, 60:317–321. This study shows that partner violence is reduced after behavioral couples therapy and nearly eliminated for alcoholic patients who remain abstinent.

    CAS  Google Scholar 

  17. O’Farrell TJ, Murphy CM, Hoover S, et al.: Domestic violence before and after couples-based alcoholism treatment: the role of treatment involvement and abstinence. Journal 2002, In press.

  18. Birchler GR, Fals-Stewart W: Use of behavioral couples therapy with alcoholic couples: effects on maladaptive responses to conflict during treatment. Poster presented at the 35th Annual Convention of the Association for the Advancement of Behavior Therapy; Philadelphia, PA. November 15–18, 2001;

  19. Fals-Stewart W, Kashdan TB, O’Farrell TJ, Birchler GR: Behavioral couples therapy for male-drug abusing patients and their partners: the effect on interpartner violence. J Subst Abuse Treat 2002, 22:1–10.

    Article  Google Scholar 

  20. Winters J, Fals-Stewart W, O’Farrell TJ, et al.: Behavioral couples therapy for female substance-abusing patients: effects on substance use and relationship adjustment. J Consult Clin Psychol 2002, 70:344–355. This is the first study of behavioral couples therapy with female drug abuse patients. It shows the same positive results obtained with BCT for drug-abusing men.

    Article  PubMed  Google Scholar 

  21. Kelley ML, Fals-Stewart W: Couples versus individual-based therapy for alcoholism and drug abuse: effects on children’s psychosocial functioning. J Consult Clin Psychol 2002, 70:417–427. This is the first study showing that behavioral couples therapy benefits the children of alcoholic and drug abusing patients.

    Article  PubMed  Google Scholar 

  22. Fals-Stewart W, O’Farrell TJ, Birchler GR: Behavioral couples therapy for male methadone maintenance patients: effects on drug-using behavior and relationship adjustment. Behav Ther 2001, 32:391–411.

    Article  Google Scholar 

  23. Fals-Stewart W, O’Farrell TJ: Behavioral family counseling and naltrexone for male opioid dependent patients. J Consult Clin Psychol 2002, In press.

  24. Fals-Stewart W, O’Farrell TJ, Martin J: Using behavioral family counseling to enhance HIV-medication compliance among HIV-infected male drug abusing patients. Paper presented at Conference on Treating Addictions in Special Populations; Binghamton, NY. November 23, 2001;

  25. O’Farrell TJ, Choquette KA, Cutter HSG: Couples relapse prevention sessions after behavioral marital therapy for alcoholics and their wives: outcomes during three years after starting treatment. J Stud Alc 1998, 59:357–370.

    CAS  Google Scholar 

  26. Fals-Stewart W, Birchler GR: A national survey of the use of couples therapy in substance abuse treatment. J Subst Abuse Treat 2001, 20:277–283.

    Article  PubMed  CAS  Google Scholar 

  27. Fals-Stewart W, O’Farrell TJ, Birchler GR: Use of abbreviated couples therapy in substance abuse. In Approaches to Brief Couples Therapy: Application and Efficiency. Symposium conducted at the World Congress of Behavioral and Cognitive Therapies; Vancouver, Canada. July 17–21, 2001;

  28. Fals-Stewart W, Birchler GR: Behavioral couples therapy with alcoholic men and their intimate partners: the comparative effectiveness of bachelor’s and master’s level counselors. Behav Ther 2002, 33:123–147.

    Article  Google Scholar 

  29. Rogers EM: Diffusion of Innovations, edn 4. New York: The Free Press; 1995.

    Google Scholar 

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Authors and Affiliations

  1. Harvard Families and Addiction Program, Department of Psychiatry, Harvard Medical School at the VA Boston Healthcare System, 940 Belmont Street, Suite 116B1, 02301, Brockton, MA, USA

    Timothy J. O’Farrell PhD

Authors
  1. Timothy J. O’Farrell PhD
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  2. William Fals-Stewart PhD
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O’Farrell, T.J., Fals-Stewart, W. Behavioral couples and family therapy for substance abusers. Curr Psychiatry Rep 4, 371–376 (2002). https://doi.org/10.1007/s11920-002-0085-7

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  • DOI: https://doi.org/10.1007/s11920-002-0085-7

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