Behavioral Couples Therapy with AOD Partners

By BRENDA J. WRIGHT

Published January 2001

Behavioral Couples Therapy (BCT)

The Institute for Addictions Studies and Training (IAST) and the Professional Social Work Continuing Education School of Social Work hosted a December training program featuring William Fals-Stewart, PhD*, a well known research scientist who is now on staff at the Research Institute on Addictions (RIA) in Buffalo, N.Y. The presentation was entitled "Couples Interventions/Treatment for Alcohol and Other Drug Abuse: A research to Practice Presentation."

Overview

Behavioral Couples Therapy (BCT) is a recognized, effective mode of treatment in the mental health field. Research results demonstrate that BCT is a highly effective treatment modality for addictions. During this workshop Fals-Stewart reviewed research findings on BCT which indicate that BCT for alcoholic and drug abusers produces better abstinence rates, improved relationships and fewer marital separations over a one to two year follow-up period than individually based treatment. The components/interventions of successful behavioral couples therapy were outlined and demonstrated during this training session. Fals-Stewart believes that researchers have failed to promote/pass on behavioral treatment approaches to Alcohol and Other Drug (AOD) practitioners.

Aspects of BCT

Unlike the family disease approach, BCT deals with both drinking and relationships. The AOD client is seen with family and/or partner to promote cohesion in the relationship: increase positive feelings, share rewarding activities and improve communication skills. Physical violence is not addressed separately outside the relationship but rather within BCT. BCT works to build support for relapse prevention via commitment, daily "sobriety/or antabuse contracts," self-help involvement, behavioral assignments, review of an ongoing recovery plan and weekly urine screens. The research model for BCT for AOD problems is based on 12 to 20 couple sessions over a three to six month period.

Advantages of Using BCT with AOD population

Treatment can be provided by practitioners with various educational degrees if they have received comprehensive training in BCT.

Outcome data for BCT

BCT compared to individual counseling, one year after treatment showed that:

  • BCT provides greater abstinence, fewer relapses, better relationships and fewer separations.
  • Domestic violence is substantially reduced.
  • Fewer drug-related arrests and hospitalizations occur.
  • Cost outcomes are good for alcohol use and superior for drug abuse populations.
  • Children are helped more by BCT than IND for both alcohol and drug abuse. 

Controversial Aspects of BCT

  • Twelve to 20 couple treatment sessions are costly and place added demands on AOD staff. Note that researchers found that once they sold managed care on the benefits and cost effectiveness of BCT, they were willing to pay for same provided the staff was adequately trained in BCT. Research outcomes for five BCT sessions as an adjunct to traditional treatment modalities is forthcoming.
  • Many practitioners will disagree with BCT treatment for domestic violence. But BCT outcomes for reduction of violence and verbal aggression appear to be significantly better than for matched couples without alcohol problems. Research should include matched control couples with alcohol problems that receive traditional domestic violence treatment.
  • Couples in the study appear to be higher functioning. Research is needed to address the success of BCT with MICA clients.
  • Although initial data indicate that children of AOD couples appear to be helped more by BCT than IND treatment, the work needs to be replicated.

Where Can I Find Out More About Behavioral Couples Therapy for Treatment of AOD?

*Fals-Stewart is currently conducting a research project titled, "Behavioral Couple Therapy in Drug Abuse," sponsored by NIDA, at the Research Institute on Addictions (RIA), University at Buffalo, 1021 Main Street, Buffalo, N.Y. 14203. Telephone: 716-887-2210; http://www.buffalo.edu/ria.html. Email: wstewart@ria.buffalo.edu

Bibliography through 1996 for BCT for AOD http://depts.washington.edu/adai/lib/bibs/tx

General Readings l996-2000:

Fals-Stewart, W., O'Farrell, T. J., & Birchler, G. R. (2000). Behavioral couples therapy vs individual-based treatment for male substance abusing patients: An evaluation of significant individual change and comparison of improvement rates. Journal of Substance Abuse Treatment, 18, 249-254.

O'Farrell, T.J., & Fals-Stewart W. (1999) Treatment models and methods - family models. In B. S. McCrady & E. E. Epstein (Eds.), Addictions: A comprehensive guidebook for practitioners (pp. 287-305). New York: Oxford University Press.

O'Farrell, T. J., & Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism and drug abuser. Journal of Substance Abuse Treatment, 18, 51-54.

O'Farrell, T. J., Van Hutton, V., & Murphy, C. M. (1999). Domestic violence after alcoholism treatment: A two-year longitudinal study. Journal of Studies on Alcohol, 60, 317-321.

Workshops/Trainings:

  1. Harvard Medical School Dept. of Continuing Education-Summer Seminars: Family Treatment for Substance Abuse: Evidence-Based Approaches, Timothy O'Farrell, PhD, ABPP, Robert Meyers, MS and Jane Alter, LICSW. July 9-13, 2001 Brewster, Cape Cod (617) 432-1525