Behavioral Couples Therapy for Alcoholism and Drug Abuse
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Thus, for every dollar spent in delivering BCT, 5 dollars in social costs are saved. There also was a demographically matched comparison sample of couples without alcohol problems. Results for the second year after BCT were similar to the first year.
Behavioral Couples Therapy (BCT) is designed for married or cohabiting individuals seeking help for alcoholism or drug abuse. BCT sees the substance. J Subst Abuse Treat. Jan;18(1) Behavioral couples therapy for alcoholism and drug abuse. O'Farrell TJ(1), Fals-Stewart W. Author information.
Thus, these 2 studies showed that male-to-female violence was significantly reduced in the first and second year after BCT and that it was nearly eliminated with abstinence. Two recent studies showed that BCT reduced partner violence and couple conflicts better than individual treatment.
Among male alcoholic patients, those who participated in BCT reported less frequent use of maladaptive responses to conflict e. These results suggest that in BCT couples do learn to handle their conflicts with less hostility and aggression. Kelley and Fals-Stewart conducted 2 studies 1 in alcoholism, 1 in drug abuse to find out whether BCT for a substance abusing parent, with its demonstrated reductions in domestic violence and reduced risk for family breakup, also has beneficial effects for the children in the family.
Results were the same for children of male alcoholic and male drug abusing fathers. Only BCT showed reduction in the number of children with clinically significant impairment. BCT has been used to increase compliance with a recovery-related medication. BCT patients, compared with their individually treated counterparts, had better naltrexone compliance, greater abstinence, and fewer substance-related problems.
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BCT also has improved compliance with pharmacotherapy in studies of disulfiram for alcoholic patients [e. Most BCT studies have examined traditional couples. However, some recent studies have expanded BCT to include family members other than spouses. These studies have targeted increased medication compliance as just described. In terms of future directions, we do need more research on BCT, to replicate and extent the most recent advances, especially for women patients and broader family constellations.
Research on BCT for couples in which both the male and female member have a current substance use problem is particularly needed because prior BCT studies have not addressed this difficult clinical challenge. Even more than additional research, we need technology transfer so that patients and their families can benefit from what we have already learned about BCT for alcoholism and drug abuse. The purpose of Behavioral Couples Therapy is to build support for abstinence and to improve relationship functioning among married or cohabiting individuals seeking help for alcoholism or drug abuse.
BCT fits well with step or other self-help groups, individual or group substance abuse counseling, and recovery medications. We hope this article will lead to increased use of BCT to the benefit of substance abusing patients and their families. In addition, the following resources are available for those interested in learning more about how to implement BCT:. National Center for Biotechnology Information , U.
J Subst Abuse Treat. Author manuscript; available in PMC Nov Correspondence concerning this article should be addressed to Timothy J. The publisher's final edited version of this article is available at J Subst Abuse Treat. See other articles in PMC that cite the published article.
Abstract Behavioral Couples Therapy BCT is designed for married or cohabiting individuals seeking help for alcoholism or drug abuse. Behavioral Couples Therapy, alcoholism, drug abuse. Overview The purpose of Behavioral Couples Therapy BCT is to build support for abstinence and to improve relationship functioning among married or cohabiting individuals seeking help for alcoholism or drug abuse. Open in a separate window. Table 2 Components of Recovery Contract. Recovery Contract Case Example 2 If both members of a couple have a current substance problem and both want abstinence, then BCT often is workable.
Behavioral couples therapy for alcoholism and drug abuse. - PubMed - NCBI
Other Support for Abstinence Reviewing urges to drink or use drugs experienced in the past week is part of each BCT session. Relationship-Focused Interventions in BCT Once the Recovery Contract is going smoothly, the substance abuser has been abstinent and the couple has been keeping scheduled appointments for a few weeks, you can start to focus on improving couple and family relationships. Listening Skills Good listening helps each spouse to feel understood and supported and to slow down couple interactions to prevent quick escalation of aversive exchanges.
Communication Sessions These are planned, structured discussions in which spouses talk privately, face-to-face, without distractions, and with each spouse taking turns expressing his or her point of view without interruptions. Negotiating for Requests Many changes that spouses desire from their partners can be achieved through the caring behaviors, rewarding activities, and communication skills that have already been mentioned.
Maintenance and Relapse Prevention We suggest using three general methods to promote long-term maintenance of the changes in substance problems made through BCT. Abstinence and Relationship Functioning A series of studies have compared substance abuse and relationship outcomes for substance abusing patients treated with BCT or individual counseling.
Impact of BCT on the Children of Couples Undergoing BCT Kelley and Fals-Stewart conducted 2 studies 1 in alcoholism, 1 in drug abuse to find out whether BCT for a substance abusing parent, with its demonstrated reductions in domestic violence and reduced risk for family breakup, also has beneficial effects for the children in the family. Needed Research In terms of future directions, we do need more research on BCT, to replicate and extent the most recent advances, especially for women patients and broader family constellations.
Summary and Conclusions The purpose of Behavioral Couples Therapy is to build support for abstinence and to improve relationship functioning among married or cohabiting individuals seeking help for alcoholism or drug abuse.
Behavioral Couples Therapy for Alcoholism and Drug Abuse
In addition, the following resources are available for those interested in learning more about how to implement BCT: Behavioral couples therapy for alcoholism and drug abuse. A web-based distance learning course on BCT www. Alcoholism treatment by Disulfiram and community reinforcement therapy.
Journal of Behavior Therapy and Experimental Psychiatry. 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. Journal of Studies on Alcohol. Disulfiram treatment of alcoholism. British Journal of Psychiatry. Behavioral couples treatment of alcohol and drug use disorders: Current status and innovations. A randomized clinical trial examining behavioral couples therapy with female alcoholic patients.
Journal of Consulting and Clinical Psychology. Behavioral couples therapy for male substance-abusing patients: Effects on relationship adjustment and drug-using behavior. Behavioral couples therapy for male-drug abusing patients and their partners: The effect on interpartner 22 violence. Journal of Substance Abuse Treatment. Fals-Stewart W, Kennedy C. Addressing intimate partner violence in substance-abuse treatment.
Brief relationship therapy for alcoholism: A randomized clinical trial examining clinical efficacy and cost-effectiveness.
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Psychology of Addictive Behaviors. Behavioral family counseling and naltrexone for male opioid dependent patients. Behavioral couples therapy increases compliance with naltrexone among male alcoholic patients. Research institute on Addiction; Buffalo NY: Behavioral couples therapy for male substance abusing patients: A cost outcomes analysis.
Behavioral couples therapy for male methadone maintenance patients: Effects on drug-using behavior and relationship adjustment. Use of abbreviated couples therapy in substance abuse.
Behavioral Couples Therapy for Substance Abuse: Rationale, Methods, and Findings
Approaches to Brief Couples Therapy: Hedberg AG, Campbell L. A comparison of four behavioral treatments of alcoholism.
Couples versus individual-based therapy for alcoholism and drug abuse: Comparative effectiveness of three types of spouse involved alcohol treatment: Outcomes 18 months after treatment. British Journal of Addiction.
Context, process, and outcome. Oxford University Press; New York: Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment. Journal of Substance Abuse. Cost-benefit and cost-effectiveness analyses of behavioral marital therapy with and without relapse prevention sessions for alcoholics and their spouses. Behavioral marital therapy for male alcoholics: Marital and drinking adjustment during the two years after treatment. Guilford Press; New York: Hopefully the next few years will see progress in closing this gap.
J Behav Ther Exp Psychiatry 13 2: J Stud Alcohol 51 4: J Consult Clin Psychol 64 5: J Consult Clin Psychol 65 5: Institute of Medicine , Bridging the gap between practice and research: National Academy of Sciences Press. Second special report to the U. Congress on alcohol and health. Department of Health, Education, and Welfare. Br J Addict 86 O'Farrell TJ , A behavioral marital therapy couples group program for alcoholics and their spouses.
Marital and family interventions. J Consult Clin Psychol 63 2: J Subst Abuse 8 2: Behavior Therapy 27 1: Professional Psychology 28 3: We've noticed that you're using an ad blocker Our content is brought to you free of charge because of the support of our advertisers. To continue enjoying our content, please turn off your ad blocker.
Skip to main content. Addiction , Alcohol Abuse. Research on BCT With Alcoholism Several studies have compared drinking and relationship outcomes for alcoholic patients treated with BCT or individual alcoholism counseling. Conclusions and Directions The findings presented here support three main conclusions. Prescribing Opioids to the Elderly.
The Therapeutic Cannabis User: Online Communities for Drug Withdrawal: What Can We Learn? Opioid Overdoses and Naloxone: What Everyone Needs to Know. It's off now Dismiss How do I disable my ad blocker? It can be temporarily disabled by clicking the "shield" icon in the address bar. Close this help box and click "It's off now". Ghostery Click the Ghostery icon on your browser. They raised two primary concerns: A series of recently completed studies addressed these concerns.
Eighty couples were randomly assigned for a week period to one of four interventions:. The findings suggest that community-based substance abuse treatment programs can provide BCT effectively. Given the significant benefits to individuals and their families who participate in BCT, researchers need to redouble their efforts to disseminate these techniques to community-based providers of substance abuse services.
Adding BCT to the treatment toolbox of these professionals will make the intervention available to more families who are very likely to benefit. National Center for Biotechnology Information , U. Journal List Sci Pract Perspect v. William Fals-Stewart , Ph. See commentary " Response: This article has been cited by other articles in PMC. Abstract Behavioral couples therapy BCT , a treatment approach for married or cohabiting drug abusers and their partners, attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it.
The family disease approach, the best known model, views alcoholism and other drug abuse as illnesses of the family, suffered not only by the substance abuser, but also by family members, who are seen as codependent. Treatment consists of encouraging the substance-abusing patient and family members to address their respective disease processes individually; formal family treatment is not the emphasis. The family systems approach, the second widely used model, applies the principles of general systems theory to families, paying particular attention to the ways in which family interactions become organized around alcohol or drug use and maintain a dynamic balance between substance use and family functioning.
A third set of models, a cluster of behavioral approaches, assumes that family interactions reinforce alcohol-and drug-using behavior. Therapy attempts to break this deleterious reinforcement and instead foster behaviors conducive to abstinence. Recently completed investigations that have shown positive effects of BCT on domains of functioning not specifically targeted by the intervention, such as reduced intimate partner violence and improved emotional and behavioral functioning on the part of children in the family. Recognizing these interrelationships, BCT and family-based treatments for substance abuse in general have three primary objectives: To eliminate abusive drinking and drug abuse;.
To restructure couple and family interaction patterns in ways conducive to long-term, stable abstinence.
Open in a separate window. Appropriate Candidates for BCT Because BCT relies on harnessing the influence of the couples system to promote abstinence, it is suitable only for couples who are committed to their relationships. General Session Content and Procedures The BCT approach has been fully manualized, with manuals and related materials readily available to researchers and practitioners. Focus on relationship enhancement and communications skills training. Continued or renewed substance use The substance-abusing partner reports substance use 2 weeks in a row or urges to use 3 weeks in a row.
Place greater emphasis on substance use issues. Encourage attendance at self-help meetings and more frequent contact with the individual counselor. Identify and reduce the stressors under- lying or contributing to cravings. Noncompliance with homework The couple fails to complete homework 2 weeks in a row.
Isolate and eliminate factors interfering with completion. Reduce the amount of homework to a level manageable by both partners. Arguments about past substance abuse Either partner reports such arguments 2 weeks in a row. This violates one of the major tenets of the intervention, which focuses on the future, not the past. Encourage the non-substance-abusing partner to discuss these issues in Al- Anon meetings or with an individual counselor.
Angry touching There have been episodes of mild physical aggression between partners.
As a condition of the recovery contract, both partners agree not to discuss past drinking or drug abuse, or fears of future substance abuse, between scheduled BCT sessions. BCT also teaches communication and increases positive activities. Because BCT relies on harnessing the influence of the couples system to promote abstinence, it is suitable only for couples who are committed to their relationships. Taken together, the data from these two studies show that reduced hospital and jail days after BCT save more than five times the cost of delivering BCT for alcoholism. Table 2 shows that domestic violence was nearly eliminated among patients who were remitted i. Behavioral couples therapy for male methadone maintenance patients: BCT also teaches communication and increases positive activities.
Refer partner to domestic violence treatment and cease BCT. Practicing communication skills—paraphrasing, empathizing, and validating—can help the substance-abusing patient and his or her partner better address stressors in their relationship and their lives. These skills are also believed to reduce the risk of relapse to substance abuse.
Planning for Continuing Recovery Once the couple has attained stability in abstinence and relationship adjustment, the partners and the therapist begin discussing plans for maintaining therapy gains after formal BCT is completed. In our BFC study, out-patient men who were living with a family member 66 percent with spouses, 25 percent with parents, and 9 percent with siblings were randomly assigned to one of two equally intensive week treatments: BFC plus individual treatment.
Patients had both individual and family sessions and took naltrexone daily in the presence of a family member as part of the recovery contract. Patients were prescribed naltrexone and were asked in counseling sessions about their compliance, but there was no family involvement or compliance contract. Dually Addicted Couples When both partners in a relationship use drugs, neither traditional individual therapy nor BCT has proven effective. Intimate partner violence IPV is highly prevalent among substance-abusing patients and their partners.
For example, recent studies among married or cohabiting men entering treatment for alcoholism have shown that: Male-to-female physical aggression was nearly eight times as likely on days of drinking as on days of no drinking Fals-Stewart, and roughly three times as high on days of cocaine use as on days of no substance use Fals-Stewart, Golden, and Schumacher, Eighty couples were randomly assigned for a week period to one of four interventions: Brief BCT with 12 sessions—6 couples sessions alternating with 6 individual sessions;.
PACT with 12 sessions—6 individual sessions alternating with 6 educational sessions for the couple. Twelve sessions of standard BCT, delivered to the partners in a couples therapy format, plus 12 sessions of group drug counseling GDC featuring session material on step facilitation;. Footnotes 1 Readers can obtain the BCT manuals for free by downloading from www.
A rapid learning-based procedure for marital counseling. Behavior Research and Therapy. The Response to Conflict Scale: Statistical Power Analysis for the Behavioral Sciences. The occurrence of interpartner physical aggression on days of alcohol consumption: A longitudinal diary study. Journal of Consulting and Clinical Psychology. A national survey of the use of couples therapy in substance abuse treatment. Journal of Substance Abuse Treatment. Behavioral couples therapy for alcoholic men and their intimate partners: Behavioral couples therapy for male substance-abusing patients: Effects on relationship adjustment and drug-using behavior.
Drug-abusing patients and their intimate partners: Dyadic adjustment, relationship stability, and substance use. Journal of Abnormal Psychology. Behavioral couples therapy for drug-abusing men and their intimate partners: Group therapy versus conjoint therapy formats. Affairs, Abuse, Drugs, and Depression: The Promises and Pitfalls of Couples Therapy. A comparison of mothers versus fathers. Journal of Family Psychology in press.
Intimate partner violence and substance use: A longitudinal day-to-day examination.