BEHAVIORAL COUPLES THERAPY FOR SUBSTANCE USE DISORDERS

ROB J. ROTUNDA, Ph.D.

DEPARTMENT OF PSYCHOLOGYUNIVERSITY OF WEST FLORIDA, PENSACOLA

WHY USE COUPLE AND FAMILY THERAPY APPROACHES TO TREAT

SUBSTANCE USE DISORDERS?

• Innovation from individual tx method

• Most importantly:

• Family members affected, not just IP • Many family members still do care & want to help• Family conflict common trigger for relapse • Solid relationships important in Relapse Prevention

HOW ALCOHOL ABUSE AFFECTS THE FAMILYHOW ALCOHOL ABUSE AFFECTS THE FAMILY

I. Basic Family Processes Disrupted

Problem-Solving: roles/duties, achieving goals, daily living disrupted

Communication:emotional needs unmet; expression of feelings difficult

Control:chaotic; influence should be firm / constructive, yet flexible

II. Other Negative Consequences Affecting Family

Indirect e.g., Loss of job, poor job performance

Direct higher rates of verbal/physical abuse:

ALCOHOL AND THE FAMILYALCOHOL AND THE FAMILY

RESEARCH SUMMARY

ALCOHOLIC FAMILIES MORE DYSFUNCTIONAL THAN CONTROLS

BUT

SIMILAR TO FAMILIES STRUGGLING WITH OTHER PROBLEMS OR DISORDERS

( final common pathway to family dysfunction )

WET vs. DRY FAMILIES

FAMILY-FOCUSED TREATMENT APPROACHESFAMILY-FOCUSED TREATMENT APPROACHES

• Family Models

• family disease - a parallel process

• family systems- substance seen as “organizing principle”- symptom may not be the problem- interconnectedness, reciprocity, homeostasis

• behavioral couples / family- substance use viewed as problem behavior- focus on both recovery and relationships

- The Counseling for Alcoholics’ Marriages (CALM) Project

FAMILY-FOCUSED TREATMENT APPROACHESFAMILY-FOCUSED TREATMENT APPROACHES

• Engaging client /couple / family

Deciding on therapy parameters & tx goals

“Intervention” approach

Working with spouses/partners without IP, with intent of helping IP or drawing IP into treatment

Working with spouses/partners without IP: Focus on partners (CRAFT approach)

Self-help group referrals

THE FOUR PHASES OF PROJECT CALM

1. Engaging Alcoholic and Partner

• providing a rationale … and hope

2. 8 - 10 Weekly Couple Sessions

3. 10 Weekly Couples Group Sessions(group modality optional but better)

4. Quarterly Follow-up Visits for 24 Months

Suitable Clients for BCT

married or cohabitating (usually 1 year+)

reside together or willing to work on reconciling

not psychotic

not high risk of serious violence

can begin tx after detox or rehab, or no prior treatment

Weekly Couple Sessions

– developing a sobriety contract

– use of Antabuse or other recovery meds

– CALM Promises – no threats of separation, focus on present, and commit to action via hmwk. exercises

STRUCTURE OF CALM COUPLES GROUPS

4-5 couples

- stabilized and appropriate for group

male and female co-therapist team

- observer for training purposes

10 weekly two-hour sessions with 10-15 minute break for refreshments

PROCESS OF CALM COUPLES GROUPS

Report on homework in first half of each session

Focus on recovery:

- Sobriety Contract & check of urges to drink or drug; Crisis intervention PRN

Skills training and practice

End with review of homework assignments for coming week - eliciting commitments

GOALS OF PROJECT CALM COUPLES GROUPS GOALS OF PROJECT CALM COUPLES GROUPS

1. Promote sobriety: Sobriety Contract

2. Increase positive activities: Catch Your Partner…SRAs, Caring Day

3. Teach communication skills: Listening; using “I” etc.

4. Negotiate desired changes: Positive Specific Requests

5. Plan for maintenance Relapse prevention of change: skills

RELATED CLINICAL ISSUES

• Screening for domestic violence

• Working with partners:

focus on coping responses, enabling etc.

- drank / used drugs with, or in presence of, client95%

- lied or made excuses to family/friends 90%

- gave client money to buy alcohol or drugs 71%

- purchased alcohol or drugs for client 55%

BCT OUTCOMES

compared to individual treatment

with added relapse prevention sessions

with women and minority IPs

effects on violence

effects on children

social cost outcomes

with dual-diagnosed clients: - ETOH dependence & PTSD