BEHAVIORAL COUPLES THERAPY FOR SUBSTANCE USE DISORDERS

ROB J. ROTUNDA, Ph.D.

DEPARTMENT OF PSYCHOLOGYUNIVERSITY OF WEST FLORIDA, PENSACOLA

and

RESEARCH ASSOCIATEHARVARD FAMILIES AND ADDICTION PROGRAM

WHY USE COUPLE AND FAMILY THERAPY APPROACHES TO TREAT

SUBSTANCE USE DISORDERS?

• Innovation from individual tx methods

• JCAHO

• Necessity of thinking more ecologically and systemically

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

HOW 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: processes may be chaotic, unpredictable

II. Other Negative Consequences Affecting Family

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

Direct higher rates of verbal/physical abuse; separation & divorce

ALCOHOL 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 APPROACHES

• Engaging client /couple / family

Deciding on therapy parameters & goals -assessment

“Intervention” approach

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

Working with spouses/partners without IP

Self-help group referrals

RELATED CLINICAL ISSUES

• Screening for domestic violence

• Working with partners:

coping responses, enabling and “codependency”

- 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%

FAMILY-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

THE FOUR PHASES OF PROJECT CALM

1. Engaging Alcoholic and Partner

• providing a rationale … and hope

2. 8 - 10 Weekly Couple Sessions

• developing a sobriety contract• use of Antabuse • CALM Promises

3. 10 Weekly Couples Group Sessions

4. Quarterly Follow-up Visits for 24 Months

STRUCTURE OF CALM COUPLES GROUPS

4-5 five couples

- stabilized and appropriate for group

male and female co-therapist team

- observer for training / research 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

1. Promote sobriety: Sobriety Contract

2. Increase positive activities: Catch Your Partner…

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

4. Negotiate desired changes: Positive Specific Requests

5. Plan for maintenance Relapse prevention of change: skills

- enabling & detachment issues

BCT OUTCOMES and EFFECTIVENESS

compared to individual treatment

with added relapse prevention sessions

with women and minority IPs

with dual-diagnosed clients:

- Alcohol dependence & PTSD

** Outcomes from Insiders **