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