Behavioral Couples Therapy for Alcoholism and Drug Abuse

Abstract

Behavioral Couples Therapy (BCT) is designed for married or cohabiting individuals seeking help for alcoholism or drug abuse. BCT sees the substance abusing patient together with the spouse or live-in partner. Its purposes are to build support for abstinence and to improve relationship functioning. BCT promotes abstinence with a "recovery contract" that involves both members of the couple in a daily ritual to reward abstinence. BCT improves the relationship with techniques for increasing positive activities and improving communication. BCT also fits well with 12-step or other self-help groups, individual or group substance abuse counseling, and recovery medications. Research shows that BCT produces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Thus research evidence supports wider use of BCT. We hope this article and new print and web-based resources on how to implement BCT will lead to increased use of BCT to the benefit of substance abusing patients and their families. KeywordsBehavioral Couples Therapy; alcoholism; drug abuse OverviewThe 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. BCT sees the substance abusing patient with the spouse or live-in partner to arrange a daily "Recovery Contract" in which the patient states his or her intent not to drink or use drugs and the spouse expresses support for the patient's efforts to stay abstinent. For patients taking a recovery-related medication (e.g., disulfiram, naltrexone), daily medication ingestion witnessed and verbally reinforced by the spouse also is part of the contract. Self-help meetings and drug urine screens are part of the contract for most patients. BCT also increases positive activities and teaches communication skills.Research shows that BCT produces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Despite the strong evidence base supporting BCT, it is rarely used in substance abuse treatment programs. Low use of BCT may stem from the recency of studies on BCT, many of which were published in the past 15 years. NIH Public Access Clinical Procedures for Behavrioal Couples TherapyBCT works directly to increase relationship factors conducive to abstinence. A behavioral approach assumes that family members can reward abstinence --and that alcoholic and drug abusing patients from happier, more cohesive relationships with better communication have a lower risk of relapse. The substance abusing patient and the spouse, are seen together in BCT, typically for 12-20 weekly outpatient couple sessions over a 3-6 month period. BCT can be an adjunct to individual counseling or it can be the only substance abuse counseling...

A Latent Profile Analysis of Aggression and Victimization Across Relationship Types Among Veterans Who Use Substances

“…Our findings are clinically significant in identifying differences in the severity and type of violence involvement among veterans. Specific to each profile, individuals with a predominantly IPV profile may benefit from an intervention that targets relationship violence (e.g., behavioral couples therapy [O'Farrell & Schein, 2011], Strength at Home [Taft et al, 2013]) and substance use, especially given evidence that violence remits as substance use remits (Chermack et al, 2017;Schumm et al, 2009). The predominantly NPV and HGV groups may benefit more from interventions more focused on alcohol and general violence prevention (e.g., anger management) as well as case management, given their legal problems.…”

Substance use, current criminal justice involvement, and lifetime suicidal thoughts and behaviors history: The moderating role of thwarted belonging

“…The current findings also highlight the importance of both relapse prevention and addressing social relationships among individuals with high alcohol-related severity. Clinicians should consider interventions aimed at reducing alcohol-and drug-related severity and preventing relapse (e.g., motivational interviewing, cognitive behavioral therapy, and dialectical behavior therapy; Dimeff & Linehan, 2008;Swogger et al, 2016), while also focusing on building positive social relationships and mending existing relationships (e.g., behavioral couples therapy; McGovern & Carroll, 2003;O'Farrell & Schein, 2011). This is important given that interpersonal stressful life events have been linked to increased risk for suicide attempts among adults with an alcohol use disorder (Conner et al, 2012).…”

Thematic review of family therapy journals 2011

“…3) on substance misuse. It contained articles on the history of systemic intervention for substance misuse (Smock et al ., ), behavioural couples therapy (BCT) for alcohol and drug problems (O'Farrell and Schein, ), incorporation of motivational interviewing for substance use into couple therapy for intimate partner violence (McCollum et al ., ), family therapy for recovering young adults (Matheson and Lukic, ), multi‐family groups and recovery (Shumway et al ., ) and a relapse resilience process model of addiction and recovery (Harris et al ., ). Smock et al .…”

“…3) on substance misuse. It contained articles on the history of systemic intervention for substance misuse , behavioural couples therapy (BCT) for alcohol and drug problems (O'Farrell and Schein, 2011), incorporation of motivational interviewing for substance use into couple therapy for intimate partner violence (McCollum et al, 2011), family therapy for recovering young adults (Matheson and Lukic, 2011), multi-family groups and recovery (Shumway et al, 2011) and a relapse resilience process model of addiction and recovery . Smock et al's (2011) historical overview is a useful article to orient readers new to the field and the remaining articles offer a wealth of detailed clinical guidance on working with families where drug and alcohol problems are a central concern.…”