Implementing Behavioral Couples Therapy for Substance Use Disorders in Real‐World Clinical Practice

Abstract

Behavioral couple therapy (BCT) is an evidence‐based, manualized treatment that has been primarily developed to treat alcohol use disorder. The treatment model leverages the intimate partner relationship to support recovery. Although the efficacy of BCT is well‐supported in randomized controlled trials, little attention has been given to the translation of BCT to everyday practice settings. This article presents recommendations for implementing BCT in such settings. We describe a stepwise approach for getting a couple into BCT and determining whether it is an appropriate treatment for the couple. In addition, we provide recommendations for broadening inclusion criteria for everyday practice settings, including the use of BCT with couples who have drug use disorders with couples where both members exhibit substance use disorders and with couples who choose controlled drinking or drug use versus abstinence. Whereas BCT has mostly been researched in speciality substance use disorder settings, we provide recommendations for its use in general couple therapy settings. Based upon the extant research, we suggest implementing BCT as a standalone treatment or as an add‐on to individual counseling for substance use disorders. We provide guidance for delivering BCT through telehealth and encourage future research to investigate this delivery modality. Future research should prioritize investigating the effectiveness of various BCT dissemination strategies and seek to determine what dosage and components of BCT will result in the best outcomes.

Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial

“…Effectiveness studies of substance use interventions in real‐world settings are lacking (McCrady et al, 2016; Schumm & Renno, 2022). Conducted in two publicly funded addiction outpatient clinics, this clinical trial offers also pragmatic evidence (Ford & Norrie, 2016), thereby increasing the feasibility of applying CCT in real‐world clinical practice.…”

“…Both models were found to be “probably efficacious” as stand‐alone treatments for drinking outcomes (Hogue et al, 2022, p. 178). Real‐world effectiveness studies for these models are currently limited (McCrady et al, 2016; Schumm & Renno, 2022). A recent meta‐analysis drew more cautious conclusions in relation to BCT outcomes for substance use and relationship adjustment in comparison with alternative treatment methods, including individual‐based treatments and brief couples' therapy (Schmit et al, 2022).…”

Angehörigenarbeit - Neu denken

“…Hierdurch wird der Befähigung stattgegeben, in der medizinischen Rehabilitation Abhängigkeitserkrankter eigenverantwortlich Einzel-und Gruppentherapiesitzungen durchzuführen. Weiterbildungen zu Suchttherapeut:innen auf Grundlage der Systemischen Therapie können von der DRV "grundsätzlich akzeptiert" werden -so der Wortlaut einer Mitteilung der zuständigen Abteilung der DRV an Weiterbildungsinstitute mit ‚anerkannten Curricula' [49]. Durch diese Aussicht könnten systemisch-familientherapeutische Weiterbildungen im Rahmen der Suchtrehabilitation etabliert werden, um sie folglich als von der DRV anerkannte Suchttherapieform anbieten zu können.…”

“…Auch in den USA werden SGS mittlerweile im Kontext und in der Wechselwirkung mit dem sozialen Umfeld und der Familie betrachtet, wodurch es nur begrenzt wirksam erscheint, lediglich die Betroffenen mit der aktiven SGS zu behandeln [50]. Schon länger existieren international einige gute Ansätze [51,52], die bereits in mehreren Rehabilitationseinrichtungen in den Vereinigten Staaten flächendeckend Anwendung finden [53]. In Deutschland sind diese nach wie vor nicht bedarfsgerecht in Institutionen der Suchthilfe implementiert, können jedoch auch auf nationaler Ebene als vielversprechende Orientierung für die Praxis dienen.…”

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

“…Evidence for the causal effects of homework ( d = 0.53; 95% confidence interval [CI] = 0.35–0.72, p < 0.0001 in Kazantzis, Whittington & Dattilio, 2010) and for homework adherence as a predictor of symptom reduction (correlational effects, r = 0.26; 95% CI = 0.19–0.33 in Mausbach, Moore, Roesch, Cardenas & Patterson, 2010) is compelling, but perfect adherence is not expected because CBT supports change through a process of experimentation (i.e., collaborative empiricism, see discussion in Dozois, 2010). Prior surveys have confirmed that rates of homework adherence are often less than 100% in clinical practice (Helbig & Fehm, 2004; Kazantzis, Lampropoulos & Deane, 2005), and guidance has been provided for maximizing homework adherence in couples and family therapy work (Bevilacqua & Dattilio, 2001; Dattilio, 2002, 2005; Dattilio & Dickson, 2007; Dattilio, L'Abate & Deane, 2005; Epstein & Baucom, 2007; Newcomb & Lebow, 2007; Robbins, Szapocznik & Perez, 2007; Schumm & Renno, 2022). However, little research has surveyed couples and family therapists' experiences of CBT, and no prior study has examined the potential for positive or negative impact of homework non‐completion (IHN) on the working alliance (see reviews in Mutschler, Malivoire, Schumm & Monson, 2022; Sibley, Link, Torres Antunez & Greenwood, 2022).…”