BEHAVIORAL COUPLES THERAPY FOR SUBSTANCE USE DISORDERS

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• BEHAVIORAL COUPLES THERAPY FOR SUBSTANCE USE
  DISORDERS
• ROB J. ROTUNDA, Ph.D.
• DEPARTMENT OF PSYCHOLOGY
• UNIVERSITY OF WEST FLORIDA, PENSACOLA
• and
• RESEARCH ASSOCIATE
• HARVARD FAMILIES AND ADDICTION PROGRAM

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• 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 ...

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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

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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
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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

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• RELATED CLINICAL ISSUES
• Screening for domestic violence
• Working with partners
• coping responses, enabling and
• codependency
• - drank / used drugs with, or in presence of,
  client 95
• - lied or made excuses to family/friends 90
• - gave client money to buy alcohol or drugs 71
• - purchased alcohol or drugs for client 55

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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

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• 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

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• 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

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• 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

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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
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• 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