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| Behavioral Couples Therapy for Substance Abuse: Rationale, Methods, and Findings |
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Behavioral couples therapy (BCT), a treatment approach for married or cohabiting drug abusers and their partners, attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it. In multiple studies with diverse populations, patients who engage in BCT have consistently reported greater reductions in substance use than have patients who receive only individual counseling. Couples receiving BCT also have reported higher levels of relationship satisfaction and more improvements in other areas of relationship and family functioning, including intimate partner violence and children's psychosocial adjustment.
This review describes the use of BCT in the treatment of substance abuse, discusses the intervention's theoretical rationale, and summarizes the supporting literature.
Historically, the treatment community and the public at large have viewed alcoholism and other drug abuse as individual problems most effectively treated on an individual basis. However, during the last three decades, professionals and the public have come to recognize family members' potentially crucial roles in the origins and maintenance of addictive behavior. Treatment providers and researchers alike have begun conceptualizing drinking and drug use from a family systems perspective and treating the family as a way to address an individual's substance abuse.
In the early 1970s, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) described couples and family therapy as "one of the most outstanding current advances in the area of psychotherapy of alcoholism" and called for controlled studies to test the effectiveness of promising family-based interventions (Keller, 1974). Many investigative teams answered the call, initially with small-scale studies and, as evidence of effectiveness accumulated, by means of large-scale, randomized clinical trials. Their results confirmed the early promise of marital and family therapy. Meta-analytic reviews of randomized clinical trials have concluded that, in comparison to interventions that focus exclusively on the substance-abusing patient, both alcoholism and drug abuse treatments that involve family result in higher levels of abstinence (see, for example, Stanton and Shadish, 1997). Behavioral couples therapy (BCT), a treatment approach for married or cohabiting drug abusers and their partners, attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it. In multiple studies with diverse populations, patients who engage in BCT have consistently reported greater reductions in substance use than have patients who receive only individual counseling. Couples receiving BCT also have reported higher levels of relationship satisfaction and more improvements in other areas of relationship and family functioning, including intimate partner violence and children's psychosocial adjustment. This review describes the use of BCT in the treatment of substance abuse, discusses the interventions theoretical rationale, and summarizes the supporting literature.
Three theoretical perspectives have come to dominate family-based conceptualizations of substance abuse and thus provide the foundation for the treatment strategies most often used with substance abusers. The family disease approach, the best known model, views alcoholism and other drug abuse as illnesses of the family, suffered not only by the substance abuser, but also by family members, who are seen as codependent. Treatment consists of encouraging the substance-abusing patient and family members to address their respective disease processes individually; formal family treatment is not the emphasis.
The family systems approach, the second widely used model, applies the principles of general systems theory to families, paying particular attention to the ways in which family interactions become organized around alcohol or drug use and maintain a dynamic balance between substance use and family functioning. Family therapy based on this model seeks to understand the role of substance use in the functioning of the family system, with the goal of modifying family dynamics and interactions to eliminate the family's need for the substance-abusing patient to drink or use drugs.
A third set of models, a cluster of behavioral approaches, assumes that family interactions reinforce alcohol and drug-using behavior. Therapy attempts to break this deleterious reinforcement and instead foster behaviors conducive to abstinence. Derived from this general behavioral conceptualization of substance abuse, behavioral couples therapy (BCT) is the approach to couples and family therapy that has, by our analysis, the strongest empirical support for its effectiveness (O'Farrell and Fals-Stewart, 2003). It is demonstrating success in broadly diverse populations, from very poor to wealthy, and among a broad range of ethnic and racial groups.
This review provides brief discussions of the theoretical rationale for the use of BCT with substance-abusing patients, including:
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Additional information regarding this subject is available at:
http://www.drugabuse.gov/Perspectives/vol2no2.html
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