BEHAVIORAL COUPLES THERAPY FOR SUBSTANCE USE DISORDERS ROB J. ROTUNDA, Ph.D. DEPARTMENT OF PSYCHOLOGY UNIVERSITY OF WEST FLORIDA, PENSACOLA

WHY USE COUPLE AND FAMILY THERAPY APPROACHES TO TREAT SUBSTANCE USE DISORDERS? Innovation from individual tx methods JCAHO 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 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 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

ALCOHOL AND THE FAMILY - Tx Approaches Family Models family disease family systems BCT

FAMILY-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 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 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 3. 10 Weekly Couples Group Sessions (group modality optional) 4. Quarterly Follow-up Visits for 24 Months

STRUCTURE OF CALM COUPLES GROUPS - 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 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, 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%

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

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