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

2. 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

3. 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:

5. 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

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

7. 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

8. THE FOUR PHASES OF PROJECT CALM
1. Engaging Alcoholic and Partner
providing a rationale … and hope
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
Weekly Couples Group Sessions
(group modality optional)
4. Quarterly Follow-up Visits for 24 Months

9. 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 minute break for refreshments

10. 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

11. 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

12. 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%

13. 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

14. 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