1. Behavioral Couples Therapy for Alcoholism and Drug Abuse Timothy O’Farrell, Ph.D. VA Boston Healthcare System, Brockton MA Harvard Medical School Department of Psychiatry

2. Counseling for Alcoholics’ Marriages (CALM) Project Couples learn new ways to cope with alcoholism’s effect on marriage

3. u Introduction & Background u Substance-Focused Methods u Relationship-Focused Methods u Relapse Prevention Behavioral Couples Therapy for Alcoholism and Drug Abuse

6. Introduction to BCT u Why use BCT? u Substance use problems & family problems often coexist u These sets of problems are often intertwined u Addressing both problems at the same time results in better outcomes

7. Introduction to BCT uBCT was designed for married or cohabiting patients seeking help for substance abuse uPurpose of BCT is to support abstinence and improve relationship functioning uBCT sees patient with spouse or live-in partner for 12-20 couple sessions over 3-6months uBCT fits well with self-help groups, medications, and other counseling

8. 4 Objectives of BCT u Engage the couple u Support abstinence with Recovery Contract (daily ritual to reward abstinence) and other support for abstinence u Improve relationship by increasing positive activities and improving communication u Continuing recovery and relapse prevention

9. u Married or living together relationship u Reside together or reconcile u Accept at least temporary abstinence u Both willing to work on problems u Not high risk of very severe violence u ? if both are substance abusers u Start after detox, rehab, IOP or no prior Tx Suitable Cases for BCT

11. Building Support for Abstinence Behavioral Couples Therapy for Alcoholism and Drug Abuse

13. “You Want Me to Say ‘Thank You’ to Him for Not Drinking? That’s Rich…Why In the World Would I do That?” BCT Recovery Contract

14. Helps the Couple u Rebuild trust u Reduce conflict about substance abuse u Reward abstinence

15. BCT Recovery Contract Daily Trust Discussion u Alcohol/drug abuser states intention to stay abstinent that day u Spouse thanks alcohol/drug abuser for efforts to stay abstinent

16. “I have been drug and alcohol free for the last 24 hours and plan to remain drug and alcohol free for the next 24 hours. Thank you for listening and being supportive of my effort to be drug and alcohol free.” “Thank you for staying drug and alcohol free for the last 24 hours. Let me know how I can help during the next 24 hours.” Client Partner Daily Trust Discussion Formula

17. BCT Recovery Contract u Daily Trust Discussion (with medication if taking it) u Focus on present & future, not past u Self-help involvement u Weekly drug urine screens u Other weekly behaviors u Calendar to record progress

18. D+

19. Other Support for Abstinence uReview urges to drink or use drugs  Helps identify triggers and build confidence uCrisis intervention for substance use  Stop use ASAP and learn from experience uDiscuss exposure to substances, including alcohol at home uAddress stressful life problems uIdentify and stop enabling

21. Relationship Focus: Increasing Positive Activities uCatch Your Partner Doing Something Nice uShared Rewarding Activities uCaring Day Assignment

22. Relationship Focus: Teaching Communication Skills u Listening Skills u Expressing Feelings Directly u Communication Sessions u Negotiating for Requests

23. Maintenance & Relapse Prevention u Continuing Recovery Plan  Actions to maintain abstinence and relation- ship gains after weekly couples Tx ends u Relapse Prevention Plan  Identify high risk situations & warning signs  Make plan to prevent or minimize relapse u Action Plan to keep partner safe wDo not argue with person who is intoxicated wGet help or leave if fear violence

25. u BCT, compared to Individual Tx alone, gives –more abstinence –happier relationships –fewer separations and less divorce u Partner violence greatly reduced after BCT u Tx & Legal system costs decrease after BCT u BCT improves recovery medication compliance u BCT may work with family members other than spouses Studies of BCT Show

26. For More Information uEmail Timothy_ofarrell@hms. harvard.edu u Web-based training www.ireta.org (see Distance Education)