1. 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

2. 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...

4. 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

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. 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

8. RELATED CLINICAL ISSUES Screening for domestic violence Working with partners: coping responses, enabling and “codependency” - drank / used drugs with, or in presence of, client95% - lied or made excuses to family/friends90% - gave client money to buy alcohol or drugs71% - purchased alcohol or drugs for client55%

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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 **