A national survey of the use of couples therapy in substance abuse treatment.

Although results from multiple studies conducted over the last two decades indicate that Behavioral Couples Therapy (BCT) is an effective treatment for married or cohabiting alcohol- and drug-abusing patients, both in terms of reduced substance use and improved relationship satisfaction, it is unclear whether BCT or other types of couples-based interventions are used in community-based substance abuse treatment programs. In the present study, program administrators (e.g., executive directors, clinical directors, staff physicians) from 398 randomly selected community-based outpatient substance abuse treatment programs in the U.S. were interviewed regarding use of different family- and couples-based therapies in their programs. According to the program administrators, 27% of the programs provided some type of couples-based treatment. However, less than 5% of the agencies used behaviorally oriented couples therapy and none used BCT specifically. Recommendations for researchers and clinicians to increase the use of BCT in community-based treatment programs are provided.

Behavioral couples therapy versus individual-based treatment for male substance-abusing patients. An evaluation of significant individual change and comparison of improvement rates.

Fals-Stewart, Birchler, and O'Farrell (1996) found that married or cohabiting substance-abusing men (n = 40) who participated in behavioral couples therapy (BCT) in addition to individual-based treatment (IBT) for substance abuse had fewer days of substance use and, along with their partners, reported higher levels of dyadic adjustment during and 1-year after treatment than husbands who received IBT only (n = 40). In the present study, significant individual change in posttreatment frequency of substance use and dyadic adjustment was evaluated and comparisons of the proportions of participants receiving IBT and BCT who were improved, unchanged, or deteriorated in these domains of functioning were made using data from Fals-Stewart et al. (1996). Growth curve analysis revealed that a larger proportion of husbands in the BCT condition showed significant reductions in substance use (n = 33, 83%) than husbands who received IBT (n = 24, 60%). Also, a larger proportion of couples who participated in BCT showed improvements in dyadic adjustment (n = 24, 60%) than couples whose husbands received IBT only (n = 14, 35%).

Drug-abusing patients and their intimate partners: dyadic adjustment, relationship stability, and substance use.

The dyadic adjustment and substance use of couples with a drug-abusing husband (n = 94), couples with a drug-abusing wife (n = 36), couples in which both partners abused drugs (n = 87), and non-substance-abusing conflicted couples (n = 70) were examined. For couples with 1 drug-abusing partner, a higher percentage of days abstinent during the year before treatment for drug abuse was associated with a higher level of relationship satisfaction. When both partners abused drugs, the relationship between percentage of days abstinent and relationship satisfaction became stronger and more negative as the time partners spent together using drugs increased. A higher percentage of days abstinent was associated with relationship stability for couples with 1 drug-abusing partner during and 1 year after treatment; for couples in which both partners abused drugs, a higher percentage of days abstinent was associated with relationship instability.

Procedures for evaluating the dyadic adjustment of drug-abusing patients and their intimate partners. A multimethod assessment approach.

This article describes a basic multimethod relationship assessment procedure used by the authors in their recent investigations to evaluate the relationship adjustment of married or cohabiting drug-abusing patients and their intimate partners. The components of the assessment include (a) semistructured clinical interviewing; (b) a battery of paper-and-pencil self-report inventories; and (c) observations of partners engaging in a conflict resolution discussion, coded using a standardized rating system. The essential features of the relationship assessment procedure (i.e., brevity, breadth, depth, and use of psychometrically sound measures) would allow this method to be used routinely in nonresearch settings that treat substance-abusing patients. A case example is provided to illustrate the use of these relationship assessment methods with a drug-abusing couple.

Behavioral couples therapy for male substance-abusing patients: a cost outcomes analysis.

The cost outcomes for married or cohabiting substance-abusing male patients (N = 80) who were randomly assigned to receive either behavioral couples therapy (BCT) or individual-based treatment (IBT) were compared. Social costs incurred by patients in several areas (e.g., cost of substance abuse treatment, support from public assistance) during the year before and the year after treatment were estimated. BCT was more cost-beneficial than IBT; although the monetary outlays for delivering IBT and BCT were not different, the average reduction in aggregate social costs from baseline to follow-up was greater for patients who received BCT (i.e., $6,628) than for patients who received IBT (i.e., $1,904). BCT was also more cost-effective than IBT; for each $100 spent on the treatment, BCT produced greater improvements than IBT on several indicators of treatment outcome (e.g., fewer days of substance use, fewer legal problems).

Sexual satisfaction and dysfunction in marriages of male alcoholics: comparison with nonalcoholic maritally conflicted and nonconflicted couples.

OBJECTIVE: This study examined the contribution of alcoholism and marital conflict to male alcoholics' sexual problems. METHOD: Married couples with an alcoholic husband (n = 26) were compared with 26 maritally conflicted and 26 nonconflicted couples without alcohol-related problems on both sexual dysfunction and sexual satisfaction. RESULTS: The male alcoholics and their wives experienced less sexual satisfaction across a range of variables and more sexual dysfunction-specifically husbands' diminished sexual interest, impotence and premature ejaculation, and wives' painful intercourse-than nonconflicted couples. However, impotence was the only aspect on which alcoholics reported more difficulties than did maritally conflicted couples. When husbands' age was considered, more frequent retarded ejaculation with older age was unique to the alcoholics since it did not occur in conflicted or nonconflicted husbands; and there was a greater decline in frequency of intercourse with older age among the alcoholic than among the conflicted couples. CONCLUSIONS: These findings are consistent with a biopsychosocial formulation of alcoholics' sexual adjustment problems that implicates (1) marital conflict as a major contributing factor to most of these problems and (2) the combined role of both marital conflict and the physical effects of chronic alcohol abuse as most relevant to the elevated rates of impotence and retarded ejaculation (among older alcoholics) and the steeper decline in intercourse frequency with age.

Behavioral couples therapy for male substance-abusing patients: effects on relationship adjustment and drug-using behavior.

Married or cohabitating substance-abusing patients (N = 80) who were entering individual outpatient treatment, most of whom were referred by the criminal justice system (n = 68; 85%), were randomly assigned to a no-couples-treatment control group (n = 40) or to 12 weekly sessions of adjunctive behavioral couples therapy (BCT; n = 40). Drug use and relationship adjustment measures were collected at pretreatment, posttreatment, and at 3-, 6-, 9-, and 12-month follow-ups. Couples who received BCT as part of individual-based treatment had better relationship outcomes, in terms of more positive dyadic adjustment and less time separated, than couples in which husbands received individual-based treatment only. Husbands in the BCT condition also reported fewer days of drug use, longer periods of abstinence, fewer drug-related arrests, and fewer drug-related hospitalizations through the 12-month follow-up period than husbands receiving individual-based treatment only. However, some of the drug use and relationship adjustment differences between these groups dissipated over the course of the follow-up period.

The role of pain behaviors in the modulation of marital conflict in chronic pain couples.

Sixty-one married male chronic benign back patients and their spouses were recruited in order to examine the relationship between marital conflict/stress and patient pain behaviors. The results suggest that marital conflict in pain couples is associated with increases in subsequent display of pain behaviors which, in turn, are associated with greater negative affective responses and more punitive behaviors by the spouse. A positive association was found between punitive spouse behaviors and patient physical and psychosocial impairment. The findings are discussed in terms of their clinical implications and the need for further experimental study of these relationships.

Interpersonal stress and pain behaviors in patients with chronic pain.

This study was designed to empirically evaluate the role of interpersonal stress in eliciting pain behavior. Thirty-four married male patients with chronic back pain (CBP) and their wives participated in a randomized between-groups study examining the effects of 2 interactional conditions (i.e., maritally focused stress interview and neutral talking control task) on subsequent persistence in a physically demanding task and with self-reports of pain. Results indicated that a significantly greater proportion of patients in the stress interview group terminated the physical activity task prematurely, compared with controls. The findings provide some of the first experimental support for the notion that uncomfortable interpersonal interactions may increase the likelihood of subsequent pain behavior in patients with CBP. Clinical implications and directions for future research are addressed.

The personality of marital distress: an empirical typology.

Couples seeking marital therapy (N = 102) completed the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943). Cluster analytic procedures were performed on partners' MMPI validity and clinical scales. Five distinct types of couples were identified: Conflicted, Depressed, Dissatisfied Wives, Dysphoric, and Domestic Calm. The resulting cluster solution was successfully replicated with a separate sample of dissatisfied couples. With reference to additional measures of marital adjustment, a description of each couple type is provided, along with implications for future research.

Sexual satisfaction and dissatisfaction in the marital relationships of male alcoholics seeking marital therapy.

Twenty-six married couples with alcoholic husbands who sought marital therapy were compared with two groups of couples without alcohol-related problems, 26 couples with marital conflict (MC) and 26 with no marital conflict (NC), on a range of sexual satisfaction variables. As predicted, the alcoholic and MC couples did not differ and both of these groups of couples reported less sexual satisfaction than the NC couples. Alcoholic and MC couples, in comparison with NC couples, reported less frequent intercourse, more change desired in intercourse frequency, greater misperception about the amount of change in sex frequency desired by their mate and more disagreement about sex. In addition, the finding that older alcoholics had less frequent intercourse replicated similar results by Jensen. Limitations of the present research and needed future research are discussed.

The clinician rating of adult communication (CRAC): a clinician's guide to the assessment of interpersonal communication skill.

This paper reports the results of an initial investigation of the psychometric properties of a new clinical marital communication assessment instrument, the Clinician Rating of Adult Communication (CRAC). The sample consisted of 36 marital communication samples from both maritally satisfied and distressed couples. Reliability results indicated that the CRAC demonstrated high levels of internal consistency, test-retest reliability, and interrater agreement. Support for the validity of the CRAC was found in its correspondence with a marital interaction coding system, its relationship to ratings of marital satisfaction, and its concordance with couples' perceptions of their conflict management behavior. Overall, these findings support the conclusion that the CRAC may provide a useful addition to the measurement armamentarium of the marital clinician and researcher.

Behavioral-systems marital therapy: dealing with resistance.

Recently there has been a dramatic increase in attempts to integrate certain intervention components of behavioral and systems approaches with marital and family therapy. This paper elaborates on a previously described behavioral-systems approach by focusing primarily on the issue of resistance to therapeutic progress within the behavioral framework. First, potential reasons for major resistance phenomena are suggested. Then, in the context of a social learning theory model of assessment and intervention, specific clinical indications are discussed for departing from the basic behavioral approach in order to deal with resistance. Finally, a variety of interpretive and strategic intervention techniques are described and illustrated by clinical case materials.