Behavioral Couples Therapy: Making a Difference for Families

By Logsdon, Timothy; Fals-Stewart, William | Addiction Professional, July 2004 | Go to article overview

Behavioral Couples Therapy: Making a Difference for Families


Logsdon, Timothy, Fals-Stewart, William, Addiction Professional


Family-based interventions are now commonplace and found in most substance abuse treatment clinics around the world. The influences of family dynamics can be a foundation of support that carries the recovering person "through the storm," or can be filled with stressors that can lead to relapse, such as arguments, poor communication, violence and much more.

Further, the importance of intimate relationships (e.g., marriage or a committed relationship) in the recovery of a person with a history of substance abuse should not be underestimated. To an even larger extent, the same types of stressors of the extended family, in addition to relationship unhappiness, poor problem-solving skills, financial problems, etc., are paramount in the addicted person's recovery. Even for the person active in treatment who is working a program, attending self-help support meetings and learning to deal with "life on life's terms," an intimate relationship can be the breaking point resulting in relapse if fears about future use, nagging and constant criticism predominate communications between the two partners.

This leaves the recovering individual with the choices of finding help for or ending the relationship, maintaining in an unhappy, stressful situation, and/or using drugs or alcohol to cope.

When recovery from the alcohol or drug problem has begun, relationship conflict is the most commonly reported precipitant of relapses. Techniques aimed at improving unhealthy dynamics and building recovery supports are therefore critical to maintaining abstinence and reducing or removing at least one stressor, maybe the most significant one in the recovering person's life (Maisto et al., 1988). Family-based interventions such as Behavioral Couples Therapy (BCT), which has the strongest empirical support for its effectiveness (O'Farrell & Fals-Stewart, 2003), aim to do just that.

For over three decades now, BCT has been shown to result in less frequent drinking, fewer alcohol-related problems, happier relationships, and lower risk of marital separation for alcoholic patients who receive it when compared to patients who receive only individual-based treatment (e.g., Azrin, Sisson, Meyers, & Godley, 1982; Hedberg & Campbell, 1974; McCrady et al., 1991). Research results for those who abuse drugs other than alcohol show fewer days of drug use, fewer drug-related arrests and hospitalizations, a longer time to relapse after treatment completion, and more positive relationship adjustment (Fals-Stewart, Birchler & O'Farrell, 1996; Fals-Stewart, O'Farrell & Birchler, 2001a, 2001b; Fals-Stewart & O'Farrell, 2003; Kelley & Fals-Stewart, 2002).

Family-based models and treatments have focused on how the interactions between partners in relationships affected by substance abuse may influence substance abuse behavior. For example, the interplay between substance use and relationship problems results in a reciprocal relationship whereby each can serve as an antecedent to the other. Sometimes described as a "vicious cycle," relationship conflict and distress are often triggers for excessive drinking or drug use, which are used to relieve tension and stress. The substance use can, and often does, become a source of conflict in its own right, which serves as a trigger for more drinking and drug use, and so forth.

Importantly, the effect of substance use on the relationship is not always negative, particularly in the short-term. Intoxication often provides adaptive consequences for the couple, such as facilitating expressions of affection (e.g., caretaking when a partner is suffering from a hangover). Such consequences can inadvertently reinforce substance use.

BCT treatment methods

Assessment in BCT focuses on three main areas: a) the severity of substance use of each partner; b) the antecedents to, and consequences of, substance use that maintain continued use or precipitate relapses, particularly those involving partner interaction; and c) relationship strengths and weaknesses. …

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