Behavioral Couples Therapy When Both Partners Have a Current Alcohol Use Disorder

Abstract

Although behavioral couples therapy (BCT) has considerable support in treating alcohol use disorder (AUD), studies have not examined BCT for dual-problem couples in which both partners have current AUD. This study compared outcomes after BCT for dual-problem couples (n = 20) with outcomes for single-problem couples in which only one partner had AUD (n = 386). Results showed that dual-problem and single-problem couples did not differ significantly on degree of improvement in abstinence following BCT. A case example illustrates the application of BCT when both partners have a current AUD.

KEYWORDS:

• Alcoholism
• couples therapy
• treatment outcomes

Notes

This research was supported by grants to the second author from the National Institute on Alcohol Abuse and Alcoholism (grants AA08637, AA10356, K02AA0234) and by the Department of Veterans Affairs. Support in preparing this manuscript was also provided by grant CDA-2-019-09S awarded to the first author by the Department of Veterans Affairs. Portions of this article were presented at the Annual Meeting of the Association for the Advancement of Behavioral and Cognitive Therapies, Chicago, November 2006; and at the Annual Convention of the American Psychological Association, Boston, August 2008.

¹All 386 single-problem couples were judged, by the master's-level clinicians who conducted the study intake interviews, not to have a partner with a current clinically significant alcohol or drug problem. These judgments were made on a clinical basis during the intake interview without reliance on the Structured Clinical Interview for DSM-III-R (SCID). However, SCID results completed after the intake interview as part of the baseline research assessment showed that the partner in 18 of these 386 couples did have a current (past 6 months) abuse or dependence on alcohol or another drug. These 18 partners had mild severity alcohol and drug problems as defined by DSM-III-R—i.e., they had few, if any, symptoms in excess of those required to make the diagnosis. In addition, these partners for the most part had already stopped or substantially reduced problem drinking or other drug use for 2 to 3 months when the couple completed the intake interview for the BCT program, and they intended to maintain these changes. Further, follow-up data showed that most of these 18 partners did maintain low or no use through 6- and 12-month follow-up. Therefore, given our goal to test BCT with clinically challenging dual-problem couples, we decided to treat these 18 couples in BCT as single-problem couples focusing only on the substance use of the patient identified in the screening interview and to include them in the single couple group in the analyses reported in this article.

†p = .079,

*p < .05,

**p < .01,

***p < .001.

²This case example is a composite case with individual identities disguised to protect the privacy and anonymity of the couple. This case example draws very heavily from page 200 to 202 of the book Behavioral Couples Therapy for Alcoholism and Drug Abuse by T. J. O'Farrell and W. Fals-Stewart, copyright 2006 by Guilford Press. This material from O'Farrell and Fals-Stewart (2006) is used with permission of The Guilford Press.