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While parental substance use disorder (SUD) has been recognized as a risk factor for child outcomes, past research seldom focused specifically on children whose mothers suffer from alcohol and drug use disorders. Are these children at risk for elevated psychosocial problems, and would such risk be reduced if maternal substance use was reduced? Children of substance-abusing mothers (COSAM, N = 130) were compared to a demographically matched comparison sample, and examined soon after their mothers entered SUD treatment and in the 18 months after treatment entry. We expected to observe elevated symptomatology among COSAM at baseline assessment, followed by a decreasing trend after maternal treatment in general, and remission in particular. Children's psychosocial problems were assessed through maternal reports on the Pediatric Symptom Checklist. Soon after their mothers entered SUD treatment, COSAM exhibited significantly greater overall and clinical-level psychosocial problems than the children from the matched comparison sample. However, at the end of the 18-months study period, these two groups no longer differed in terms of problems. Results from the longitudinal growth models revealed reductions in COSAM's overall and clinical-level problems following their mothers' SUD treatment. However, these reductions were similar for all COSAM, regardless of whether their mothers relapsed or remitted. Psychosocial problems were significantly reduced in COSAM following maternal SUD treatment, such that COSAM did not significantly differ from children from the matched comparison sample by the end of the 18-month study period.

Objective This naturalistic study (conducted from 1992 to 1998) of behavioral couples therapy (BCT) compared female and male alcohol use disorder (AUD) patients on improvement and on drinking and relationship outcomes after BCT. We also evaluated gender differences on presenting clinical problems and extent of BCT participation. Method Participants were 103 female and 303 male AUD patients (98.5% alcohol dependence, 1.5% alcohol abuse) and their heterosexual partners, mostly White in their forties. Couples received 20–22 BCT sessions over 5–6 months. Drinking outcomes were percentage days abstinent (PDA) and alcohol-related problems. Relationship outcome was Dyadic Adjustment Scale. Outcome data were examined at baseline, post-treatment, and 6- and 12-month follow-up. Presenting problems were demographics, alcohol problem severity, illicit drug use, emotional distress, and relationship adjustment. BCT participation was BCT attendance and BCT-targeted behaviors. Results We found few differences between female and male patients, who did not differ on improvement and outcomes after BCT. Both females and males showed significant large effect size improvements through 12-month follow-up on PDA and alcohol-related problems, and significant small to medium effect size improvements on relationship adjustment. Both females and males had high levels of BCT participation. Gender differences in presenting clinical problems (females being lower on age, years problem drinking, and baseline PDA, and higher on emotional distress) did not translate into gender differences in response to BCT. Conclusion Results showed no support for the suggestion that BCT might lead to greater improvement and better outcomes for female than male AUD patients on drinking or on relationship outcomes.

Substance-dependent patients (N=29) living with a family member other than a spouse were randomly assigned to equally intensive treatments consisting of either (a) Behavioral Family Counseling (BFC) plus Individual-Based Treatment (IBT) or (b) IBT alone. Outcome data were collected at baseline, post-treatment, and at 3- and 6-month follow-up. BFC patients remained in treatment significantly longer than IBT patients. BFC patients improved significantly from baseline at all time periods on all outcomes studied, and had a medium effect size reflecting better primary outcomes of increased abstinence and reduced substance use than IBT patients. For secondary outcomes of reduced negative consequences and improved relationship adjustment, both BFC and IBT patients improved significantly and to an equivalent extent. The present results show BFC is a promising method for retaining patients in treatment, increasing abstinence, and reducing substance use. These results also provide support for larger scale, randomized trials examining the efficacy of behavioral family counseling for patients living with family members beyond spouses.

Two earlier studies showed that a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification increased aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member with whom the patient lived to review aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Based on the earlier research results, we trained a newly hired staff person to continue providing BFT. We monitored key process benchmarks derived from the earlier research studies to ensure ongoing fidelity in delivering BFT. This method proved successful in transferring BFT from delivery in a research study to ongoing delivery in routine clinical practice after the research ended. It also ensured that a high proportion of patients had their families contacted and included in planning the patients' aftercare.

This study examined two sources of concurrent validity information for a brief Drug Use Frequency (DUF) measure--the well-validated Timeline Followback (TLFB) measure and knowledgeable collateral informants (i.e., spouses)--for 106 male alcoholic patients and their female partners (treatment sample couples) and for 130 male and female participants without current alcohol/drug problems (community sample couples). Results showed generally good concurrent validity of self-reported frequency of illicit drug use on the DUF. Treatment sample results showed high correlations (a) between patient self-reported frequency of drug use on the DUF and on the TLFB for all drug types and (b) between self- and collateral reports on the DUF for male patients and their female partners for the most commonly abused drugs (cannabis, cocaine, and heroin). Community sample results showed (a) high correlations between self- and collateral reports on the DUF for male and female participants for frequency of cannabis and cocaine use and (b) average percent agreement of 99% for all drug types on whether or not male and female participants had used each drug.

Married male alcoholics (N = 36), who had recently begun individual outpatient alcoholism counseling, were randomly assigned to a no-marital-treatment control group or to 10 weekly sessions of either a behavioral marital therapy (BMT) or an interactional couples therapy group. Impotence decreased from before to after counseling irrespective of whether the alcoholic patients received additional marital therapy. Husbands who received BMT reported increased frequency of wives' orgasm during intercourse and greater increases in satisfaction with the privacy and context of their sexual activities than did couples in the other two treatment groups. These findings support a biopsychosocial formulation of alcoholics' sexual problems that implicates the physical effects of acute and chronic alcohol intake as most relevant to the elevated rates of impotence and marital conflict as a major contributing factor to most sexual problems of alcoholics. The improvement observed in sexual adjustment was rather limited. Despite the improvements in impotence, the alcoholics still experienced over twice the rate of impotence reported by demographically similar nonalcoholics. In terms of sexual satisfaction, BMT produced only modest gains as viewed by husbands and no gains from the wives' perspective. Perhaps sexual adjustment is one of the last areas of the alcoholic's marriage to improve after treatment. The limited time frame of the present study may have precluded observing further improvements in sexual adjustment that would emerge later after a longer period of recovery.

The major purpose of this study was to provide descriptive data on the first relapse episodes and reasons for terminating relapses of subjects who completed a course of behavioral marital therapy (BMT) for alcoholism. Another aim of the study was to compare the relapse episodes and relapse terminations of subjects who received BMT with or without additional relapse prevention (RP) treatment for one year. The subjects were selected from a sample of 74 men who began an outpatient Department of Veterans Affairs BMT program. These men were evaluated pre- and post-BMT, and at 3, 6, 9, and 12 months after completing BMT. A total of 31 subjects relapsed at least once after they began BMT. The data showed that these men tended to report more than one situational or personal precipitant of their first relapses. Similarly, they tended to report more than one reason for ending their relapse episodes. Comparison of the subjects assigned to the two RP conditions revealed an equal number (12) of relapse episodes, but RP subjects' relapses tended to last fewer days than did no-RP subjects'. The consistency of these findings with previous research on cognitive-behavioral models of relapse and the implications of these findings for the concept of high-risk situation, are discussed.

This study examined parenting satisfaction among a clinical sample of 88 men with alcoholism at baseline and 6-month and 12-month follow-up. Findings indicated no overall improvements in parenting satisfaction from the outset of treatment across assessments. Alcohol consumption variables were associated with parenting satisfaction at the bivariate level, and changes in alcohol consumption from pre to post treatment emerged as a significant predictor of changes in parenting satisfaction over the course of the study. Greater decreases in alcohol consumption were associated with greater improvement in parenting satisfaction.

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Results indicated that male substance abusing patients who received BFT ( N = 14), as compared with a matched treatment as usual (TAU) comparison group ( N = 14) that did not, showed a trend toward being more likely to enter an aftercare program and to attend more days of aftercare in the 3 months after detoxification. The magnitude of these differences favoring BFT over TAU was midway between a medium and a large effect size. Days using alcohol or drugs in the 3 months after detox were lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (trend, medium effect), and for patients who entered aftercare regardless of treatment condition (significant large effect).

Outcomes after behavioral couples therapy (BCT) were compared for 19 dually diagnosed veterans with combat-related PTSD and a substance use disorder (SUD, primarily alcohol dependence) and 19 veterans with SUD only. Clients with and without comorbid PTSD had very similar pre-treatment clinical profiles on dimensions of substance misuse, relationship functioning, and psychological symptoms. Further, both PTSD and non-PTSD clients showed good compliance with BCT, attending a high number of BCT sessions, taking Antabuse, and going to AA. Finally, both PTSD and non-PTSD groups improved from before BCT to immediately after and 12 months after BCT. Specific improvements noted were increased relationship satisfaction and reductions in drinking, negative consequences of drinking, male-to-female violence, and psychological distress symptoms. Extent and pattern of improvement over time were similar whether the client had PTSD or not. The present results suggest that BCT may have promise in treating clients with comorbid SUD and combat-related PTSD.

The present study used objective indices of academic performance to test the hypothesis that children of alcoholic fathers (COA's) have poorer school adjustment than children of nonalcoholic parents (non-COA's). Subjects were 39 children of male alcoholics treated for alcoholism in a VA program and 33 control children whose nonalcoholic parents (matched on demographic indices) reported low marital conflict. The results showed that daughters of alcoholics, but not the sons, showed more variability than controls in their school attendance. There was suggestive evidence that they also missed more school days than controls, with a reversed pattern for the sons of alcoholics. Generally, however, the COA group was not compromised academically and did not show more conduct problems compared to controls. Within the COA group, long-term paternal drinking adjustment (years of problem drinking and total number of hospitalizations for drinking) appeared to be related to poorer GPA, while short-term adjustment (alcohol-related days in jail and number of days drinking in year previous to treatment) were more related to poorer attendance. The results are discussed in terms of the mechanism of the effect of paternal drinking on children's school adjustment and the difficulty in making generalizations about the consequences of being the child of an alcoholic.

This study employed naloxone, an opiate antagonist, to explore whether a learned opioid response, mediated by drinking experience, accounts for ethanol and placebo analgesia. Cold pressor pain was evaluated before and after ethanol (0.5 g/kg), placebo, and no-alcohol control treatments (administered in randomized order) and again after double-blind administration (6 mg/kg) of naloxone to 11 men and saline to 9. A triple interaction of treatments, antagonist conditions, and drinking experience indicated that naloxone as compared to saline diminished ethanol and placebo analgesia among experienced drinkers but had opposite effects among the same men in the control treatment. Six men, who reported that the injection of naloxone had an effect on pain, had higher drinking experience scores than the five men who reported naloxone had no effect. The similar pattern of response to both the alcohol and the placebo treatments suggests that the opioid system response to alcohol is learned.

Although numerous studies have investigated the relapse attributions of alcoholics, few have considered the biases inherent in such attributions. Two sources of bias were investigated in the relapse attributions of 26 alcoholic men and their wives: the passage of time and actor-observer perspective. As predicted: (a) Wives made more dispositional attributions than their husbands (an actor-observer difference); (b) the attributions of the husbands showed a dispositional shift over time, while their wives' attributions showed no temporal effects; and (c) attributional concordance within couples increased over time. Several explanations for these results were considered and implications for couples therapy with recovering alcoholics and their spouses were discussed.

A survey was conducted to assess the extent of alcohol abuse, drug abuse, obesity, and smoking among patients hospitalized on other than substance abuse treatment wards of a large psychiatric hospital. The results revealed extensive addictive behavior problems in the sample with nearly 90% of the patients having at least one of the problems. Prevalence rates for smoking and alcohol abuse substantially exceeded, and for obesity was equivalent to, the prevalence of these behaviors in the general population. Drug abuse was the least frequent problem and comparisons to the general population could not be made. Another major finding was that a relatively small proportion of patients was receiving any treatment for their addictive problems that was likely to be effective. For the most part, it seemed that patients receiving treatment were cases in which the addictive problem caused a serious immediate danger to the patient or others on the ward or seriously disrupted the ward routine.