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Behavioral couples therapy (BCT) for substance use disorder shares similar intervention strategies with empirically supported couples therapies for posttraumatic stress disorder (PTSD). Like couples-based PTSD therapies, BCT includes interventions that may help to improve PTSD, such as increasing positive behavioral exchanges and improving communication. Studies have yet to examine whether BCT, which has demonstrated efficacy for improving substance-related outcomes, is efficacious for reducing PTSD. We conducted a secondary analysis of a randomized clinical trial comparing individually based treatment (IBT) to BCT plus IBT (BCT+IBT) for women with drug use disorders. Women in both conditions received 26 therapy sessions over 13 weeks. Women completed the PTSD Diagnostic Scale at baseline, posttreatment, and quarterly during the 1-year follow-up. Of the 61 women who were randomized to treatment, 51 (83.6%) reported a lifetime traumatic event. Of the 50 women who endorsed a "worst traumatic event," 25 (50.0%) had a baseline PTSD diagnosis. The treatments did not differ on baseline PTSD severity or diagnosis. Women who received BCT+IBT had significant reductions in PTSD severity from baseline to each of four posttreatment follow-ups, ds = 0.34-0.80; there were no changes in the IBT group. Generalized estimating equation results showed that women who received BCT+IBT had significantly lower PTSD severity during follow-up versus those who received IBT, d = 0.35. There were no differences in the proportion of participants diagnosed with PTSD following treatment. This was the first study to show that BCT+IBT is efficacious for reducing PTSD among women with drug use disorders.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Eficacia de la Terapia conductual de pareja frente a la Consejería de recuperación individual para tratar el TEPT entre las mujeres con Trastornos de Uso de Drogas. ABUSO DE DROGAS EN MUJERES Y TEPT La terapia conductual de pareja (TCP) para el trastorno por consumo de sustancias comparte estrategias de intervención con apoyo empírico similares a la terapia de pareja para el trastorno de estrés postraumático (TEPT). Al igual que las terapias de pareja basadas en TEPT, la TCP incluye intervenciones que pueden ayudar a mejorar el TEPT, como el aumento de los intercambios conductuales positivos y la mejora de la comunicación. Los estudios aún no han examinado si la TCP, la cual ha demostrado ser eficaz para mejorar los resultados relacionados con sustancias, es eficaz para reducir el TEPT. Se realizó un análisis secundario de un ensayo clínico aleatorio que comparó el tratamiento individualizado (TI) con la TCP más la TI (TI+ TCP) para las mujeres con trastornos por el consumo de drogas. Las mujeres en ambas condiciones recibieron 26 sesiones de terapia durante 13 semanas. Las mujeres completaron la Escala de Diagnóstico del TEPT al inicio, después del tratamiento y trimestralmente durante el seguimiento de un año. De las 61 mujeres que fueron asignadas al azar al tratamiento, 51 (83.6%) reportaron un evento traumático en la vida. De las 50 mujeres que señalaron un “peor evento traumático”, 25 (50.0%) tuvieron un diagnóstico inicial de TEPT. Los tratamientos no difirieron según la gravedad o el diagnóstico inicial del TEPT. Las mujeres que recibieron TCP +TI tuvieron reducciones significativas en la gravedad del TEPT desde el inicio hasta cada uno de los cuatro seguimientos posteriores al tratamiento, ds = 0.34 - 0.80; no hubo cambios en el grupo de TI. Los resultados de la ecuación de estimación generalizada mostraron que las mujeres que recibieron TCP+TI tuvieron una gravedad de TEPT significativamente menor durante el seguimiento en comparación con las que recibieron TI, d = 0.35. No hubo diferencias en la proporción de participantes diagnosticados con TEPT después del tratamiento. Este fue el primer estudio en mostrar que la TCP +TI es eficaz para reducir el TEPT entre las mujeres con trastornos por el uso de drogas.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Efficacy of Behavioral Couples Therapy versus Individual Recovery Counseling for Addressing PTSD among Women with Drug Use Disorders Traditional Chinese 標題: 比較行為取向的伴侶治療與個人復康輔導在改善濫用藥物女性的PTSD方面的功效 撮要: 為治療濫用藥物提供的行為取向的伴侶治療(BCT), 跟具實證支持用以治療創傷後壓力症(PTSD)的伴侶治療有相似的干預策略。與PTSD的伴侶治療一樣, BCT包含可改善PTSD的干預, 例如提升正向的行為交流和改善溝通。BCT已顯示能有效改善濫用藥物相關的症狀。然而, 目前仍未有研究檢視其是否能有效改善PTSD。我們對一隨機臨床試驗進行次級資料分析, 比較濫用藥物的女性樣本只接受個人治療(IBT), 與共同接受BCT和IBT(BCT+IBT)的效果。兩組的女性樣本都於13週內接受了26個治療節段, 並於基線、完成療程後、及完成療程後的一年跟進期內每3個月接受PTSD診斷量表測量。在61名接受隨機分派治療組別的樣本中, 51人(83.6%)經歷過一次生命創傷事件。50名經歷過「最壞的創傷事件」的樣本中, 25人(50.0%)在基線被診斷出患PTSD。治療效果並無因基線PTSD嚴重度或診斷而生異。接受BCT+IBT的樣本, 其PTSD嚴重度從基線到完成療程後每3個月的跟進都有顯著改善(ds = 0.34-0.80), 而接受IBT的樣本則沒變。廣義估計方程式結果顯示, 接受BCT+IBT的女性樣本, 相比只接受IBT的樣本, 其PTSD嚴重度於跟進期有顯著改善(d = 0.35)。治療後有PTSD的樣本比例沒變。這是首個研究證實BCT+IBT能有效改善濫用藥物女性的PTSD。 Simplified Chinese 标题: 比较行为取向的伴侣治疗与个人复康辅导在改善滥用药物女性的PTSD方面的功效 撮要: 为治疗滥用药物提供的行为取向的伴侣治疗(BCT), 跟具实证支持用以治疗创伤后压力症(PTSD)的伴侣治疗有相似的干预策略。与PTSD的伴侣治疗一样, BCT包含可改善PTSD的干预, 例如提升正向的行为交流和改善沟通。BCT已显示能有效改善滥用药物相关的症状。然而, 目前仍未有研究检视其是否能有效改善PTSD。我们对一随机临床试验进行次级数据分析, 比较滥用药物的女性样本只接受个人治疗(IBT), 与共同接受BCT和IBT(BCT+IBT)的效果。两组的女性样本都于13周内接受了26个治疗节段, 并于基线、完成疗程后、及完成疗程后的一年跟进期内每3个月接受PTSD诊断量表测量。在61名接受随机分派治疗组别的样本中, 51人(83.6%)经历过一次生命创伤事件。50名经历过「最坏的创伤事件」的样本中, 25人(50.0%)在基线被诊断出患PTSD。治疗效果并无因基线PTSD严重度或诊断而生异。接受BCT+IBT的样本, 其PTSD严重度从基线到完成疗程后每3个月的跟进都有显著改善(ds = 0.34-0.80), 而接受IBT的样本则没变。广义估计方程式结果显示, 接受BCT+IBT的女性样本, 相比只接受IBT的样本, 其PTSD严重度于跟进期有显著改善(d = 0.35)。治疗后有PTSD的样本比例没变。这是首个研究证实BCT+IBT能有效改善滥用药物女性的PTSD。.

Historically, the prevailing wisdom in treating substance abuse was that it was a personal problem, best treated on an individual basis. However, the near myopic focus on individual-based treatment has slowly given way to a greater acknowledgment of the family’s role in the development and maintenance of drug and alcohol misuse problems. Over the past four decades, the results of numerous studies have concluded that partner- and family-involved treatments produce better outcomes across several domains of functioning (e.g., reduced substance use, improved marital and family functioning) compared to individual-based interventions. The purpose of this chapter is to (a) discuss the impact of substance abuse on the family; (b) present the models, techniques, and principles of couples and family therapy that have been used with substance-abusing clients, their partners, and extended family members; (c) discuss the potential barriers to implementing partner- and family-involved approaches for substance use; and (d) explore future directions with respect to partner- and family-involved therapies for substance-abusing clients.

OBJECTIVE: The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners—group behavioral couples’ therapy plus individual-based treatment (G-BCT), or standard behavioral couples’ therapy plus individual-based treatment (S-BCT). METHOD: We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS: The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS: As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples’therapy.

Behavioral couples therapy (BCT) is more efficacious than individually-based therapy (IBT) for substance and relationship outcomes among substance use disorder patients. This study compared BCT with IBT for drug-abusing women.Sixty-one women, mostly White, late 30s, with primary substance use disorder other than alcohol (74% opioid), and male partners were randomized to 26 sessions over 13 weeks of BCT plus 12-step-oriented IBT (i.e., BCT + IBT) or IBT. Substance-related outcomes were percentage days abstinent (PDA), percentage days drug use (PDDU), Inventory of Drug Use Consequences. Relationship outcomes were Dyadic Adjustment Scale (DAS), days separated. Data were collected at baseline, posttreatment, and quarterly for 1-year follow-up.On PDA, PDDU, and substance-related problems, both BCT + IBT and IBT patients showed significant (p.01) large effect size improvements throughout 1-year follow-up (d.8 for most time periods). BCT + IBT showed a significant (p.001) large effect size (d = -.85) advantage versus IBT on fewer substance-related problems, while BCT + IBT and IBT did not differ on PDA or PDDU (ps.47). On relationship outcomes, compared to IBT, BCT + IBT had significantly higher male-reported Dyadic Adjustment Scale (p.001, d = .57) and fewer days separated (p = .01, d = -.47) throughout 1-year follow-up.BCT + IBT for drug-abusing women was more efficacious than IBT in improving relationship satisfaction and preventing relationship breakup. On substance use and substance-related problems, women receiving both treatments substantially improved, and women receiving BCT + IBT had fewer substance-related problems than IBT. (PsycINFO Database Record

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.

Intimate partners consuming different amounts of alcohol tend to have lower relationship satisfaction, whereas those drinking at similar levels often report happier unions. It is presently unclear how dyadic alcohol use patterns impact relationship satisfaction for couples wherein one member has an alcohol use disorder. We examined this using longitudinal data from an alcoholic treatment sample ( N = 181) and further explored whether conflict pursuant to differential use played a mediating role. Partners similar in their baseline frequency of alcohol intoxication reported higher initial satisfaction but experienced significant declines in satisfaction longitudinally. Highly differential alcohol use was associated with lower satisfaction for both partners at baseline, which was mediated by conflict specific to men’s alcohol use. Notably, baseline relationship variables also predicted subsequent changes in alcohol use. These findings overall support a dyadic understanding of alcoholism and highlight that drinking patterns may link to long-term relationship outcomes differently for alcoholics.

Objective Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among patients with alcohol use disorder. To facilitate dissemination, a multicouple, rolling admission Group BCT (G-BCT) format has been suggested as an alternative to the 1 couple at a time, conjoint Standard BCT (S-BCT) format. This randomized study compared outcomes of G-BCT versus S-BCT over a 1-year follow-up. The authors predicted that G-BCT, as compared to S-BCT, would have equivalent (i.e., noninferior) improvements on substance and relationship outcomes. Method Participants were patients (N = 101) with alcohol dependence and their heterosexual relationship partners without substance use disorder. Participants were mostly White, in their 40s, and 30% of patients were women. Patients were randomized to either G-BCT plus 12-step-oriented IBT or S-BCT plus IBT. Primary outcomes included Timeline Followback Interview percentage days abstinent and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcome was Dyadic Adjustment Scale. Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. Results Results overall found no support for the predicted statistical equivalency of G-BCT and S-BCT. Rather than the predicted equivalent outcomes, substance and relationship outcomes were significantly worse for G-BCT than S-BCT in the last 6-9 months of the 12-month follow-up period, because G-BCT deteriorated and S-BCT maintained gains during follow-up. Conclusion This was the first study of the newer rolling admission group format for BCT. It proved to have worse not equivalent outcomes compared to standard conjoint BCT. (PsycINFO Database Record

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.

Introduction Studies have found reductions in female-to-male (F-to-M) and male-to-female (M-to-F) intimate partner violence (IPV) following alcohol-related treatment. Despite high prevalence of IPV among drug-abusing women, there are no controlled studies examining IPV following drug-related treatment for women. This is a secondary analysis of a randomized clinical trial comparing behavioral couples therapy plus individually-based treatment (BCT + IBT) versus individually-based treatment (IBT) for drug-abusing women and their male partners (N = 61; see O'Farrell, Schumm, Murphy, & Muchowski, 2017). We hypothesized that both treatments would have reductions in F-to-M and M-to-F IPV, but reductions would be greater in BCT + IBT. Material and methods Women were mostly White, and all exhibited drug use disorders (74% opioid use disorder). Forty-five percent had a male partner with a current substance problem. The Revised Conflict Tactics Scales (CTS2) were administered at baseline and 12-months after treatment (85% follow-up rate). Results Psychological aggression frequency and F-to-M physical assault declined in both treatments. M-to-F physical assault, M-to-F sexual coercion, and female and male injury declined in IBT. However, these outcomes did not change in BCT + IBT. Thus, results showed that IBT, but not BCT + IBT, reduced M-to-F physical assault and M-to-F sexual coercion. Contrary to our hypothesis, IBT was lower than BCT + IBT on F-to-M and M-to-F physical assault, M-to-F sexual coercion, and female injury. M-to-F physical assault frequency was lower at follow-up if the male partner had versus did not have a current substance problem. Conclusions BCT + IBT and IBT are viable interventions for reducing both partners' psychological aggression and F-to-M physical assault frequency among drug-abusing women and their male partners. IBT is promising for reducing M-to-F physical assault and female physical injury. There appears to be greater risk of M-to-F physical assault when the female but not male partner is substance-abusing.

We studied 13 U.S. male military veterans and their female partners who consented to participate in an uncontrolled trial of couple treatment for alcohol use disorder and posttraumatic stress disorder (CTAP). CTAP is a 15-session, manualized therapy, integrating behavioral couples therapy for alcohol use disorder (AUD) with cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Due to ineligibility (n = 1) and attrition (n = 3), 9 couples completed the study, and 7 completed 12 or more sessions. There were 8 veterans who showed clinically reliable pre- to posttreatment reduction of PTSD outcomes. There were also significant group-level reductions in clinician-, veteran-, and partner-rated PTSD symptoms (d = 0.94 to 1.71). Most veterans showed clinically reliable reductions in percentage days of heavy drinking. Group-level reduction in veterans' percentage days of heavy drinking was significant (d = 1.01). There were 4 veterans and 3 partners with clinically reliable reductions in depression, and group-level change was significant for veterans (d = 0.93) and partners (d = 1.06). On relationship satisfaction, 3 veterans and 4 partners had reliable improvements, and 2 veterans and 1 partner had reliable deterioration. Group-level findings were nonsignificant for veteran relationship satisfaction (d = 0.26) and for partners (d = 0.52). These findings indicate that CTAP may be a promising intervention for individuals with comorbid PTSD and AUD who have relationship partners.

Objective: There is a paucity of research on the temporal association between substance use and intimate partner violence (IPV) perpetration and victimization, especially among women arrested for domestic violence. The current study examined whether the probability of IPV perpetration and victimization increases following alcohol or drug use relative to days of no use among women arrested for domestic violence. Method: Women arrested for domestic violence and court referred to batterer intervention programs who met criteria for hazardous drinking participated in the current study (N = 105). Women who reported drinking 4 or more drinks on 1 occasion at least once per month for the past 6 months were considered hazardous drinkers. Violence and substance use were assessed with the Timeline Followback Interviews for substance use and IPV. Results: Women were more likely to perpetrate physical violence on a drinking day (OR = 10.58; 95% CI [5.38, 20.79]) and on a heavy drinking day (OR = 12.81; 95% CI [8.10, 33.57]), relative to a nondrinking day. Women were more likely to be victimized by physical violence on a drinking day (OR = 5.22; 95% CI [2.79, 9.77]) and on a heavy drinking day (OR = 6.16; 95% CI [3.25, 11.68]), relative to a nondrinking day. They were more likely to be victims of sexual coercion (OR = 6.06; 95% CI [1.19, 30.80]) on a cocaine use day relative to a nonuse day. Conclusions: Alcohol use was temporally associated with physical violence perpetration and victimization, and cocaine use was temporally associated with sexual coercion victimization, suggesting that substance use should be targeted in batterer intervention programs for women. (PsycINFO Database Record (c) 2013 APA, all rights reserved). Language: en

Historically, alcohol and other substance use disorders were viewed as individual-based problems that were most effectively treated by focusing on the diagnosed individual. However, in response to numerous clinical trials demonstrating the efficacy (and often superiority) of couple and family treatments for alcoholism and drug abuse, this emphasis on treating the individual has slowly given way to a greater awareness of family members' crucial roles in the etiology, maintenance, and long-term course of substance use and addictive behavior. As a result, clinicians are increasingly interested in understanding substance misuse from a systemic perspective and exploring how partner- and family-involved interventions may be used to address individuals' substance abuse.

AIMS: The efficacy of batterer intervention programs to reduce intimate partner violence (IPV) is questionable with individuals with alcohol problems particularly unlikely to benefit. We examined whether adding adjunctive alcohol intervention to batterer intervention reduced the likelihood of substance use and violence relative to batterer intervention alone. DESIGN: Randomized clinical trial. SETTING: Batterer intervention programs in Rhode Island, USA. PARTICIPANTS: 252 hazardous drinking men in batterer intervention programs. Participants were randomized to receive 40 hours of standard batterer program (SBP), or the SBP plus a 90-minute alcohol intervention (SBP+BAI). None withdrew due to adverse effects. Data were collected at baseline, 3-, 6-, and 12-month follow-up, with follow-up rates of 95%, 89%, and 82%, respectively. MEASUREMENTS: Substance use was measured with a well-validated calendar-assisted interview. Violence was measured with a validated questionnaire. Arrest records were obtained for all participants. The primary substance use outcome was drinks per drinking day (DPDD) and the primary violence outcome was frequency of any physical IPV. FINDINGS: Relative to SBP alone, men receiving SBP+BAI reported consuming fewer DPDD at 3-month follow-up (B=-1.36,95%CI=-2.65,-.04,p=.04) but not 6-month or 12-month follow-up. In secondary analyses, men receiving SBP+BAI reported significantly greater abstinence at 3- (B=.09,95%CI=.03,.14,p=.002) and 6-month (B=.06,95%CI=.01,.11,p=.01) follow-up but not 12-month follow-up. There were no significant differences in physical IPV between men receiving SBP and men receiving SBP+BAI. In secondary analyses, men receiving SBP+BAI reported less severe physical aggression at 3-month (IRR=.18,95%CI=.05,.65, p=.009) but not 6-month or 12-month follow-up. Men receiving SBP+BAI reported less severe psychological aggression (B=-1.24,95%CI=-2.47,-.02,p=.04) and fewer injuries to partners at 3- and 6-month follow-up (IRR=.33,95%CI=.12,.92,p=.03), with differences fading by 12 months. Conclusions: Men with a history of intimate partner violence and hazardous drinking who received a batterer intervention plus an alcohol intervention showed improved alcohol and violence outcomes initially, but improvements faded by 12 months. Language: en

Illicit substance use (ISU) predicts intimate partner violence (IPV) above and beyond alcohol use and other known IPV correlates. Stuart and colleagues (2008) provided evidence for a theoretical framework by which ISU contributes both directly and indirectly to IPV. We sought to replicate and extend their findings using data from 181 married or cohabiting heterosexual couples in which the male had recently begun a substance abuse treatment program and met criteria for alcohol dependence (97%) or abuse (3%). Using SEM, we found that (a) Stuart et al.’s model provided a good fit to the data; (b) men’s cocaine use and women’s sedative use emerged as particularly relevant to their respective perpetration of IPV; (c) a positive association between men’s antisociality and physical aggression was mediated by increased stimulant use; and (d) the specific pattern of IPV predicted by women’s sedative use differed across levels of aggression severity. These findings not only highlight the direct role of ISU in relationship aggression, but also support a larger theory-driven model comprising various proximal and distal precursors of IPV.

Despite extensive intimate partner violence (IPV) among women in substance use disorder treatment, few studies have investigated IPV risk factors within this population. Conceptual models, which have received support in other populations, propose that antisociality and generalized violence, alcohol and drug use, and relationship adjustment may be interrelated pathways that influence IPV. The purpose of this study was to test a conceptual model that integrates these individual and relationship pathways to explain IPV among women entering substance use disorder treatment.Women entering substance use disorder treatment (N = 277) who had a male relationship partner completed measures of the following domains about themselves and their male partners: antisociality/generalized violence, heavy alcohol use, drug use, relationship adjustment, and psychological and physical IPV.Structural equation modeling analyses showed that the antisociality/generalized violence of each partner had direct and indirect effects on IPV. Each partner's antisociality/generalized violence was directly related to her or his physical IPV. Female antisociality/ generalized violence was indirectly related to female physical IPV via female drug use and female psychological IPV. Male antisociality/generalized violence was indirectly associated with male physical IPV via male drinking, relationship adjustment, and male psychological IPV. A reciprocal relationship was found between partners' psychological IPV but not physical IPV. When accounting for other individual and relational IPV predictors, male partners' physical IPV influenced women's physical IPV, but women's physical IPV did not influence their male partner's physical IPV.Both partners' antisociality/generalized violence, substance use, and overall relationship adjustment are important in understanding IPV among women entering substance use disorder treatment.

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates our earlier review (XXXXXXX). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better; and Community Reinforcement and Family Training (CRAFT) promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics; and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.

Behavioral Couples Therapy (BCT) is designed for married or cohabiting individuals seeking help for alcoholism or drug abuse. BCT sees the substance-abusing patient together with the spouse or live-in partner. Its purposes are to build support for abstinence and to improve relationship functioning. BCT promotes abstinence with a “recovery contract” that involves both members of the couple in a daily ritual to reward abstinence. BCT improves the relationship with techniques for increasing positive activities and improving communication. BCT also fits well with 12-step or other self-help groups, individual or group substance-abuse counseling, and recovery medications. Research shows that BCT produces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Thus, research evidence supports wider use of BCT. It is hoped that this article and new print and Web-based resources on h...

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.

Gay (N = 52) and lesbian (N = 48) alcohol use disorder (AUD) patients and their nonsubstance-abusing same-sex relationship partners were randomly assigned to equally intensive interventions consisting of: (a) behavioral couples therapy plus individual-based treatment (BCT); or (b) individual-based treatment only (IBT). This study reports two separate trials, one with gay male participants and one with lesbian female participants. For both gay and lesbian AUD patients, those who received BCT had a significantly lower percentage of days of heavy drinking during the year after treatment than patients who received IBT only. In addition, both gay and lesbian couples who received BCT reported higher levels of relationship adjustment at the end of treatment and in the year after treatment than those who received IBT only. Thus, the response of gay and lesbian couples with an alcoholic member to BCT was consistent with what has been observed with heterosexual couples.

This study examined whether female-to-male (FTM) psychological aggression predicted men’s relapse of substance use disorder (SUD) 6 months following substance use treatment. Men diagnosed with either a substance abuse or dependence disorder who had recently begun an SUD treatment program participated in the study with their female relationship partners (N = 173). Logistic regression was used to examine the relationship between baseline FTM psychological aggression and SUD relapse when controlling for baseline demographic, dyadic, substance abuse- and treatment-related variables, as well as frequencies of other male- and female-perpetrated aggressive dyadic behaviors. Higher frequencies of severe, but not minor, forms of FTM psychological aggression uniquely predicted an increased risk of relapse at 6 months follow-up. These data add to the developing research program highlighting the negative sequelae of female-perpetrated psychological aggression and also provide an empirical basis for targeting specific dyadic behaviors in the context of SUD treatment and relapse prevention.

We investigated longitudinal associations between alcohol-dependent fathers' 12-step treatment involvement and their children's internalizing and externalizing problems (N = 125, M(age) = 9.8 +/- 3.1), testing the hypotheses that fathers' greater treatment involvement would benefit later child behavior and that this effect would be mediated by fathers' posttreatment behaviors. The initial association was established between fathers' treatment involvement and children's externalizing problems only, whereas Structural Equation Modeling (SEM) results supported mediating hypotheses. Fathers' greater treatment involvement predicted children's lower externalizing problems 12 months later, and fathers' posttreatment behaviors mediated this association: Greater treatment involvement predicted greater posttreatment Alcoholics Anonymous attendance, which in turn predicted greater abstinence. Finally, fathers' abstinence was associated with lower externalizing problems in children. Theoretical and practical implications of these findings are discussed.

A substantial body of research supports a strong cross-sectional and longitudinal association between substance misuse and perpetration of intimate partner violence (IPV). This article briefly addresses the theoretical connection between substance use and intimate partner violence and research on the association between substance misuse and IPV. Studies examining the effect of individual and couples-based addiction treatments on IPV are reviewed. The implications of this work and future directions for research are discussed.

Although the prevention of intimate partner violence is a major public health priority for the United States, little is known about how to prevent this form of violence. The strong cross-sectional and longitudinal association between substance misuse and partner violence suggests that substance-misusing populations may be an ideal audience for implementing partner violence prevention programs. This approach is reviewed from the perspective of universal, selective, and indicated prevention programs.

SUMMARY Behavioral Couples Therapy (BCT) is designed for married or cohabiting individuals seeking help for alcohol or other drug abuse. BCT sees the drug abusing patient together with the spouse or live-in partner. Its purposes are to build support for abstinence and to improve relationship functioning. BCT promotes abstinence with a “recovery contract” that involves both members of the couple in a daily ritual to reward abstinence. BCT improves the relationship with techniques for increasing positive activities and improving communication. BCT also fits well with 12-step or other self-help groups, individual or group substance abuse counseling, and recovery medications.

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.

We studied 13 U.S. male military veterans and their female partners who consented to participate in an uncontrolled trial of couple treatment for alcohol use disorder and posttraumatic stress disorder (CTAP). CTAP is a 15-session, manualized therapy, integrating behavioral couples therapy for alcohol use disorder (AUD) with cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Due to ineligibility (n = 1) and attrition (n = 3), 9 couples completed the study, and 7 completed 12 or more sessions. There were 8 veterans who showed clinically reliable pre- to posttreatment reduction of PTSD outcomes. There were also significant group-level reductions in clinician-, veteran-, and partner-rated PTSD symptoms (d = 0.94 to 1.71). Most veterans showed clinically reliable reductions in percentage days of heavy drinking. Group-level reduction in veterans' percentage days of heavy drinking was significant (d = 1.01). There were 4 veterans and 3 partners with clinically reliable reductions in depression, and group-level change was significant for veterans (d = 0.93) and partners (d = 1.06). On relationship satisfaction, 3 veterans and 4 partners had reliable improvements, and 2 veterans and 1 partner had reliable deterioration. Group-level findings were nonsignificant for veteran relationship satisfaction (d = 0.26) and for partners (d = 0.52). These findings indicate that CTAP may be a promising intervention for individuals with comorbid PTSD and AUD who have relationship partners.

Behavioral couples therapy (BCT) has been found to improve long-term abstinence rates in alcohol- and substance-dependent populations but has not been tested for smoking cessation. This pilot study examined the feasibility and acceptability of BCT for smoking-discordant couples. Forty-nine smokers (smoking10 cigarettes/day) with nonsmoking partners were randomized to receive a couples social support (BCT-S) intervention or an individually delivered, standard smoking cessation treatment (ST). The couples were married or had been cohabiting for at least 1 year, with partners who had never smoked or had not used tobacco in 1 year. Both treatments included 7 weekly sessions and 8 weeks of nicotine replacement therapy. Participants were followed for 6 months posttreatment. The Partner Interaction Questionnaire was used to measure perceived smoking-specific partner support. Participants were 67% male and 88% White. Biochemically verified cessation rates were 40.9%, 50%, and 45% in BCT-S and 59.1%, 50%, and 55% in ST at end of treatment, after 3 month, and after 6 months, respectively, and did not differ significantly between treatment conditions at any time point. Perceived smoking-specific partner support at posttreatment did not significantly differ between treatment groups. Results of this pilot study do not provide support for the efficacy of BCT in smoking-discordant couples.

Psychosocial adjustment in children of alcoholi cs (COAs; N = 125) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment. Before their fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sam?le, but they improved significantly following their fathers' treatment. Children of stably remitted fathers were similar to their demographic counterparts from the comparison sample and had fewer adjustment problems than children of relapses fathers, even after accounting for children's baseline adjustment. Thus, COAs' adjustment improved wht n their fathers received treatment for alcoholism, and fathers' recovery from alcoholism was associated will clinically significant reductions in child problems.

In this study, the authors examined the correlates of psychological aggression victimization and perpetration among a community sample of 145 heterosexual couples. For both women and men, psychological aggression victimization was associated with greater psychological distress, anxiety, and physical health symptoms beyond the effects of physical aggression. Psychological aggression victimization was also uniquely associated with higher levels of depression for women. Trait anger and poor relationship adjustment were the strongest correlates of psychological aggression perpetration across genders. Childhood father-to-child and father-to-mother aggressions were associated with psychological aggression perpetration for men only, suggesting possible distinct etiologies across genders. These data highlight the importance of the further development of models for psychological aggression in both women and men.

The purpose of this study was to examine the clinical efficacy and cost effectiveness of brief relationship therapy (BRT), a shortened version of standard behavioral couples therapy (S-BCT), with alcoholic male patients (N = 100) and their nonsubstance-abusing female partners. Participants were randomly assigned to 1 of 4 treatment conditions: (a) BRT, (b) S-BCT, (c) individual-based treatment (IBT), or (d) psychoeducational attention control treatment (PACT). Equivalency testing revealed that, compared with those assigned to S-BCT, participants who were randomly assigned to BRT had equivalent posttreatment and 12-month follow-up heavy drinking outcomes. Moreover, at 12-month follow-up, heavy drinking and dyadic adjustment outcomes for patients who received BRT were superior to those of patients who received IBT or PACT. BRT was significantly more cost effective than the S-BCT, IBT, or PACT.

Among the various types of couple and family therapies used to treat substance abuse, Behavioral Couples Therapy (BCT) has the strongest empirical support for its effectiveness. During the last 3 decades, multiple studies have consistently found participation in BCT by married or cohabiting substance-abusing patients results in significant reductions in substance use, decreased problems related to substance use (e.g., job loss, hospitalization), and improved relationship satisfaction. Recently, investigations exploring other outcomes have found that, compared to traditional individual-based treatments, participation in BCT results in significantly (a) higher reductions in partner violence, (b) greater improvements in psychosocial functioning of children who live with parents who receive the intervention, and (c) better cost-benefit and cost-effectiveness. In addition to providing an overview of the theoretical underpinnings of BCT, methods used with this intervention, and the literature supporting its use, this article also examines the future directions of BCT research for substance abuse.

Alcoholic men and their relationship partners were interviewed about a conflict in which physical assault occurred and 1 in which psychological aggression occurred without physical assault. The interview assessed the quantity of alcohol consumed prior to each conflict, other drug use, and the topics, location, timing, duration, and speed of escalation for each conflict. The number of standard drinks consumed by the husband in the previous 12 hr was significantly higher prior to violent versus nonviolent conflicts for both self- and collateral reports, as was blood alcohol concentration estimated from self-report. Other drug use was not significantly different. Greater drinking by wives prior to violent conflicts was found in some analyses. These within-subject comparisons help to rule out individual difference explanations for the alcohol-violence association and indicate that alcohol consumption is a proximal risk factor for partner violence in alcoholic men.

Behavioral couples therapy (BCT), a treatment approach for married or cohabiting drug abusers and their partners, attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it. In multiple studies with diverse populations, patients who engage in BCT have consistently reported greater reductions in substance use than have patients who receive only individual counseling. Couples receiving BCT also have reported higher levels of relationship satisfaction and more improvements in other areas of relationship and family functioning, including intimate partner violence and children’s psychosocial adjustment. This review describes the use of BCT in the treatment of substance abuse, discusses the intervention’s theoretical rationale, and summarizes the supporting literature.

Substance use disorders affect not only the identified client but significant others as well. Clinical work and some research suggest that partner responses to drinking may either facilitate or hinder treatment acceptance and recovery efforts. Female partners of male alcoholics have received much of this attention, and have been labeled as codependents or enablers. We administered a clinically derived assessment tool, the Behavioral Enabling Scale, to 42 alcoholic clients and their partners enrolled in a couples counseling program to determine the extent of specific partner behaviors that might reasonably be thought to reinforce drinking or hinder recovery. Results indicated that, among other findings, the majority of both clients and partners reported the partner took over chores or duties from the alcoholic client at some point during the relationship, drank or used other drugs with the client, and lied or made excuses to others to cover for the drinker. Moreover, particular relationship beliefs were associated with higher behavioral enabling scores, providing clear direction for cognitive and behavioral interventions. It is argued that efforts to understand and treat alcohol dependence will be more productive if partner behaviors are incorporated into assessment and intervention procedures.

Men (N = 124) entering treatment for opioid dependence who were living with a family member were randomly assigned to one of two 24-week treatments: (a) behavioral family counseling (BFC) plus individual treatment (patients had both individual and family sessions and took naltrexone daily in presence of family member) or (b) individual-based treatment only (IBT; patients were given naltrexone and were asked in counseling sessions about their compliance, but there was no family involvement). BFC patients, compared with their IBT counterparts, ingested more doses of naltrexone, attended more scheduled treatment sessions, had more days abstinent from opioids and other drugs during treatment and during the year after treatment, and had fewer drug-related, legal, and family problems at 1-year follow-up.

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.

This article represents the proceedings of a symposium at the 2002 RSA meeting in San Francisco, California. The presentations were (1) Assessing couples' agreement about alcohol involvement in intimate partner violence, by John Schafer; (2) The occurrence of partner physical aggression on days of alcohol consumption: a longitudinal diary study, by Williams Fals-Stewart; (3) The 5-year stability of intimate partner violence and drinking among White, Black, and Hispanic couples, by Raul Caetano; (4) Partner violence before and after individually-based alcoholism treatment for male alcoholic patients, by Timothy O'Farrell. The discussant was Brenda Miller.

We reviewed 38 controlled studies of marital and family therapy (MFT) in alcoholism treatment. We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, (a) Al-Anon facilitation and referral help family members cope better; (b) Community Reinforcement and Family Training promotes treatment entry; and (c) the popular Johnson intervention apparently does not effectively promote treatment entry. Once the alcoholic enters treatment. MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. BCT also reduces social costs, domestic violence, and emotional problems of the couple's children. Future studies need to specifically evaluate: MFT with women and with minority patients, mechanisms and processes of change, and transportability of evidence-based MFT approaches to clinical practice settings.

This study described the extent of partner violence victimization and perpetration among married or cohabiting female alcoholic patients and the factors associated with it.Male-to-female and female-to-male physical partner violence were examined for 103 female alcoholic patients seeking couples-based outpatient alcoholism treatment. Partner violent (PV) and nonpartner violent (NPV) groups were compared on hypothesized risk factors.In the year before treatment, about two thirds of the women were victimized by their male partners, and a similar proportion engaged in violence toward their male partners. Severe violence also was high, with 22% victimization and 50% perpetration prevalence. Women committed more violent acts overall and were more likely to commit severely violent acts than the men in these couples. Risk factors for PV in both the victimization and perpetration models were as predicted: less education, lower income, greater relationship problems, stronger beliefs in the link between relationship problems and the female patient's drinking, greater cocaine use by the perpetrator of violence and greater emotional distress of the men. Greater alcohol and drug use and more severe alcohol problems also distinguished male perpetrators from their nonviolent counterparts in the female victimization model. Predictions that female patients in the PV group would report greater substance use and problems, childhood violence exposure and emotional distress than their female counterparts in the NPV group were not supported for either victimization or perpetration models.Partner violence is a serious problem for women in alcoholism treatment. More research is needed to increase understanding of risk factors and explanatory models for such violence.

Behavioral couples therapy (BCT) sees the substance-abusing patient with the spouse to arrange a daily "sobriety contract" in which the patient states his or her intent not to drink or use drugs, and the spouse expresses support for the patient's efforts to stay abstinent. For patients taking a recovery-related medication (eg, disulfiram, naltrexone), daily medication ingestion witnessed and verbally reinforced by the spouse also is part of the contract. Behavioral couples therapy also teaches communication and increases positive activities. Findings of the past few years have added considerably to the evidence base showing that BCT produces greater abstinence and better relationship functioning than typical individual-based treatment; BCT also reduces social costs and domestic violence. Noteworthy recent advances have extended the positive effects of BCT to women drug abusers, showed the indirect benefits of BCT for the couple's children, expanded BCT to include family members other than spouses, integrated BCT with pharmacotherapy, and started to address barriers to technology transfer.

Using data from a previous investigation (Fals-Stewart, Birchler, & O’Farrell, 1996), the purpose of the present study was to examine the effect of Behavioral Couples Therapy (BCT) on the prevalence of partner violence among married or cohabiting substance-abusing men (N = 80). Participants were randomly assigned to receive either BCT or individual-based treatment (IBT). The proportion of couples who engaged in male-to-female physical aggression was not different during the year before treatment for dyads in BCT (n = 17, 43%) and IBT (n = 19, 48%). However, a smaller proportion of couples in the BCT condition reported male-to-female physical aggression during the year after treatment (n = 7, 18%) than those in the IBT condition (n = 17, 43%). Dyadic adjustment, frequency of heavy drinking, and frequency of drug use during the year after treatment mediated the relationship between type of treatment and the prevalence of male-to-female physical aggression. D 2002 Elsevier Science Inc. All rights reserved.

Married or cohabiting female drug-abusing patients (N = 75) were randomly assigned to either a behavioral couples therapy condition (BCT; n = 37), which consisted of group, individual, and behavioral couples therapy sessions, or to an equally intensive individual-based treatment condition (IBT; n = 38), which consisted of group and individual counseling. During most of the 1-year follow-up, compared with participants who received IBT, those who received BCT reported (a) fewer days of substance use, (b) longer periods of continuous abstinence, (c) lower levels of alcohol, drug, and family problems, and (d) higher relationship satisfaction. However, differences in relationship satisfaction and number of days of substance use dissipated over the course of the posttreatment follow-up period and were not significantly different by the end of 1 year.

Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among men with alcohol use disorder (AUD). The present study compared BCT with IBT for women with AUD.Participants were women with AUD (N = 105) and their male partners without substance use disorder. Participants were mostly White and in their 40s. Women were randomized to equally intensive treatments consisting of either BCT plus 12-step-oriented IBT or IBT only. Primary outcomes included time line follow-back interview percentage days abstinent (PDA) and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcomes included the Dyadic Adjustment Scale (DAS), Relationship Happiness Scale (RHS), and Revised Conflict Tactics Scales measure of intimate partner violence (IPV). Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up.Compared with IBT only, BCT plus IBT had significantly better primary outcomes of higher PDA and fewer substance-related problems during the 1-year follow-up period. Compared with IBT only, BCT had significantly higher male RHS during the 1-year follow-up. Women with lower pretreatment DAS had significantly higher DAS following BCT versus IBT, and there was an increasing advantage for BCT on female DAS over the follow-up. IPV was significantly reduced from pretreatment to follow-up, with no differences between treatment conditions.RESULTS showed that BCT for women with AUD was more efficacious than IBT in reducing substance use and substance-related problems and improving partner relationships.