Several aspects of marital functioning were associated with subsequent relapse to opiate abuse in 17 married addicts. The addicts and spouses were evaluated in a task-oriented interview and rated using the Beavers Timberlawn Family Assessment instrument. The global health-pathology ratings on this instrument indicated that most couples had rigid patterns of interacting, rather than a chaotic lack of structure or a flexible, negotiated partnership. Within this range of rigid functioning, higher ratings were associated with longer times drug-free (up to 18 months with a mean of 7 months). On the seven subscales of the Beavers', five were significantly correlated with the time drug-free: effective and clear leadership, closeness between the spouses, a nonhostile mood, empathy, and efficient negotiation and problem solving. The subscales associated with drug abstinence were quite different for a group of seven single ex-addicts participating in the same outpatient program, but living with their parents. For these single ex-addicts three subscales were correlated with the time drug-free: parental reaction to separation strivings, the open expression of thoughts and feelings, and empathy. This difference in the subscales associated with abstinence for married versus single addicts suggested some specificity in the characteristics of family structure and interaction that may be related to drug abstinence.

Family therapy may help addicts remain drug abstinent by improving family functioning. In a outpatient pilot study eight addict families were evaluated before and after 16 weeks of multiple family therapy (MFT), while the addict was maintained on naltrexone, an opiate antagonist. The Beavers Timberlawn Family Assessment was used to rate videotapes on problem solving, family structure, individual autonomy, and affect. The 8 families showed significant improvement in global functioning, problem solving, structure, and autonomy, but not in affect. One addict relapsed during the 10 month follow up, and his was the only family that functioned worse at follow up. We concluded that MFT can help addict families progress from chaotic interactions to more stable family structures and from rigid to more flexible family functioning. This improvement in family functioning may be associated with ex-addicts remaining abstinent.

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