Marital and family therapy of alcohol use disorders: Bridging the gap between research and practice.

Abstract

and West RoxburyClients with alcohol and other substance use disorders are routinely encountered by practitioners in various treatment settings. This article traces the rationale for using marital and family therapy with alcoholics and describes an ongoing behavioral marital therapy program that exemplifies an integration of clinical practice and research in this area. Specific treatment suggestions are offered and practical considerations for therapists working with families struggling with alcoholism are discussed, including the role of self-help groups in family treatment, the danger of having preconceived notions about "alcoholic families," and the necessity for clinics and clinicians to possess the capacity to assess and treat comorbid psychological disorders as well as addictive behaviors.ROBEKT J. ROTUNDA received his PhD from the University of South Carolina in 1993. He is currently assistant professor of psychology at the University of West Florida and lecturer on psychology in the Department of Psychiatry at Harvard Medical School. His research interests are in the areas of marital and family assessment and therapy, addictive behaviors, and posttraumatic stress disorder.

Enabling behavior in a clinical sample of alcohol-dependent clients and their partners

“…The client sample included 39 white and 3 minority group members who presented for outpatient couples therapy with their non-alcoholic partners at the Counseling for Alcoholics' Marriages Project (Project CALM), a behavioral couples therapy program and component of the Families and Addiction Program in the Harvard Medical School Department of Psychiatry (O'Farrell, 1993;Rotunda & O'Farrell, 1997). Participants screened for the present study included 50 heterosexual couples that entered the CALM program within a specified period when the instrument of interest, the Behavioral Enabling Scale, was being utilized.…”

“…One aspect of the field of addiction that has generated significant study is the relationship between the substance-dependent person and the family, the ways in which addiction affects the behavior of the entire family, and how significant others have participated in treatment to aid recovery. For example, the application of marital and family therapy approaches to substance use disorders has included empirical accounts of treatment effectiveness at various stages of recovery (Edwards & Steinglass, 1995;Epstein & McCrady, 1998;O'Farrell & Fals-Stewart, 2003;Rotunda & O'Farrell, 1997). The behaviors and responses of family members may influence the impaired individual as well.…”

Understanding and managing expressed emotion in the couples treatment of alcoholism

“…CALM has four distinct phases including initial engagement of the identified client and his or her partner, 10 to 12 weekly couple sessions, 10 weekly couples group sessions, and quarterly follow-up visits for the final 24 months. Portions of the following summary appear in more detail elsewhere (O'Farrell, 1993;Rotunda & O'Farrell, 1997).…”

“…However, studies that have compared couples and families of alcoholics to nonalcoholic but distressed families found similarly dysfunctional processes. This general finding suggests that numerous pathways can lead to similar impairments in family functioning across client populations (for example, presentation of clinically similar communication and role performance issues may be apparent in couples trying to manage one partner's anxiety, alcohol use or mood disorder), and that available marital and family therapy approaches that have been applied to other clinical problems can also be used to help families affected by alcohol abuse, especially after drinking has stopped (Rotunda & O'Farrell, 1997).…”

Partner Enabling of Substance Use Disorders: Critical Review and Future Directions

“…The application of marital and family therapy approaches to substance use disorders has deservedly received more emphasis during the last decade, including empirical accounts of treatment effectiveness at various stages of recovery (Edwards & Steinglass, 1995;Epstein & McCrady, 1998;O'Farrell, 1993;Rotunda & O'Farrell, 1997). Some of these treatment approaches are based on research of basic family processes, and more specifically, the family functioning and dynamics of those struggling with addictions.…”