Marriage Counseling with Alcoholics and Their Spouses‐II The Correlation of Excessive Drinking Behavior with Family Pathology and Social Deterioration

Abstract

Excessive drinking behavior, family pathology and social deterioration are variables frequently discussed in the literature on alcoholism. Many of the studies which have examined the inter-relationships among the three have reported inconsistent and often contradictory findings. Studies by Pfeffer and Berger;l Gerard, Saenger, and Wile;2 and a paper by Pattison et aL3 present evidence for a consistent relationship between these variables. More recently, Pattison4 has begun to qualify this conclusion. Hill and Blane,5 applying statistical techniques to data presented by Rossi, Stach and Bradley conclude that they can find no evidence that improvement in drinking behavior is associated with improved adjustment in most areas. Regardless of the findings, however, most of these studies have started out with the implicit assumption that if a change in drinking behavior is related to a change in family pathology and social deterioration, the temporal sequence, or cause-effect direction is from drinking behavior to other areas.This paper reports the results of a project which was based on an alternative implicit assumption : that, for a married alcoholic, the question of temporal sequence is irrelevant. The relationship between excessive drinking behaviour and family pathology seems to be one of mutual reinforcement.6 While this would not have been denied in most of the studies cited above, they generally do not give sufficient recognition to the independent importance of the family situation.? Given this implicit assumption, Marriage Council of Philadelphiat undertook to counsel maritally conflicted alcoholics and their non-alcoholic spouses in the belief that alleviation of the marital problems might have an effect upon the drinking behavior. Therefore, the "therapy" is focused on the marital conflict (family pathology) , with consideration of a drinking problem taking place only in the context of the overt and covert roles it plays in that conflict. If an c'improvement" in this secondary area can be associated with a lessening of family pathology, support will be indicated for the indirect approach to the treatment of alcoholism. 3

Determinants of the posttreatment functioning of alcoholic patients: A conceptual framework.

“…Bromet and Moos (1977) found that among married patients, a more positive family milieu was associated with better outcome (drinking, psychological, and social) 6 months after treatment. Similarly, other researchers have reported that higher levels of cohesion and support and lower levels of conflict are associated with more favorable outcome during follow-up periods ranging from 6 to 18 months (Burton & Kaplan, 1968;Finney et al, 1980;Moos, Bromet, Tsu, & Moos, 1979;Orford etal., 1975).…”

Posttreatment experiences and treatment outcome of alcoholic patients six months and two years after hospitalization.

“…Six marital discord and breakdown items from a measure of wives' coping behavior were also predictively associated with 12-month drinking outcome (Orford et al, 1975). Finally, Burton and Kaplan (1968) found that a reduction in the number of areas of disagreement between the alcoholic and his or her spouse was associated with rated improvement in drinking behavior.…”

Alcohol‐Focused Behavioral Couple Therapy

“…The earliest studies described family system‐based models with some cognitive‐behavioral elements, and many reported comparisons of conjoint therapy to other approaches using nonrandomized groups (e.g., comparing outcomes for men in treatment whose wives did or did not participate in sessions). Follow‐ups varied widely in duration, from 6 to 39 months, and typically reported substantially more positive drinking outcomes for men whose wives participated in the treatment than those who did not, as well as improvements in relationship functioning (Burton & Kaplan, , ; Gallant, Rich, Bey, & Terranova, ; Smith, , ). By the mid‐1970s, descriptions of behavioral approaches to conjoint therapy for AUDs began to appear in the literature, and controlled outcome studies of cognitive‐behavioral approaches began in the late 1970s (e.g., McCrady et al., ; O'Farrell, Cutter, & Floyd, ).…”