behavioral couples therapy for substance use disorders resources:
DESCRIPTION
BEHAVIORAL COUPLES THERAPY FOR SUBSTANCE USE DISORDERS Resources: O'Farrell, T. (1993). Treating alcohol problems: Marital and family interventions. New York: Guilford. - PowerPoint PPT PresentationTRANSCRIPT
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BEHAVIORAL COUPLES THERAPY FOR SUBSTANCE USE DISORDERS
Resources:
O'Farrell, T. (1993). Treating alcohol problems: Marital and family interventions. New York: Guilford.
Ruff S, McComb JL, Coker CJ, Sprenkle DH (2010). Behavioral couples therapy for the treatment of substance abuse: a substantive and methodological review of O'Farrell, Fals-Stewart, and colleagues' program of research. Family Process, 49 (4), 439-56.
National Registry of Evidence-based Programs and Practices(NREPP): a searchable online database of mental health andsubstance abuse interventions. BCT review online at:
http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=134
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FAMILY-FOCUSED TREATMENT APPROACHESFAMILY-FOCUSED TREATMENT APPROACHES
Engaging client /couple / family
Deciding on therapy parameters & goals -assessment
“Intervention” approach
Working with spouses/partners without IP, with intent of helping IP or drawing IP into treatment
Working with spouses/partners without IP
Self-help group referrals
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FAMILY-FOCUSED TREATMENT APPROACHESFAMILY-FOCUSED TREATMENT APPROACHES
• Family Models
• family disease - a parallel process
• family systems- substance seen as “organizing principle”- symptom may not be the problem- interconnectedness, reciprocity, homeostasis
• behavioral couples / family- substance use viewed as problem behavior- focus on both recovery and relationships
- The Counseling for Alcoholics’ Marriages (CALM) Project --- example of BCT
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Background & Introduction
Substance-Focused Methods
Relationship-Focused Methods
Relapse Prevention
Behavioral Couples Therapy for Alcoholism and Drug Abuse
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Behavioral Couples Therapy for Alcoholism and Drug AbusePurpose of BCT is to increase relationship factors
conducive to abstinence
Daily Sobriety Contract supports abstinence
Behavioral therapy increases positive activities and constructive communication
Plan for relapse prevention
12-20 couple sessions over 3-6months
BCT fits well with self-help groups, medications, and other counseling
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BCT gives more abstinence, happier re-lationships & fewer separations than IND
Benefit to cost ratio greater than 5:1
Domestic violence is greatly reduced
Children helped more by BCT than IND
BCT improves medication compliance
BCT works with family members other than spouses
Studies of BCT for Alcoholism and Drug Abuse Show
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Married or living together relationship
Reside together or reconcile
Not psychotic past 90 days
Not high risk of injurious/lethal violence
? if both are substance abusers
Start after detox, rehab, or no prior Tx
Suitable Cases for BCT
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THE FOUR PHASES OF PROJECT CALM
1. Engaging Alcoholic and Partner
• providing a rationale … and hope
2. 8 - 10 Weekly Couple Sessions
3. 10 Weekly Couples Group Sessions(group modality optional but better)
4. Quarterly Follow-up Visits for 24 Months
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Weekly Couple Sessions
– developing a sobriety contract
– use of Antabuse or other recovery meds
– CALM Promises – no threats of separation, focus on present, and commit to action via hmwk. exercises
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STRUCTURE OF CALM COUPLES GROUPS
4-5 couples
- stabilized and appropriate for group
male and female co-therapist team
- observer for training purposes
10 weekly two-hour sessions with 10-15 minute break for refreshments
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PROCESS OF CALM COUPLES GROUPS
Report on homework in first half of each session
Focus on recovery:
- Sobriety Contract & check of urges to drink or drug; Crisis intervention PRN
Skills training and practice
End with review of homework assignments for coming week - eliciting commitments
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Building Support
for
Abstinence
Substance-Focused Methods
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BCT Sobriety Contract
Helps the CoupleReward abstinence
Reduce distrust and conflict
Refrain from punishing sobriety
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BCT Sobriety Contract
Sobriety Trust DiscussionAlcohol/drug abuser states
intention to stay abstinent that day
Spouse thanks alcohol/drug abuser for efforts to stay abstinent
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BCT Sobriety ContractDaily Sobriety Trust Discussion
Medication (Antabuse, Naltrexone) to aid
recovery
Self-help involvement
Weekly drug urine screens
Calendar to record progress
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Other Support for AbstinenceReviewing urges to drink or use drugs
Helps identify cues for alcohol or drug use
Resisting urges builds confidence
Crisis intervention for substance useGet substance use stopped ASAP
Use as a learning experience
Discuss exposure to substances, including alcohol at home
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Increasing
Positive Activities
Relationship-Focused Methods
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Increasing Positive Activities
Catch Your Partner Doing Something Nice
Caring Day Assignment
Shared Rewarding Activities
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CATCH YOUR PARTNER DOING SOMETHING NICE
NAME: Mike PARTNER’S NAME: Nancy
DAY DATE PLEASING BEHAVIOR NOTICED
MON 4/6 Waited to have dinner with me whenI had to stay late at work
TUES 4/7 Told me she loved me
WED 4/8 Cooked a delicious dinner
THUR 4/9 Was patient with me when I camehome tired and moody from work
FRI 4/10 Enjoyed a walk together
SAT 4/11 Woke me gently and rubbed my back
SUN 4/12 Helped plan a picnic with f riends
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Increasing Positive Activities
Shared Rewarding ActivitiesEach partner lists possible activities
Plan one activity each week
Activity can be “date at home”, out with other couples or families, simple or large
Such activities linked with recovery
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Teaching
Communication Skills
Relationship-Focused Methods
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Teaching Communication Skills
Listening Skills
Expressing Feelings Directly
Communication Sessions
Negotiating for Requests
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Maintenance and Relapse Prevention
Continuing Recovery Plan
Specifies activities to do to
maintain abstinence and
relationship recovery after weekly
couple sessions end
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Maintenance and Relapse Prevention
Relapse Prevention PlanIdentify high risk situations
and early warning signs
Formulate and rehearse plan to
Prevent relapse
Minimize duration and negative consequences of substance use if it occurs
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RELATED CLINICAL ISSUES
• Screening for Enabling
• Working with partners to:
focus on coping responses, eliminate enabling
- drank / used drugs with, or in presence of, client95%
- lied or made excuses to family/friends 90%
- gave client money to buy alcohol or drugs 71%
- purchased alcohol or drugs for client 55%
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Dealing with Domestic Violence in Couples Counseling
Assess Domestic Violence
– Interview as Couple and Separately– Conflict Tactics Scale
Assess Current Risk of Lethal/Injurious Violence
– History and Nature of Violence (e.g., verbal, physical, weapons used?)
– Fear of Recurrence– Recent Threats of Violence– Has violence occurred only or mostly when alcoholic is/was
drinking?
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Dealing with Domestic Violence
If Risk of Lethal/Injurious Violence is High:
– Provide Separate Treatment for Alcoholic and Spouse
– Make a Safety Plan
If Risk of Lethal/Injurious Violence is NOT High:
– Treat with Caution and Address Violence
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Dealing with Domestic Violence
Address Violence in Couples Counseling:
– Commitment to nonviolence (“No angry touching.” “No threats.”)
– Review at each session successes and challenges to keeping nonviolence commitment
– “Time Out” to reduce escalating conflict– Communication Skills Training– Written agreement for at least temporary separation if
violence occurs– Address risk of violence if relapse occurs