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The purpose of  KMCSRO Behavioral Couples Therapy (BCT) is to build support for abstinence
and to improve relationship functioning among married or cohabiting individuals seeking
help for alcoholism or drug abuse. KMCSRO BCT sees the substance abusing patient with the
spouse or live-in partner 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 (e.g.,
disulfiram, naltrexone), daily medication ingestion witnessed and verbally reinforced by the
spouse also is part of the contract. Self-help meetings and drug urine screens are part of
the contract for most patients.

 

KMCSRO BCT also increases positive activities and teaches Domestic Violence Outcomes
A recent study (O’Farrell, Murphy, Hoover, Fals-Stewart & Murphy, 2002) examined
male-to-female partner violence before and after BCT for 303 married or cohabiting male
alcoholic patients. There also was a demographically matched comparison sample of
couples without alcohol problems. In the year before BCT, 60% of alcoholic patients had
been violent toward their female partner, five times the comparison sample rate of 12%. In
the year after BCT, violence decreased significantly to 24% of the alcoholic sample but
remained higher than the comparison group. Among remitted alcoholics after BCT, violence
prevalence of 12% was identical to the comparison sample and less than half the rate
among relapsed patients (30%). Results for the second year after BCT were similar to the
first year. An earlier study (O’Farrell & Murphy, 1995) found nearly identical results. Thus,
these 2 studies showed that male-to-female violence was significantly reduced in the first
and second year after BCT and that it was nearly eliminated with abstinence.
Two recent studies showed that BCT reduced partner violence and couple conflicts
better than individual treatment. Among male drug abusing patients, while nearly half of
the couples reported male-to-female violence in the year before treatment, the number
reporting violence in the year after treatment was significantly lower for BCT (17%) than for
individual treatment (42%) (Fals-Stewart, Kashdan, O’Farrell, Birchler & Kelley, 2002).
Among male alcoholic patients, those who participated in BCT reported less frequent use of maladaptive responses to conflict (e.g., yelling, name-calling, threatening to hit, hitting)
during treatment than those who received individual treatment (Birchler & Fals-Stewart,
2001). These results suggest that in BCT couples do learn to handle their conflicts with less hostility and aggression. 

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CLINICAL GUIDELINE FOR BEHAVIORAL COUPLES THERAPY


BCT works directly to increase relationship factors conducive to abstinence. A
behavioral approach assumes that family members can reward abstinence -- and that
alcoholic and drug abusing patients from happier, more cohesive relationships with better
communication have a lower risk of relapse. The substance abusing patient and the
spouse, are seen together in BCT, typically for 12-20 weekly outpatient couple sessions
over a 3-6 month period. BCT can be an adjunct to individual counseling or it can be the
only substance abuse counseling the patient receives. Generally couples are married or cohabiting for at least a year, without
current psychosis, and one member of
the couple has a current problem with
alcoholism and/or drug abuse. The
couple starts BCT soon after the
substance abuser seeks help. BCT can
start immediately after detoxification or a
short-term intensive rehab program or when the substance abuser seeks outpatient
counseling. The remainder of this guideline is written in the form of instructions to a
counselor who wants to use BCT.
To engage the spouse and the patient together in BCT, first get the substance
abusing patient’s permission to contact the spouse. Then talk directly to the spouse to
invite him or her for an initial BCT couple session. The initial BCT session involves
assessing substance abuse and relationship functioning and gaining commitment to and
starting BCT (see O’Farrell, 1993b for more details). You start first with substance-focused
interventions that continue throughout BCT to promote abstinence. When abstinence and attendance at BCT sessions have stabilized for a month or so, you add relationship-focused
interventions to increases positive activities and teach communication. These specific BCT
interventions are described in detail next
communication skills

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