DIAGNOSIS: Substance and Alcohol Use Disorders
Behavioral Couples Therapy for Alcohol Use Disorders
Status: Strong Research Support
Behavioral Couples Therapy for Alcohol use Disorders (ABCT) is an outpatient treatment for individuals with alcohol use disorders and their intimate partners. ABCT is based on four assumptions: (1) intimate partner behaviors and couple interactions can be triggers for drinking; (2) intimate partners can reward abstinence; (3) a positive intimate relationship is a key source of motivation to change drinking behavior; and (4) reducing relationship distress lessens risk for relapse. Using cognitive-behavioral therapy, the ABCT therapist works with both the person who is abusing alcohol and his or her partner to identify and decrease the partner's behaviors that cue or reinforce the client's drinking; strengthen the partner's support of the client's efforts to change through reinforcement of positive change and the use of sobriety contracts; increase positive couple interactions through activities and assignments designed to increase positive feelings and improve constructive communication and problem-solving; and improve the client's coping skills and relapse prevention techniques to achieve and maintain abstinence.
The treatment program consists of 2-3 hours of assessment for treatment planning, followed by 12-20 weekly therapy sessions for the client with his or her partner. Treatment follows cognitive-behavioral principles applied to couples therapy and specific therapeutic interventions for alcohol use disorders. A typical session follows this sequence: (1) the therapist asks about any drinking since the last session; (2) the couple presents and discusses homework assigned at the last session and use of a sobriety contract, if applicable; (3) the couple discusses any drinking or relationship problems since the last session; (4) the therapist presents new material and the couple engages in active learning activities in the session related to the new material; (5) the couple discusses up-coming high risk situations; and (6) the therapist assigns new homework.
The optimal implementation of ABCT occurs in the context of an existing clinic or private practice with certified/licensed mental health or addictions professionals who have a background in treating alcohol use disorders and knowledge of cognitive-behavioral therapy.
Key References (in reverse chronological order)
- McCrady, B. S., Epstein, E. E., Cook, S., Jensen, N. K., & Hildebrandt, T. (2009). A randomized trial of individual and couple behavioral alcohol treatment for women. Journal of Consulting and Clinical Psychology, 77, 243-256.
- O'Farrell, T. J., Kleinke, C., & Cutter, H. S. G. (1998). Sexual adjustment of male alcoholics: Changes from before to after receiving alcoholism counseling with and without marital therapy. Addictive Behaviors, 23, 419-425.
- O'Farrell, T. J., Choquette, K. A., Cutter, H. S. G., Floyd, F. J., Bayog, R. D., Brown, E. D., Lowe, J., Chan, A., & Deneault, P. (1996). Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment. Journal of Substance Abuse, 8, 145-166.
- O'Farrell, T. J., Cutter, H. S. G., Choquette, K. A., Floyd, F. J., & Bayog, R. D. (1992). Behavioral marital therapy for male alcoholics: Marital and drinking adjustment during the two years after treatment. Behavior Therapy, 23, 529-549.
- McCrady, B. S., Noel, N. E., Stout, R. L., Abrams, D. B. & Nelson, H. F. (1991). Effectiveness of three types of spouse involved behavioral alcoholism treatment: Outcome 18 months after treatment. British Journal of Addictions, 86, 1415 1424.
- McCrady, B. S., Noel, N. E., Stout, R. L., Abrams, D. B., Fisher Nelson, H. & Hay, W. (1986). Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment. Journal of Studies on Alcohol, 47, 459 467.
- O'Farrell, T. J., Cutter, H. S. G., & Floyd, F. J. (1985). Evaluating behavioral marital therapy for male alcoholics: Effects on marital adjustment and communication from before to after therapy. Behavior Therapy, 16, 147-167.
- McCrady, B. S. & Epstein, E. E. (2009). Overcoming alcohol problems: A couples-focused program. New York: Oxford University Press.
- McCrady, B. S. & Epstein, E. E. (2009). Overcoming alcohol problems: Workbook for couples. New York: Oxford University Press.
- O'Farrell, T. J., & Fals-Stewart, W. (2006). Behavioral Couples Therapy for Alcoholism and Drug Abuse. New York: The Guilford Press.
- Epstein, E.E., & McCrady, B.S. (2002). Couple therapy in the treatment of alcoholism. In A.S. Gurman and N. Jacobson (Eds.) Clinical Handbook of Marital Therapy, 3nd Edition. New York: Guilford Publications (pps. 597-628).
Training opportunities and resources are available from:
- Elizabeth E. Epstein, Rutgers University, firstname.lastname@example.org
- Barbara McCrady, University New Mexico, email@example.com
- Timothy J. O'Farrell, Harvard Medical School, firstname.lastname@example.org
- Christopher Barrick, Research Institute on Addictions, email@example.com
- McCrady, B. S. (2000). Couples therapy for addictions. [In J. Lewis & J. Carlson (producers), Brief therapy for addictions. Mill Valley, CA: Psychotherapy.Net
- Institute for Research, Education, and Training in Addiction. (2006). Behavioral Couples Therapy in Alcoholism and Drug Abuse Treatment web-based training. (www.ireta.org under distance learning courses)
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice