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Substance Abuse Treatment Modalities: Literature Review

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Marital/Family Therapy

For many years marital therapy has been evaluated as a treatment for alcohol problems, but such evaluations are lacking for marital therapy as an approach to other drug problems. Thus, this summary will be confined to marital therapy for alcohol abusers. Research has demonstrated that many alcoholics have marital and family problems (O'Farrell & Birchler, 1987), that positive marital and family adjustment is related to positive treatment outcomes (Moos, Finney & Gamble, 1982; Moos & Moos, 1984), and that marital and family problems may precipitate relapse in abstinent alcoholics (Maisto, et al., 1988). One major theory even proposes that alcohol abuse can serve a stabilizing and even adaptive function for families (Steinglass, Weiner & Mendelson, 1971). These sorts of findings have provided the underpinnings for marital therapy approaches to treatment.

Although a variety of marital therapy approaches have been used [e.g., joint hospitalization of marital couples, group therapy for married couples, intensive short–term family intervention programs (i.e., 3-7 days) as part of Minnesota model inpatient treatment, day treatment for married couples, Al-Anon, family education, confrontational family sessions, marital systems treatment, etc.], most of these approaches have not been subjected to research evaluations and comparisons between different approaches are lacking (Kaufman, 1985). Only marital therapy conducted from a behavioural orientation has undergone extensive evaluation (O'Farrell & Cowles, 1989). Thus, conclusions presented here should not be assumed to apply to other than behavioural types of marital therapy. Another obvious limitation of marital therapy approaches is that they can only be used with individuals who are involved in a couples relationship, where the individual is willing to have his/her partner involved, and where the partner is willing to be involved in the treatment.

Marital therapy for alcohol problems typically has two major objectives: to alleviate distress and encourage positive adjustment in the marital relationship, and to reduce alcohol problems. Usually it is thought that better marital relations will serve to reduce alcohol problems. Thus, studies typically measure two outcomes: effects on the marriage, and effects on drinking. This is an important distinction because the most typical outcome of marital therapy for alcohol problems has been improvement in the marital relationship but inconsistent effects on drinking. The best designed studies have found short term effects (i.e., for a few months) on drinking that are no longer present at longer intervals (e.g., O'Farrell, Cutter & Floyd, 1985; McCrady et al., 1982, 1986). One particularly beneficial involvement of a partner in treatment has been to monitor the alcohol abuser's ingestion of anti-alcohol medication (Azrin et al., 1982; Keane et al., 1984).


References for Marital/Family Therapy:

Azrin, N. H., Sisson, R. W., Meyers, R., & Godley, M. (1982), “ Alcoholism treatment by disulfiram and community reinforcement therapy”, Journal of Behavior Therapy and Experimental Psychiatry, 13, 105-112.

Bowers, T. G., & Al-Redha, M. R. (1990), “A comparison of outcome with group/marital and standard/individual therapies with alcoholics”, Journal of Studies on Alcohol, 51, 301-309.

Jacobson, N. S., Holtzworth-Munroe, A., & Schmaling, K.B. (1989), “Marital therapy and spouse involvement in the treatment of depression, agoraphobia, and alcoholism”, Journal of Consulting and Clinical Psychology, 57, 5-10.

Kaufman, E. (1985), “Family therapy in the treatment of alcoholism”, In T.E. Bratter & G.G. Forrest (Eds.), Alcoholism and Substance Abuse: Strategies for clinical intervention. (pp. 376-397). New York: Free Press, .

Maisto, S. A., O'Farrell, T. J., McKay, J. R., Connors, G. J., & Pelcovits, M. (1988), “Alcoholic and spouse concordance on attributions about relapse to drinking” Journal of Substance Abuse Treatment, 5, 179-181.

McCrady, B. S., Moreau, J., Paolino, T. J., Jr., & Longabaugh, R. (1982), “Joint hospitalization and couples therapy for alcoholism: A four-year follow-up”, Journal of Studies on Alcohol, 43, 1244-1250.

McCrady, B. S., Noel, N. E., Abrams, D. B., Stout, R. L., Nelson, H. F., & Hay, W. M. (1986), “Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment”, Journal of Studies on Alcohol, 47, 459-467.

Miller, W. R., & Hester, R. K. (1986), “The effectiveness of alcoholism treatment: What research reveals”, In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 121-174), New York: Plenum.

Moos, R. H., Finney, J. W., & Chan, D. (1982), “The process of recovery from alcoholism. II. Comparing spouses of alcoholic patients and matched community controls”, Journal of Studies on Alcohol, 43, 888-909.

Moos, R.H. & Moos, B.S. (1984), “The process of recovery from alcoholism. III. Comparing functioning in families of alcoholics and matched control families”, Journal of Studies on Alcohol, 45, 111-118.

O' Farrell, T. J., Choquette, K. A., Cutter, H. S. G., Brown, E. D., & McCourt, W. F. (1993), “Behavioral marital therapy with and without additional couples relapse prevention sessions for alcoholics and their wives”, Journal of Studies on Alcohol, 54, 652-666.

O'Farrell, T. J., & Cowles, K. S. (1989), “Marital and family therapy”, In R. Hester & W. R. Miller (Eds.), Comprehensive handbook of alcoholism treatment approaches (pp. 183-205), New York: Pergamon Press.

O'Farrell, T. J., & Cutter, H. S. G. (1984), “Behavioral marital therapy couples groups for male alcoholics and their wives”, Journal of Substance Abuse Treatment, 1, 191-204.

O'Farrell, T. J. (1989), “Marital and family therapy in alcoholism treatment”, Journal of Substance Abuse Treatment, 6, 23-29.

O'Farrell, T. J., Cutter, H. S. G., & Floyd, F. J. (1985), “Evaluating behavioral marital therapy for male alcoholics: Effects on marital adjustment and communications from before to after treatment”, Behavior Therapy, 16, 147-168.

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 2 years after treatment”, Behavior Therapy, 23, 529-549.

O'Farrell, T. J. & Birchler, G. R. (1987), “Marital relationships of alcoholic, conflicted, and nonconflicted couples”, Journal of Marital and Family Therapy, 13, 259-274.

Steinglass, P., Weiner, S., & Mendelson, J.H. (1971), “A systems approach to alcoholism: A model and its clinical application”, Archives of General Psychiatry, 24, 401-408.

Zweben, A., Pearlman, S., & Li, S. (1988), “A comparison of brief advice and conjoint therapy in the treatment of alcohol abuse: The results of the marital systems study”, British Journal of Addiction, 83, 899-916.