Fals–Stewart and colleagues (2000) reanalyzed data from the Fals–Stewart, Birchler, and O’Farrell (1996) study to compare the change in substance use frequency and dyadic adjustment between intervention groups. The sample consisted of 86 couples randomly assigned to Behavioral Couples Therapy for Substance Abuse (BCT) or individual-based treatment (IBT). Of the 86 couples randomized, 3 from each intervention were excluded from this analysis for not completing at least half of the assigned sessions. The final sample consisted of 40 couples in BCT and 40 couples in IBT.
Couples were recruited when the husband or cohabiting male partner entered one of two community-based outpatient clinics for substance abuse. Male patients had to be a) between 20 and 60 years old, b) either married for at least 1 year or in a stable cohabitating relationship for at least 2, c) meet abuse or dependence criteria per the Diagnostic and Statistical Manual of Mental Disorders, Third Addition Revised (DSM–III–R) for at least one psychoactive drug, d) agree to abstain from drug use during treatment, and e) agree to refrain from seeking additional substance abuse treatment. Excluded couples were those in which the female met DSM–III–R criteria for abuse or dependence of a psychoactive drug, either partner met DSM–III–R criteria for an organic mental disorder, or if either partner participated in a methadone maintenance program and had sought additional outpatient support.
Male patients in the IBT group received two 60-minute individual therapy sessions and one 90-minute group therapy session each week. This intervention aimed to teach coping skills to help patients remain abstinent of drugs and alcohol. Urinalysis and blood alcohol breath samples were taken weekly.
Data was collected from each partner as couples entered the study, at treatment completion, and every 3 months thereafter for 1 year. Use of alcohol and drugs was measured with the Timeline Followback Interview (TLFB), using the percentage of days abstinent (PDA) index. Relationship adjustment was measured with the Locke–Wallace Marital Adjustment Test (MAT) by averaging scores from each partner.
Winters and colleagues (2002) looked at females entering substance abuse treatment and their male partners to examine the effect BCT had on relationship satisfaction and substance use. Seventy-five patients were randomly assigned to either BCT (n= 37) or IBT (n= 38) interventions. Patients in the IBT intervention group received twice-weekly 60-minute individual therapy sessions and once-weekly 90-minute group therapy sessions. Both intervention groups were required to give weekly urine and blood–alcohol breath samples.
Females were included in the study if they a) were between the ages of 20 and 60, b) were married for at least a year or living with their male partner for at least 2, c) met abuse or dependence criteria for at least one psychoactive drug per the DSM–IV, d) agreed to refrain from substance use, and e) agreed to not seek additional treatment. A couple was excluded if the male partner met DSM–IV criteria for drug abuse or dependence in the past 6 months, if either partner met DSM–IV criteria for a mental or psychotic disorder, or if the female patient was in a methadone maintenance program.
Relationship satisfaction was measured using the Dyadic Adjustment Scale (DAS) and the Marital Happiness Scale (MHS). Substance use was measured using the TLFB and the Addiction Severity Index. Surveys were completed at pretreatment, at discharge, and at 3 months, 6 months, 9 months, and 1 year posttreatment. The MHS was also completed weekly during treatment.
Fals–Stewart, Birchler, and Kelley (2006) used a randomized controlled trial to examine whether BCT participants would report lower frequency alcohol use and higher relationship satisfaction than the comparison groups. They also looked at the effect of BCT on partner violence. Participants were female alcoholics entering treatment and their non–substance abusing male partners. Couples were assigned to one of three interventions: BCT with IBT, IBT only, or psychoeducational attention control treatment (PACT). Each intervention was assigned 46 couples who met the study criteria and were not significantly different. Women in the IBT intervention participated in individual therapy without a couple’s component. Women in the PACT intervention attended individual therapy, while their partners attended lectures about substance abuse.
To be included in the study, females had to a) be between 20 and 60 years old, b) be married at least 1 year or live with a romantic partner for 2, c) meet alcohol abuse or dependency criteria according to the DSM–IV, d) have alcohol as their drug of choice, e) agree to remain abstinent of alcohol or other drugs during treatment, and f) agree to not seek other substance abuse treatment unless recommended by their counselors. A couple was excluded if the male partner met DSM–IV criteria for a substance use disorder or if either partner showed evidence of a psychotic disorder. All eligible couples gave informed consent to participate.
Alcohol use was measured by a PDA index derived from the TLFB. Adverse drinking consequences were measured with the Drinker Inventory of Consequences (DrInC). Relationship satisfaction was measured by the DAS. Partner violence was measured by items taken from the Conflict Tactics Scale of the TLFB–Spousal Violence (TLFB–SV) method. Participants completed interviews as they entered the study, at the end of the discharge phase, and every 3 months thereafter for 12 months.