SOCIETY LECTURE 2011: Family interventions for alcohol & drug problems

We started our research program with two basic premises:  (a) that families are integrally involved with alcohol and other substance use disorders, and (b) that involving families in treatment could improve outcomes.  In our earliest study, we experimented with jointly admitting persons with alcohol use disorders (AUDs) and their spouses to the hospital for treatment.  From this first study, we learned that family involvement was beneficial, but joint hospitalization was not necessary to effect positive outcomes.  We then developed an outpatient treatment model that drew heavily from behavioral couple therapy and cognitive behavior therapy, Alcohol Behavioral Couple Therapy (ABCT).  In a series of studies, we established that (a) treatment including individual interventions to help the drinker and partners as well as couple-focused interventions resulted in better outcomes in drinking and relationship satisfaction and stability; (b) adding relapse prevention (RP) elements to the treatment provided some additional benefit but combining ABCT with Alcoholics Anonymous did not provide additional benefits; (c) the benefits of ABCT also applied to women with alcohol use disorders; (d) couple therapy was more efficacious than individual therapy for women with other Axis I and Axis II disorders; (e) if given a choice between individual and couple therapy, most women opted for some form of individual treatment.  Given the consistently positive results for couple-involved treatment, we now are expanding our research to test the mechanisms by which we believe ABCT works.  We also are developing a briefer and more flexible treatment that could be used with any family member, are testing a brief intervention for affected families identified in primary care settings.  Finally, we are learning more about the mechanisms by which social support affects alcohol and other substance use disorders, as well as other disease states.