Advertisement

Alcoholism pp 329-356 | Cite as

Family-Involved Alcoholism Treatment An Update

  • Timothy J. O’Farrell
  • William Fals-Stewart
Part of the Recent Developments in Alcoholism book series (RDIA, volume 15)

Abstract

We reviewed 36 randomized studies of family-involved treatment and comparison conditions. A meta-analysis showed a medium effect size favoring family-involved treatments, over individual treatment or wait-list, for outcomes of alcohol use, treatment entry/attendance, and family adjustment. Studies of family-involved treatment when the alcoholic is unwilling to seek help show: (1) Al-Anon facilitation and referral help family members cope better; (2) the popular Johnson intervention apparently does not effectively promote treatment entry; and (3) Community Reinforcement and Family Training promotes treatment entry and should be disseminated if replicated. Studies of family-involved treatment to aid recovery when the alcoholic has sought help show: (1) evidence supporting behavioral couples therapy (BCT) has grown considerably; (2) the disulfiram contract procedure should be disseminated as part of a BCT treatment package; and (3) studies of family systems and of family disease approaches are beginning to ap pear in the literature. Future studies need to include more women and minority patients and focus on children.

Keywords

Alcoholic Patient Marital Adjustment Communication Skill Training Treatment Entry Alcoholism Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Keller M (ed): Trends in treatment of alcoholism, in Second Special Report to the U.S. Congress on Alcohol and Health. Washington, DC. Department of Health, Education, and Welfare, 1974, p 145–167.Google Scholar
  2. 2.
    Steinglass P: Experimenting with family treatment approaches to alcoholism, 1950–1975: A review. Fam Process 15:97–123, 1976.PubMedCrossRefGoogle Scholar
  3. 3.
    McCrady BS: Outcomes of family-involved alcoholism treatment. In M. Galanter (ed): Recent Developments in Alcoholism: vol. 7. Treatment Research. New York, Plenum, 1989, p 165–182Google Scholar
  4. 4.
    O’Farrell TJ (ed): Treating Alcohol Problems: Marital and Family Interventions. New York: Guilford Press,1993.Google Scholar
  5. 5.
    Rosenthal R, Rubin DB: Meta-analytic procedures for combining studies with multiple effect sizes. Psychol Bull 99:400–406, 1986.CrossRefGoogle Scholar
  6. 6.
    Rosenthal R: Meta-analytic Procedures for Social Research (revised ed). Newbury Park, CA, Sage Publications, 1991.Google Scholar
  7. 7.
    Cohen J: Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ. Lawrence Earlbaum, 1988.Google Scholar
  8. 8.
    Steering Committee of the Physicians Health Study Research Group: Preliminary report: Findings from the aspirin component of the ongoing physicians’ health study. N Engl J Med 318:262–264, 1988.Google Scholar
  9. 9.
    Zetterlind U, Hansson H, Aberg-Orbeck K, et al: Coping skill therapy, group support and information for spouses of alcoholics: A controlled randomized study. Poster presented at the International Conference on the Treatment of Addictive Behaviors, Santa Fe, New Mexico, 1998.Google Scholar
  10. 10.
    Rychtarik RG, McGillicuddy NB: Effects of skill training and twelve-step facilitation on posttreatment coping skills in women with alcoholic partners. Poster presented at the International Conference on the Treatment of Addictive Behaviors, Santa Fe, New Mexico, 1998.Google Scholar
  11. 11.
    Al-Anon Family Groups: This is Al-Anon. New York. Al-Anon Family Groups, 1981.Google Scholar
  12. 12.
    Sisson RW, Azrin NH: Family-member involvement to initiate and promote treatment of problem drinkers. JBehav Ther Exp Psychiatry 17:15–21,1986CrossRefGoogle Scholar
  13. 13.
    Barber JG, Gilbertson R: An experimental study of brief unilateral intervention for the partners of heavy drinkers. Res Soc WorkPract 6:325–336, 1996.CrossRefGoogle Scholar
  14. 14.
    Nowinski JK: Family Recovery and Substance Abuse: A Twelve-Step Guide for Treatment. Thousand Oaks CA. Sage Publications, 1999.Google Scholar
  15. 15.
    Miller PM, Meyers RJ, Tonigan JS: Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. J Consult Clin Psychol 67:688–697,1999.PubMedCrossRefGoogle Scholar
  16. 16.
    Dittrich JE, Trapold MA: Wives of alcoholics: A treatment program and outcome study. Bull Soc Psychol Addict Behav 3:91–102,1984CrossRefGoogle Scholar
  17. 17.
    Thomas EJ, Santa CA, Bronson D, et al: Unilateral family therapy with spouses of alcoholics. J SocServRes 10:145–163, 1987.Google Scholar
  18. 18.
    Thomas EJ, Yoshioka M, Ager R, et al: Reaching the uncooperative alcohol abuser through a cooperative spouse. Paper presented at the Fifth Congress of the International Society for Bio-Medical Research on Alcoholism, Toronto, June 1990.Google Scholar
  19. 19.
    Barber JG, Crisp BR: The “pressure to change” approach to working with the partners of heavy drinkers. Addiction 90:269–276, 1995.PubMedCrossRefGoogle Scholar
  20. 20.
    Barber JG, Gilbertson R: Evaluation of a self-help manual for the female partners of heavy drinkers. Res Soc WorkPract 8:141–151, 1998.CrossRefGoogle Scholar
  21. 21.
    Johnson VE: Intervention: How to Help Someone Who Doesn’t Want Help. Minneapolis, MN. Johnson Institute Books, 1986.Google Scholar
  22. 22.
    Liepman MR, Nirenberg TD, Begin AM: Evaluation of a program designed to help family and significant others to motivate resistant alcoholics into recovery. Am J Drug Alcohol Abuse 15:209–221, 1989.PubMedCrossRefGoogle Scholar
  23. 23.
    Logan DG: Getting alcoholics to treatment by social network intervention. Hosp Commun Psyhciatr 34:360–361, 1983.Google Scholar
  24. 24.
    Meyers RJ, Miller WR, Hill DE, et al: Community Reinforcement and Family Training (CRAFT): Engaging unmotivated drug users in treatment. J Subst Abuse 10:291–308, 1999.CrossRefGoogle Scholar
  25. 25.
    Kirby KC, Marlowe DB, Festinger DS, et al: Community reinforcement training for family and significant others of drug abusers: A unilateral intervention to increase treatment entry of drug users. Drug Alcohol Depend 56:85–96, 1999.PubMedCrossRefGoogle Scholar
  26. 26.
    Hunt GM, Azrin NH: A community-reinforcement approach to alcoholism. Behav Res Ther 11:91–114,1976.CrossRefGoogle Scholar
  27. 27.
    Hedberg AG, Campbell L: A comparison of four behavioral treatment of alcoholism. J Behav Ther ExpPsychiatry 5:251–256, 1974.CrossRefGoogle Scholar
  28. 28.
    Ossip-Klein DJ, Vanlandingham W, Prue DM, et al: Increasing attendance at alcohol aftercare using calendar prompts and home based contracting. Addict Behav 9:85–89, 1984.PubMedCrossRefGoogle Scholar
  29. 29.
    Ahles TA, Schlundt DG, Prue DM, et al: Impact of aftercare arrangements on the maintenance of treatment success in abusive drinkers. Addict Behav 8:53–58, 1983.PubMedCrossRefGoogle Scholar
  30. 30.
    Fuller RK, Branchey L, Brightwell DR, et al: Disulfiram treatment of alcoholism: A Veterans Administration Cooperative Study. JAMA 256:1449–1455, 1986.PubMedCrossRefGoogle Scholar
  31. 31.
    Rotunda R, O’Farrell TJ: Marital and family therapy of alcohol use disorders: Bridging the gap between research and practice. Prof Psychol 28:246–252, 1997.CrossRefGoogle Scholar
  32. 32.
    Farrell, TJ, Bayog RD: Antabuse contracts for married alcoholics and their spouses: A method to insure Antabuse taking and decrease conflict about alcohol. J Subst Abuse Treat 3:1–8, 1986.CrossRefGoogle Scholar
  33. 33.
    Farrell TJ, Cutter HSG, Floyd FJ: Evaluation of behavioral marital therapy for male alcoholics: Effects on marital adjustment and communication from before to after therapy. Behav Ther 16:147–167,1985.CrossRefGoogle Scholar
  34. 34.
    O’Farrell TJ, Cutter HSG, Choquette KA, et al: Behavioral marital therapy for male alcoholics: Marital and drinking adjustment during the two years after treatment. Behav Ther 23:529–549, 1992.CrossRefGoogle Scholar
  35. 35.
    McCrady BS, Paolino TJ Jr, Longabaugh R, et al: Effects of joint hospital admission and couples treatment for hospitalized alcoholics: A pilot study. Addict Behav 4:155–165, 1979.PubMedCrossRefGoogle Scholar
  36. 36.
    O’Farrell TJ, Choquette KA, Cutter HSG, et al: Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment. J Subst Abuse 8:145–166, 1996.CrossRefGoogle Scholar
  37. 37.
    O’Farrell TJ, Choquette KA, Cutter HSG, et al: Behavioral marital therapy with and without additional couples relapse prevention sessions for alcoholics and their wives. J Stud Alcohol 54:652–666, 1993.Google Scholar
  38. 38.
    Farrell TJ, Choquette KA, Cutter HSG: Couples relapse prevention sessions after behavioral marital therapy for alcoholics and their wives: Outcomes during three years after starting treatment. J Stud Alcohol 59:357–370, 1998.Google Scholar
  39. 39.
    Azrin NH: Improvements in the community-reinforcement approach to alcoholism. Behav Res Ther 14:339–348, 1976.PubMedCrossRefGoogle Scholar
  40. 40.
    Azrin NH, Sisson RW, Meyers R, et al: Alcoholism treatment by disulfiram and community reinforcement therapy. J Behav Ther Exp Psychiatry 13:105–112, 1982.PubMedCrossRefGoogle Scholar
  41. 41.
    Chick J, Gough K, Falkowski W, et al: Disulfiram treatment of alcoholism. Br J Psychiatry 161:84–89, 1992.PubMedGoogle Scholar
  42. 42.
    Keane TM, Foy DW, Nunn B, et al: Spouse contracting to increase Antabuse compliance in alcoholic veterans. J Clin Psychol 40:340–344, 1984.PubMedCrossRefGoogle Scholar
  43. 43.
    McCrady BS, Noel NE, Abrams DB, et al: Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment. J Stud Alcohol 47:459–467, 1986.PubMedGoogle Scholar
  44. 44.
    McCrady BS, Stout RL, Noel N, et al: Comparative effectiveness of three types of spouse-involved alcoholism treatment: Outcomes 18 months after treatment. Br J Addict 86:1415–1424, 1991.PubMedCrossRefGoogle Scholar
  45. 45.
    McCrady BS, Epstein E, Hirsch L: Maintaining change after conjoint behavioral alcohol treatment for men: Outcomes at 6 months. Addiction 94:1381–1396, 1999.PubMedCrossRefGoogle Scholar
  46. 46.
    Longabaugh R, Wirtz PW, Beattie M, et al: Matching treatment focus to patient social investment and support: 18-month follow-up results. J Consult Clin Psychol 63:296–307, 1995.PubMedCrossRefGoogle Scholar
  47. 47.
    Bowers TG, Al-Rehda MR: A comparison of outcome with group/marital and standard/individual therapies with alcoholics. J Stud Alcohol 51:301–309, 1990.PubMedGoogle Scholar
  48. 48.
    Monti PM, Abrams DB, Binkoff JA, et al: Communication skills training, communication skills training with family, and cognitive behavioral mood management training for alcoholics. J Stud Alcohol 51:263–270, 1990.PubMedGoogle Scholar
  49. 49.
    Steinglass P, Bennett L, Wolin S, et al: The Alcoholic Family. New York. Basic Books, 1987.Google Scholar
  50. 50.
    McCrady BS, Moreau J, Paolino TJ Jr, et al: Joint hospitalization and couples therapy for alcoholism: A four year follow-up. J Stud Alcohol 43:1244–1250, 1982.PubMedGoogle Scholar
  51. 51.
    Orchen MD: A treatment efficacy study comparing relaxation training, EEG biofeedback, and family therapy among heavy drinkers. Doctoral dissertation, Long Island University, 1983.Google Scholar
  52. 52.
    Grigg DN: An ecological assessment of the efficacy of individual and couples treatment formats of experiential systemic therapy for alcohol dependency. Doctoral dissertation, University of British Columbia, 1994.Google Scholar
  53. 53.
    Kearney MS: A comparative study of multiple family group therapy and individual conjoint family therapy within an outpatient chemical dependency treatment program. Doctoral dissertation, University of Minnesota, 1984.Google Scholar
  54. 54.
    Bennun I: Treating the system or symptom: Investigating family therapy for alcohol problems. Behav Psychother 16:165–176, 1988.CrossRefGoogle Scholar
  55. 55.
    Zweben A, Pearlman S, Li S: A comparison of brief advice and conjoint therapy in the treatment of alcohol abuse: The results of the Marital Systems study. BrJAddict 83:899–916, 1988.Google Scholar
  56. 56.
    Shoham V, Rohrbaugh MJ, Jacob T, et al: Demand-withdraw couple interaction moderates retention in cognitive-behavioral versus family-systems treatments for alcoholism. JFam Psychol 12:557–577, 1998.Google Scholar
  57. 57.
    Miller WR, Rollnick S: Motivational interviewing: Preparing People to Change Addictive Behavior. New York. Guilford Press, 1991.Google Scholar
  58. 58.
    Corder BF, Corder RF, Laidlaw ND: An intensive treatment program for alcoholics and their wives. QJ Stud Alcohol 33:1144–1146, 1972.Google Scholar
  59. 59.
    Cadogan, DA: Marital group therapy in the treatment of alcoholism. Q J Stud Alcohol 34:1187–1194,1973.PubMedGoogle Scholar
  60. 60.
    Fichter MM, Frick U: The key relative’s impact on treatment and course of alcoholism. Psychiatry Clin Neurosci 243:87–94, 1993.CrossRefGoogle Scholar
  61. 61.
    Chapman PLH, Huygens I: An evaluation of three treatment programs for alcoholism: An experimental study with 6-and 18-month follow-ups. BrJAddict 83:67–81, 1988.Google Scholar
  62. 62.
    Sobell LC, Sobell MB, Leo GI: Spousal support as a motivational intervention for problem drinkers. Paper presented at the 27th Annual Meeting of the Association for the Advancement of Behavior Therapy, Atlanta, Georgia, 1993.Google Scholar
  63. 63.
    O’Farrell TJ, Murphy CM: Marital violence before and after alcoholism treatment. J Consult Clin Psychol 63:256–262, 1995.CrossRefGoogle Scholar
  64. 64.
    O’Farrell TJ, Van Hutton V, Murphy CM: Domestic violence after alcoholism treatment: A two-year longitudinal study. J Stud Alcohol 60:317–321, 1999.Google Scholar
  65. 65.
    O’Farrell TJ, Choquette KA, Cutter HSG, et al: Cost-benefit and cost-effectiveness analyses of behavioral marital therapy with and without relapse prevention sessions for alcoholics and their spouses. Behav Ther 27:7–24, 1996.CrossRefGoogle Scholar
  66. 66.
    Fals-Stewart W, Birchler GR, O’Farrell TJ: Behavioral couples therapy for male substance-abusing patients: Effects on relationship adjustment and drug-using behavior. J Consult Clin Psychol 64:959–972, 1996.PubMedCrossRefGoogle Scholar
  67. 67.
    Fals-Stewart W, O’Farrell TJ, Birchler GR: (2000). Behavioral couples therapy versus individual-based treatment for male substance abusing patients: An evaluation of significant individual change and comparison of improvement rates. J Subst Abuse Treat 18:249–254.PubMedCrossRefGoogle Scholar
  68. 68.
    Fals-Stewart W, O’Farrell TJ, Birchler GR: Behavioral couples therapy for male substance abusing patients: A cost outcomes analysis. J Consult Clin Psychol 65:789–802, 1997.PubMedCrossRefGoogle Scholar
  69. 69.
    O’Neill S, Freitas TT, Fals-Stewart W The effect of behavioral couples therapy on spousal violence among drug abusers. Paper presented at the Annual Meeting of the Association for the Advancement of Behavior Therapy, Toronto, 1999.Google Scholar
  70. 70.
    Fals-Stewart W, O’Farrell TJ, Finneran S, et al: The use of behavioral couples therapy with metha-done maintenance patients: Effects on drug use and dyadic adjustment. Paper presented at the Annual Meeting of the Association for the Advancement of Behavior Therapy, New York, 1996.Google Scholar
  71. 71.
    Fals-Stewart W, O’Farrell TJ: Behavioral therapy enhancement of opioid antagonist treatment: Naltrexone with supervised administration using behavioral family counseling. Unpublished manuscript, Old Dominion University, Norfolk, Virginia, 1999.Google Scholar
  72. 72.
    Fals-Stewart W Behavioral couples therapy enhancement of HIV-medication compliance among HIV-infected male drug abusing patients. Unpublished manuscript, Old Dominion University, Norfolk, Virginia, 1999.Google Scholar
  73. 73.
    O’Farrell TJ, Fals-Stewart W Behavioral couples therapy for alcoholism and drug abuse. J Subst Abuse Treat 18:51–54, 2000.CrossRefGoogle Scholar
  74. 74.
    O’Farrell TJ, Feehan M: Alcohol treatment and the family: Do family and individual treatment for adult alcoholics have preventive effects for children? J Stud Alcohol, Supplement No.13:125–129, 1999.Google Scholar
  75. 75.
    Galanter M: Network Therapy for Alcohol and Drug Abuse. New York. Guilford Press, 1999.Google Scholar
  76. 76.
    Keller DS, Galanter M: Technology transfer of network therapy to community-based addictions counselors. J Subst Abuse Treat 16:183–189,1999.PubMedCrossRefGoogle Scholar
  77. 77.
    Institute of Medicine: Bridging the gap between practice and research: Forging partnerships with community-based drug and alcohol treatment. Washington, DC, National Academy of Sciences Press, 1998.Google Scholar
  78. 78.
    Ferguson JH: Technology transfer: Consensus and participation. The NIH Consensus Development Program. Jt Comm J Qual Improv 21(7):332–336, 1995.PubMedGoogle Scholar
  79. 79.
    Rogers EM: Diffusion of innovations, 4th ed. New York. The Free Press, 1995.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Timothy J. O’Farrell
    • 1
  • William Fals-Stewart
    • 2
  1. 1.Harvard Families and Addiction Program, Harvard Medical School Department of PsychiatryVeterans Affairs Medical CenterBrockton
  2. 2.Research Institute on AddictionsUniversity at Buffalo, The State University of New YorkBuffalo

Personalised recommendations