1. Behavioral Couples Therapy for Substance Abuse

Behavioral Couples Therapy for Substance Abuse

Program Goals

Behavioral Couples Therapy for Substance Abuse (BCT) is a family-based treatment approach for substance- and alcohol-abusing couples and their families. The assumption underlying BCT is that therapeutic interventions that are designed to address substance abuse problems while concurrently dealing with a patient's family and relationship issues may provide a significant benefit because family and relationship factors appear to play a critical role in a patient’s abstinence from substance abuse and relapse after treatment. Involvement of intimate partners in the therapeutic process could increase the success of treatment and reduce the risk of relapse.


Patients are required to remain abstinent from drugs and alcohol through a sobriety contract, which is verbally agreed to and is reinforced with the help of the patient’s significant other. Patients are taught communication skills such as active listening and expressing feelings directly. They are also taught Cognitive Behavioral Therapy skills to: cope with exposure to drugs, identify high-risk situations, deal with cravings, and confront thoughts of use. Couples are encouraged to find positive behaviors and enjoyable activities that can be shared together to increase relationship satisfaction.


Program Components

Meetings usually last 60 to 90 minutes and include individual, group, and couples sessions. BCT consists of three phases: orientation, primary treatment, and discharge.


During the 4-week orientation phase, basic medical information and history are collected. Patients attend the individual and group therapy sessions during this phase.


The primary treatment phase lasts 12 weeks. Couples therapy sessions are added to the ongoing individual and group sessions. Couples are also asked to complete a Marriage Happiness Scale each week to measure the general happiness of partners in the relationship.


During the 8-week discharge phase, patients attend only individual therapy sessions.


Throughout treatment, patients are required to submit urine or blood–alcohol breath samples at each session, though only one urine sample is tested a week.

Intervention ID

20 to 60


Study 1

Substance Use

The study by Fals–Stewart and colleagues (2000) found that at pretreatment and immediately following posttreatment both intervention groups had no significant difference in percentage of days abstinent (PDA). But at the 3- and 6-month follow-up periods the Behavioral Couples Therapy for Substance Abuse (BCT) group showed a significantly greater PDA than the individual-based treatment (IBT) group showed. Over the entire follow-up period, the BCT group showed a significantly larger proportion of patients reporting significant reductions in substance use, when compared to those in the IBT group.


Relationship Adjustment

Relationship adjustment scores at pretreatment were not different. But immediately posttreatment and at the 3-month follow-up, the BCT group had significantly higher scores. Compared over time, the BCT group showed significant improvements on their Marital Adjustment Test (MAT) scores, when compared with couples in the IBT group. Couples in the IBT group showed significant deterioration of scores over time.


Study 2

Relationship Satisfaction

The study by Winters and colleagues (2002) showed that couples in the BCT intervention reported significantly higher Marital Happiness Scale (MHS) scores during weeks 5–12 of treatment than couples in the IBT group reported. Relationship adjustment from the DAS scores was significantly higher for the BCT group during the 3- and 6-month follow-ups but not at any other time.


Substance Use

At the 3-, 6-, and 9-month follow-ups, BCT patients showed a significantly higher PDA than the IBT group, but no significant difference was found at any other point in time. The BCT group relapsed at a significantly slower rate than the IBT group over time.


Study 3

Alcohol Use

There was no significant difference between interventions for PDA at pretreatment and posttreatment or rate of change during treatment in the Fals–Stewart, Birchler, and Kelley (2006) study. Over the 12-month follow-up period, however, BCT patients increased their drinking at a significantly slower rate than patients in IBT or psychoeducational attention control treatment (PACT).


Relationship Satisfaction

During treatment, BCT couples had a faster rate of improvement in relationship satisfaction than couples in IBT or PACT. Immediately posttreatment, BCT couples had higher Dyadic Adjustment Scale (DAS) scores and declined at a slower rate during the 12-month follow-up period.


Partner Violence

At pretreatment there were no differences between interventions on the Drinker Inventory of Consequences (DrInC) or the Conflict Tactics Scale of the Timeline Followback Interview–Spousal Violence (TLFB–SV). The 12-month follow-up revealed significantly greater reductions on the Interpersonal, Intrapersonal, and Social Responsibility subscales of the DrInC and in the Days Any Violence (Male to Female and Female to Male) subscales of the TLFB–SV for the BCT couples.

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