Couples  and  Family  Involvement  

Nancy  A.  Haug,  Ph.D.  

Psychological  Treatment  for  Substance  
Abuse  
Week  9  
 Recovery  and  RelaFonships  
•  “Sobriety  may  be  harmful  to  your  
relaFonships…  and  your  relaFonships  may  be  
harmful  to  your  ability  to  maintain  sobriety.”  
 Family  and  AddicFon  Hypotheses  
•  Disturbed  Spouse  Hypothesis  
•  Disturbed  Family  Hypothesis  
•  Codependence  Hypothesis  
 Family  and  AddicFon  Hypotheses  
•  No  scienFfic  evidence  that  there  is  something  
wrong  with  spouses  or  family  members  of  
people  with  addicFon.  
 Family  Adjustment  Model  
•  Stress-­‐coping  Hypothesis:  SO  or  family  
members  demonstrate  a  normal  adjusFve  
reacFon  to  the  addicFve  behavior  of  their  
loved  one.  
–  Behaviors  may  include:  buying  alcohol  or  drugs,  
protecFng  loved  one  from  negaFve  
consequences.  
 How  can  family  members  help?  
•  Reinforce  sobriety  à  Learn  to  disFnguish  
between  behaviors  that  favor  recovery  and  
those  that  favor  conFnued  use  and  addicFon.    
–  Enabling  behavior  vs.  posiFve  reinforcement  for  
not  using  and  alternaFves  to  using  
–  Al-­‐Anon  à  “loving  detachment”  
 Behavioral  Couples  Therapy  
•  Designed  for  married  or  cohabitaFng  couples  
in  which  one  person  is  seeking  help  for  
addicFon.  
•  12-­‐20  weekly  sessions  over  3-­‐6  months  
•  Can  be  adjunct  to  individual  therapy  
•  Couples  are  married  or  cohabitaFng  for  at  
least  1  year  
 BCT:  Goals  
•  Build  moFvaFon  for  engagement  and  discuss  
approach  with  couple.  
•  Achieve  and  maintain  absFnence.  
•  Have  couple  improve  quality  of  relaFonship.  
•  Maintenance  plan  for  conFnuing  recovery.  
 Behavioral  Couples  Therapy  
1.  Substance-­‐focused  intervenFons  
–  Daily  recovery  contract  
–  FuncFonal  analysis  
–  Self-­‐help  
–  Coping  skills  
2.  RelaFonship-­‐focused  intervenFons  
–  Increasing  posiFve  behaviors  
–  Strengthening  communicaFon  skills  
 Family  Treatment  for  Adolescents  
•  MulFsystemic  Therapy  (MST):  family  and  
community-­‐based  treatment  for  adolescents  
involved  in  criminal  jusFce  system  
•  Brief  Strategic  Family  Therapy  (BSFT):  manualized  
brief  intervenFon  (8-­‐24  sessions)  to  treat  
behavioral  problems  and  substance  abuse.  
•  MulFdimensional  Family  Therapy  (MDFT):  family-­‐
based  approach;  targets  mulFple  pathways  
 SAMSHA’s  NaFonal  Registry  of  
Evidence-­‐based  programs  and  
PracFces  (NREPP)  
•  hcp://www.nrepp.samhsa.gov/
ViewIntervenFon.aspx?id=254  
•  hcp://www.nrepp.samhsa.gov/
ViewIntervenFon.aspx?id=151  
•  hcp://www.nrepp.samhsa.gov/
ViewIntervenFon.aspx?id=16  
 ConFngency  Management  
•  IncenFves  are  provided  to  clients  conFngent  
upon  objecFve  evidence  of  drug  absFnence.  
•  One  of  the  most  effecFve  approaches  to  
promoFng  absFnence  during  and  ajer  
treatment  (Dallery  &  Raiff,  2012)  
–  Cocaine  use  
–  Heroin  use  
–  Polydrug  use  
–  Cigarece  smoking  
 CM  Methods  
•  Voucher-­‐based  CM  
•  Intermicent  prizes  (Fishbowl)  
•  Employment-­‐based  
•  Cash    
•  Deposit  contract  
•  Take-­‐home  doses  
 Variables  that  Influence  CM  
•  Schedule  of  reinforcement  
–  EscalaFng  
–  Reset  
•  Reinforcer  magnitude  
•  Delay  to  reinforcement  
•  Shaping  
 Reinforcement  of  other  target  
behaviors  
•  Therapy  acendance  
•  Treatment  plans  
•  MedicaFon  adherence  
 CM  ConsideraFons  
•  Vouchers  must  be  spent  on  non-­‐drug  acFviFes  
–  Groceries  
–  Discount/department  stores  
–  Auto  and  home  maintenance  
–  Restaurants  
–  Entertainment  
–  Children’s  needs  
•  Financial  decision-­‐making