Henry S. G. Cutter

Evaluating behavioral marital therapy for male alcoholics: Effects on marital adjustment and communication from before to after treatment

Married couples, in which the husband had recently begun individual outpatient alcoholism counseling, were randomly assigned to a no-marital-treatment control group or to 10 weekly sessions of either a behavioral or an interactional couples therapy group. Couples who received the behavioral marital therapy (BMT) improved significantly from before to after treatment on overall marital adjustment, extent of desired relationship change, marital stability, and positiveness of communication when discussing a current marital problem. Interactionally treated couples improved on extent of desired relationship change and positive communication while discussing vignettes from the Inventory of Marital Conflicts. The control couples did not improve on any of the marital relationship variables. BMT produced better results than no marital therapy on marital adjustment and

Sensation seeking and novelty seeking : are they the same ?

Responses to Zuckermans Sensation Seeking Scale (SSS) and Cloningers Tridimensional Personality Questionnaire (which consists of novelty seeking, harm avoidance, and rewarddependence dimensions) have been linked to a variety of behavioral and psychiatric variables. The relationship of these two measures to one another has not been examined previously and, in the present study, is evaluated in a group of men briefly hospitalized for treatment of alcohol and chemical dependence. Total sensation seeking scale scores were significantly correlated (Pearson r) with total novelty seeking scale scores. Set correlation analysis revealed significant overall relationships between sensation seeking and both high novelty seeking and low harm avoidance. Most of these overall relationships were attributable to six subscales, although broad relationships were observed between the SSS disinhibition and novelty seeking subscales, and between a harm avoidance subscale and all SSS subscales. Neither statistical approach identified an association between reward dependence and sensation seeking.

Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment

Thirty-six newly abstinent married male alcoholics, who had recently begun outpatient individual alcoholism counseling, were randomly assigned to a no-marital-therapy control group or to 10 weekly sessions of a behavioral marital therapy (BMT) or an interactional couples group. The cost-benefit analysis of BMT plus individual alcoholism counseling showed (a) decreases in health care and legal costs in the 2 years after as compared to the year before treatment, (b) a positive cost offset, and (c) a benefit-to-cost ratio greater than 1 indicating that health and legal system cost savings (i.e., benefits) exceeded the cost of delivering the BMT treatment. None of the positive cost-benefit results observed for BMT were true for participants given interactional couples therapy plus individual alcoholism counseling for which posttreatment utilization costs increased. Thus, adding BMT to individual alcoholism counseling produced a positive cost benefit, whereas the addition of interactional couples therapy did not. Individual counseling both alone and with BMT added showed substantial and significant cost savings from reduced utilization that substantially and significantly exceeded the cost of delivering the treatment; and the two treatments did not differ significantly on these cost savings and cost offsets. Individual counseling alone did have a significantly more positive benefit-to-cost ratio than BMT plus individual counseling due to the lower cost of delivering the individual counseling which was about half the cost of delivering BMT plus individual counseling. Cost-effectiveness analyses indicated that BMT plus individual counseling was less cost effective than individual counseling alone and modestly more cost effective than interactional therapy in producing abstinence from drinking. When marital adjustment outcomes were considered, the three treatments were equally cost effective except during the active treatment phase when BMT was more cost effective than interactional couples therapy. Study limitations are discussed.

Cost-benefit and cost-effectiveness analyses of behavioral marital therapy with and without relapse prevention sessions for alcoholics and their spouses

Fifty-nine couples with a newly abstinent alcoholic husband, after participating in weekly behavioral marital therapy (BMT) couples sessions for 5 to 6 months, were randomly assigned to receive or not to receive 15 additional conjoint couples relapse prevention (RP) sessions over the next 12 months. Costs of treatment delivery and health and legal service utilization were measured for the 12 months before and 12 months after BMT. Cost-benefit analysis results for both standard BMT and for the longer and more costly form of BMT with the additional RP sessions showed (a) decreases in health care and legal costs after, as compared to before, treatment, (b) positive cost offsets, and (c) benefit to cost ratios greater than 1, indicating that health and legal system cost savings (i.e., benefits) exceeded the costs of delivering the BMT treatments. In fact, cost savings from reduced utilization were more than 5 times greater than the cost of delivering the standard 5- to 6-month BMT program. Although adding RP to BMT led to less drinking and better marital adjustment, it did not lead to greater cost savings in health and legal service utilization. A trend for subjects with higher baseline costs to incur lower costs at follow-up if they received BMT plus RP suggested additional cost savings from RP may come only for more severe problem patients who have a history of high utilization of services. Cost-effectiveness analyses indicated that BMT only was more cost-effective than BMT plus RP in producing abstinence from drinking, but the 2 treatments were equally cost-effective when marital adjustment outcomes were considered. Since BMT only was actually less effective than BMT plus RP in producing abstinent days, it was the lower cost of BMT only that produced its greater cost-effectiveness in relation to abstinence. Study limitations are discussed.

Research Notes: Personality Characteristics and Drug of Choice

This research is addressed to the question: Do personality characteristics measured by MMPI scales differ with the drug of choice of drug abuser populations? Several studies indicate that drug abusers tend to produce high scores in measures of psychopathic deviance and depression. Gilbert and Lombardi (1967) found that the items of the MMPI most significant in identifying drug abusers (not differentiated by drug of choice) were derived from the D and Pd scales.

Behavioral marital therapy couples groups for male alcoholics and their wives

This article presents in detail the clinical procedures for a behavioral marital therapy (BMT) couples group for male alcoholics. Methods used to recruit and prepare couples for therapy are presented. In the BMT couples group, therapists use behavioral rehearsal and weekly homework assignments to help couples decrease drinking and alcohol-related interactions by making an Antabuse Contract and discussing relapse prevention; plan shared recreational activities; notice, acknowledge, and initiate daily caring behaviors; learn communication skills of listening, expressing feelings directly, and the use of planned communication sessions; and negotiate desired changes using positive specific requests, compromise, and written agreements. Methods for dealing with resistance and noncompliance in the group are also described. Finally, modifications in the BMT treatment package presented here that may be helpful in other settings are described.

Experience with alcohol and the endogenous opioid system in ethanol analgesia

This study employed naloxone, an opiate antagonist, to explore whether a learned opioid response, mediated by drinking experience, accounts for ethanol and placebo analgesia. Cold pressor pain was evaluated before and after ethanol (0.5 g/kg), placebo, and no-alcohol control treatments (administered in randomized order) and again after double-blind administration (6 mg/kg) of naloxone to 11 men and saline to 9. A triple interaction of treatments, antagonist conditions, and drinking experience indicated that naloxone as compared to saline diminished ethanol and placebo analgesia among experienced drinkers but had opposite effects among the same men in the control treatment. Six men, who reported that the injection of naloxone had an effect on pain, had higher drinking experience scores than the five men who reported naloxone had no effect. The similar pattern of response to both the alcohol and the placebo treatments suggests that the opioid system response to alcohol is learned.

Behavioral Marital Therapy for Male Alcoholics: Clinical Procedures from a Treatment Outcome Study in Progress.

Abstract This paper presents in detail the clinical procedures from a study in progress comparing behavioral with nonbehavioral couples group therapy for male alcoholics. Methods used to recruit and prepare couples for both types of therapy are presented. The interactional couples group provided feedback on current negative interaction patterns and suggested changes in couple behavior but did not use behavioral rehearsal or specific homework assignments. The behavioral couples group used behavioral rehearsal and weekly homework assignments to help couples: 1) decrease drinking and alcohol-related interactions by making an Antabuse Contract and discussing relapse prevention; 2) plan shared recreational activities; 3) notice, acknowledge, and initiate daily caring behaviors; 4) learn communication skills of listening, expressing feelings directly, and the use of planned communication sessions; and 5) negotiate desired changes using positive specific requests, compromise, and written agreements. Methods for ...

Mood, Primary Heroin Withdrawal, and Acute Methadone Administration

This study was designed to: describe the internal state of addicts undergoing primary withdrawal, determine how the internal state is altered by the alleviation of withdrawal stress through an acute dose of methadone, and to determine a predictor of the probability of a patient completing detoxification. Sixty-seven male and female heroin addicts accepted for methadone detoxification were administered a 65-item Profile of Mood States (POMS). Forty-nine of the Ss were tested immediately prior to receiving their initial dose of methadone and again 45 minutes later, while the remaining 18 Ss were only tested 45 minutes after receiving their methadone in order to control for the effects of repeated testing. Each of the subscales measured by the POMS showed a significant decrease in mood disturbance following methadone administration (p less than .0001); these differences could not be attributed to the effects of repeated testing. Factor analysis of pre- and post-methadone treatment scores indicated a two-factor structure prior to receiving methadone and a single unified mood state after the alleviation of primary withdrawal stress. The Anger subscale, administered immediately prior to receiving methadone, was a highly significant predictor of the completion of detoxification (p less than .005). Further implications of the results were discussed.

Family experience and the motives for drinking.

Family socialization experience as reported by 128 students was posited to be related (both linearly and curvilinearly) to the seriousness of the reasons or motives for drinking. A correlational analysis, following orthogonalization of the independent variables, indicated that the frequency of intoxication by the mother was linearly and positively related to the number of reasons checked by students for drinking. Extreme closeness and extreme distance between the parents was related to drinking for personal effects (i.e., to improve self-esteem), while neutral or ambiguous attitudes toward drinking by the father were related principally to moderately serious personal and interpersonal reasons for drinking. The findings suggest that college students are at risk of becoming problem drinkers to the extent their family socialization experience included maternal deviant drinking, weak or fuzzy paternal norms about drinking, and extreme closeness or distance between parents. Family conditions that lead to poor self-esteem were seen as a necessary but not sufficient cause of problem drinking. Suggestions are made for future research and for a new, conceptually related alcoholism-prevention program.