Marie Murphy

Partner violence before and after couples-based alcoholism treatment for male alcoholic patients: the role of treatment involvement and abstinence

This study examined partner violence before and after behavioral couples therapy (BCT) for 303 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before BCT, 60% of alcoholic patients had been violent toward their female partner, 5 times the comparison sample rate of 12%. In the 1st and 2nd year after BCT, violence decreased significantly from the year before BCT, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after BCT. Structural equation modeling indicated that greater treatment involvement (attending BCT sessions and using BCT-targeted behaviors) was related to lower violence after BCT and that this association was mediated by reduced problem drinking and enhanced relationship functioning.

Alcohol consumption and intimate partner violence by alcoholic men: comparing violent and nonviolent conflicts.

Alcoholic men and their relationship partners were interviewed about a conflict in which physical assault occurred and 1 in which psychological aggression occurred without physical assault. The interview assessed the quantity of alcohol consumed prior to each conflict, other drug use, and the topics, location, timing, duration, and speed of escalation for each conflict. The number of standard drinks consumed by the husband in the previous 12 hr was significantly higher prior to violent versus nonviolent conflicts for both self- and collateral reports, as was blood alcohol concentration estimated from self-report. Other drug use was not significantly different. Greater drinking by wives prior to violent conflicts was found in some analyses. These within-subject comparisons help to rule out individual difference explanations for the alcohol-violence association and indicate that alcohol consumption is a proximal risk factor for partner violence in alcoholic men.

Examining the Correlates of Psychological Aggression Among a Community Sample of Couples

In this study, the authors examined the correlates of psychological aggression victimization and perpetration among a community sample of 145 heterosexual couples. For both women and men, psychological aggression victimization was associated with greater psychological distress, anxiety, and physical health symptoms beyond the effects of physical aggression. Psychological aggression victimization was also uniquely associated with higher levels of depression for women. Trait anger and poor relationship adjustment were the strongest correlates of psychological aggression perpetration across genders. Childhood father-to-child and father-to-mother aggressions were associated with psychological aggression perpetration for men only, suggesting possible distinct etiologies across genders. These data highlight the importance of the further development of models for psychological aggression in both women and men.

Concurrent validity of a brief self-report Drug Use Frequency measure

This study examined two sources of concurrent validity information for a brief Drug Use Frequency (DUF) measure--the well-validated Timeline Followback (TLFB) measure and knowledgeable collateral informants (i.e., spouses)--for 106 male alcoholic patients and their female partners (treatment sample couples) and for 130 male and female participants without current alcohol/drug problems (community sample couples). Results showed generally good concurrent validity of self-reported frequency of illicit drug use on the DUF. Treatment sample results showed high correlations (a) between patient self-reported frequency of drug use on the DUF and on the TLFB for all drug types and (b) between self- and collateral reports on the DUF for male patients and their female partners for the most commonly abused drugs (cannabis, cocaine, and heroin). Community sample results showed (a) high correlations between self- and collateral reports on the DUF for male and female participants for frequency of cannabis and cocaine use and (b) average percent agreement of 99% for all drug types on whether or not male and female participants had used each drug.

Intimate Partner Aggression Reporting Concordance and Correlates of Agreement Among Men With Alcohol use Disorders and Their Female Partners

This study examined relationship aggression reporting concordance among 303 men with alcohol use disorders and their female partners enrolled in couples-based alcohol abuse treatment. Agreement for physical and psychological aggression was generally consistent with, or higher than, concordance rates reported among other populations. Men’s antisocial personality disorder characteristics were the strongest predictor of higher concordance for male- and female-perpetrated aggression. Higher alcohol problem severity, poorer relationship adjustment, and higher psychopathic personality features were associated with better concordance in some analyses. Women reported experiencing more physical aggression than men reported perpetrating, and women reported perpetrating more psychological aggression than men reported experiencing. Findings highlight the importance of obtaining aggression reports from both partners and the need for research investigating methods for improving concordance.

A Randomized Clinical Trial of Behavioral Couples Therapy Versus Individually Based Treatment for Women With Alcohol Dependence

OBJECTIVE Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among men with alcohol use disorder (AUD). The present study compared BCT with IBT for women with AUD. METHOD Participants were women with AUD (N = 105) and their male partners without substance use disorder. Participants were mostly White and in their 40s. Women were randomized to equally intensive treatments consisting of either BCT plus 12-step-oriented IBT or IBT only. Primary outcomes included time line follow-back interview percentage days abstinent (PDA) and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcomes included the Dyadic Adjustment Scale (DAS), Relationship Happiness Scale (RHS), and Revised Conflict Tactics Scales measure of intimate partner violence (IPV). Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. RESULTS Compared with IBT only, BCT plus IBT had significantly better primary outcomes of higher PDA and fewer substance-related problems during the 1-year follow-up period. Compared with IBT only, BCT had significantly higher male RHS during the 1-year follow-up. Women with lower pretreatment DAS had significantly higher DAS following BCT versus IBT, and there was an increasing advantage for BCT on female DAS over the follow-up. IPV was significantly reduced from pretreatment to follow-up, with no differences between treatment conditions. CONCLUSION RESULTS showed that BCT for women with AUD was more efficacious than IBT in reducing substance use and substance-related problems and improving partner relationships.

Behavioral family counseling for substance abuse: a treatment development pilot study

Substance-dependent patients (N=29) living with a family member other than a spouse were randomly assigned to equally intensive treatments consisting of either (a) Behavioral Family Counseling (BFC) plus Individual-Based Treatment (IBT) or (b) IBT alone. Outcome data were collected at baseline, post-treatment, and at 3- and 6-month follow-up. BFC patients remained in treatment significantly longer than IBT patients. BFC patients improved significantly from baseline at all time periods on all outcomes studied, and had a medium effect size reflecting better primary outcomes of increased abstinence and reduced substance use than IBT patients. For secondary outcomes of reduced negative consequences and improved relationship adjustment, both BFC and IBT patients improved significantly and to an equivalent extent. The present results show BFC is a promising method for retaining patients in treatment, increasing abstinence, and reducing substance use. These results also provide support for larger scale, randomized trials examining the efficacy of behavioral family counseling for patients living with family members beyond spouses.

A Randomized Clinical Trial of Behavioral Couples Therapy Versus Individually-based Treatment for Drug-abusing Women

Objective: Behavioral couples therapy (BCT) is more efficacious than individually-based therapy (IBT) for substance and relationship outcomes among substance use disorder patients. This study compared BCT with IBT for drug-abusing women. Method: Sixty-one women, mostly White, late 30s, with primary substance use disorder other than alcohol (74% opioid), and male partners were randomized to 26 sessions over 13 weeks of BCT plus 12-step-oriented IBT (i.e., BCT + IBT) or IBT. Substance-related outcomes were percentage days abstinent (PDA), percentage days drug use (PDDU), Inventory of Drug Use Consequences. Relationship outcomes were Dyadic Adjustment Scale (DAS), days separated. Data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. Results: On PDA, PDDU, and substance-related problems, both BCT + IBT and IBT patients showed significant (p < .01) large effect size improvements throughout 1-year follow-up (d > .8 for most time periods). BCT + IBT showed a significant (p < .001) large effect size (d = −.85) advantage versus IBT on fewer substance-related problems, while BCT + IBT and IBT did not differ on PDA or PDDU (ps > .47). On relationship outcomes, compared to IBT, BCT + IBT had significantly higher male-reported Dyadic Adjustment Scale (p < .001, d = .57) and fewer days separated (p = .01, d = −.47) throughout 1-year follow-up. Conclusion: BCT + IBT for drug-abusing women was more efficacious than IBT in improving relationship satisfaction and preventing relationship breakup. On substance use and substance-related problems, women receiving both treatments substantially improved, and women receiving BCT + IBT had fewer substance-related problems than IBT.

A randomized clinical trial of group versus standard behavioral couples therapy plus individually based treatment for patients with alcohol dependence

OBJECTIVE Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among patients with alcohol use disorder. To facilitate dissemination, a multicouple, rolling admission Group BCT (G-BCT) format has been suggested as an alternative to the 1 couple at a time, conjoint Standard BCT (S-BCT) format. This randomized study compared outcomes of G-BCT versus S-BCT over a 1-year follow-up. The authors predicted that G-BCT, as compared to S-BCT, would have equivalent (i.e., noninferior) improvements on substance and relationship outcomes. METHOD Participants were patients (N = 101) with alcohol dependence and their heterosexual relationship partners without substance use disorder. Participants were mostly White, in their 40s, and 30% of patients were women. Patients were randomized to either G-BCT plus 12-step-oriented IBT or S-BCT plus IBT. Primary outcomes included Timeline Followback Interview percentage days abstinent and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcome was Dyadic Adjustment Scale. Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. RESULTS Results overall found no support for the predicted statistical equivalency of G-BCT and S-BCT. Rather than the predicted equivalent outcomes, substance and relationship outcomes were significantly worse for G-BCT than S-BCT in the last 6-9 months of the 12-month follow-up period, because G-BCT deteriorated and S-BCT maintained gains during follow-up. CONCLUSION This was the first study of the newer rolling admission group format for BCT. It proved to have worse not equivalent outcomes compared to standard conjoint BCT. (PsycINFO Database Record

Do outcomes after behavioral couples therapy differ based on the gender of the alcohol use disorder patient

OBJECTIVE This naturalistic study (conducted from 1992 to 1998) of behavioral couples therapy (BCT) compared female and male alcohol use disorder (AUD) patients on improvement and on drinking and relationship outcomes after BCT. We also evaluated gender differences on presenting clinical problems and extent of BCT participation. METHOD Participants were 103 female and 303 male AUD patients (98.5% alcohol dependence, 1.5% alcohol abuse) and their heterosexual partners, mostly White in their forties. Couples received 20-22 BCT sessions over 5-6 months. Drinking outcomes were percentage days abstinent (PDA) and alcohol-related problems. Relationship outcome was Dyadic Adjustment Scale. Outcome data were examined at baseline, post-treatment, and 6- and 12-month follow-up. Presenting problems were demographics, alcohol problem severity, illicit drug use, emotional distress, and relationship adjustment. BCT participation was BCT attendance and BCT-targeted behaviors. RESULTS We found few differences between female and male patients, who did not differ on improvement and outcomes after BCT. Both females and males showed significant large effect size improvements through 12-month follow-up on PDA and alcohol-related problems, and significant small to medium effect size improvements on relationship adjustment. Both females and males had high levels of BCT participation. Gender differences in presenting clinical problems (females being lower on age, years problem drinking, and baseline PDA, and higher on emotional distress) did not translate into gender differences in response to BCT. CONCLUSION Results showed no support for the suggestion that BCT might lead to greater improvement and better outcomes for female than male AUD patients on drinking or on relationship outcomes.