William Fals-Stewart

A comparison of behavioral group therapy and individual behavior therapy in treating obsessive-compulsive disorder

Outpatients with a primary DSM-III axis I diagnosis of obsessive-compulsive disorder (OCD; N = 93) were randomly assigned to one of three treatment groups: One group (N = 30) received 24 sessions of behavioral group therapy over a 12-week period; a second group (N = 31) received 24 individual behavior therapy sessions over the same treatment interval; and members of a control group (N = 32) received 24 individual sessions of progressive muscle relaxation. The Yale-Brown Obsessive-Compulsive Scale was administered before treatment, at 2-week intervals during treatment, and at 6-month follow-up to measure changes in distress caused by OCD symptoms. The Beck Depression Inventory and the Self-Rating Anxiety Scale were also administered at pretreatment, posttreatment, and 6-month follow-up. Both individual and group interventions proved to be equally effective at reducing distress caused by OCD symptoms, general depression, and anxiety by the end of treatment, although patients in the individual behavior therapy condition demonstrated faster reductions in OCD symptom severity. Patients in the group and individual behavioral interventions were able to maintain their gains at 6-month follow-up. Implications of these findings for outpatient treatment are discussed.

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.

The Occurrence of Male-to-Female Intimate Partner Violence on Days of Men's Drinking: The Moderating Effects of Antisocial Personality Disorder.

In this study, the moderating effects of antisocial personality disorder (ASPD) on the day-to-day relationship between male partner alcohol consumption and male-to-female intimate partner violence (IPV) for men entering a domestic violence treatment program (n=170) or an alcoholism treatment program (n=169) were examined. For both samples, alcohol consumption was associated with an increased likelihood of nonsevere IPV among men without a diagnosis of ASPD but not among men with ASPD (who tended to engage in nonsevere IPV whether they did or did not drink). Drinking was more strongly associated with a likelihood of severe IPV among men with ASPD compared with those without ASPD who also drank. These results provide partial support for a multiple threshold model of intoxication and aggression.

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.

Behavioral couples therapy for drug-abusing patients: effects on partner violence

Using data from a previous investigation, the purpose of the present study was to examine the effect of Behavioral Couples Therapy (BCT) on the prevalence of partner violence among married or cohabiting substance-abusing men (N = 80). Participants were randomly assigned to receive either BCT or individual-based treatment (IBT). The proportion of couples who engaged in male-to-female physical aggression was not different during the year before treatment for dyads in BCT (n = 17, 43%) and IBT (n = 19, 48%). However, a smaller proportion of couples in the BCT condition reported male-to-female physical aggression during the year after treatment (n = 7, 18%) than those in the IBT condition (n = 17, 43%). Dyadic adjustment, frequency of heavy drinking, and frequency of drug use during the year after treatment mediated the relationship between type of treatment and the prevalence of male-to-female physical aggression.

Behavioral couples therapy for female substance-abusing patients: Effects on substance use and relationship adjustment.

Married or cohabiting female drug-abusing patients (N = 75) were randomly assigned to either a behavioral couples therapy condition (BCT; n = 37), which consisted of group, individual, and behavioral couples therapy sessions, or to an equally intensive individual-based treatment condition (IBT; n = 38), which consisted of group and individual counseling. During most of the 1-year follow-up, compared with participants who received IBT, those who received BCT reported (a) fewer days of substance use, (b) longer periods of continuous abstinence, (c) lower levels of alcohol, drug, and family problems, and (d) higher relationship satisfaction. However, differences in relationship satisfaction and number of days of substance use dissipated over the course of the posttreatment follow-up period and were not significantly different by the end of 1 year.

Domestic violence treatment referrals for men seeking alcohol treatment

The annual prevalence of intimate partner violence (IPV) in samples of men seeking alcohol treatment has been estimated at 50% or higher. One proposed approach to these co-occurring problems is the provision of IPV screening and treatment referrals within alcohol treatment programs. The current study found that alcohol treatment providers infrequently referred men with a pretreatment year history of IPV to domestic violence treatment programs, and that men receiving such referrals rarely followed the recommendation and sought additional treatment. These findings suggest future research is necessary to identify factors that may act as barriers to IPV assessment or referral in alcohol treatment settings, factors that may limit client follow-through on such referrals, and new strategies for addressing IPV in substance abusing populations.

Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients.

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence.

A national survey of the use of couples therapy in substance abuse treatment

Although results from multiple studies conducted over the last two decades indicate that Behavioral Couples Therapy (BCT) is an effective treatment for married or cohabiting alcohol- and drug-abusing patients, both in terms of reduced substance use and improved relationship satisfaction, it is unclear whether BCT or other types of couples-based interventions are used in community-based substance abuse treatment programs. In the present study, program administrators (e.g., executive directors, clinical directors, staff physicians) from 398 randomly selected community-based outpatient substance abuse treatment programs in the U.S. were interviewed regarding use of different family- and couples-based therapies in their programs. According to the program administrators, 27% of the programs provided some type of couples-based treatment. However, less than 5% of the agencies used behaviorally oriented couples therapy and none used BCT specifically. Recommendations for researchers and clinicians to increase the use of BCT in community-based treatment programs are provided.

The relationship between length of stay in drug-free therapeutic communities and neurocognitive functioning

The relationship between neurocognitive functioning and length of stay in drug-free therapeutic communities (TCs) was investigated. The Wechsler Adult Intelligence Scale (WAIS) was administered to 495 patients admitted to a therapeutic community. It was hypothesized that Digit Symbol and Block Design, which have been found to be more sensitive to diffuse neuropsychological impairment than other WAIS subtests, would be significant predictors of length of stay. A hierarchical regression analysis was performed, and both subtests were found to be predictive of time-in-residence. These findings are congruent with recent investigations that have found a relationship between cognitive impairment and treatment process and outcome in substance abuse treatment.