Patients and Couples Therapy for Those Who Engage in Substance Abuse

Introduction

Domestic violence and intimate partner violence (IPV) constitutes a significant relationship challenge in the US. Fals-Stewart, Kashdan, O’Farrell, and Birchler (2002) inform that about 8.7 million couples encounter physical violence that is acerbated by their partners every year in the US. Research conducted by Schafer, Caetano, and Clark (1998) suggests that one in every five couples encounters inter-partner violence at least once each year.

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This violence is acerbated in the form of domestic conflicts. Also referred to as spousal abuse, domestic violence entangles the expression of a certain pattern of behavior that is abusive towards one’s partner in a relationship that involves marriage, cohabitation, dating, or a familial affair. It is acerbated in several ways, including battering, expressive mistreatment, sexual exploitation, economic dispossession, domineering, and threats among other forms of personal oppression.

Fals-Stewart et al. (2002) assert that alcohol abuse and the use of various psychoactive substances constitute a major risk factor for both domestic violence and IPV. The researchers also state that more than 50 percent of male partners who engage in substance abuse treatment programs acerbate violence towards their partners within the past one year (Fals-Stewart et al., 2002). This claim suggests a direct relationship between substance abuse and IPV.

To address the problem of domestic violence and IPV, partners must engage in evidence-based drugs and substance abuse treatment programs. This paper discusses behavioral couple therapy as one of the treatment programs for some identified patients and couples who engage in substance abuse. It first offers a background to behavioral couple therapy (BCT) before identifying patients and couples where the intervention can help reduce drugs dependence to improve their relationships.

Behavioral Couple Therapy (BCT)

Behavioral Couple Therapy (BCT) aids in reducing dependence on substances whilst enabling partners to improve their relationships. Over the last four decades, BCT has received immense scholarly support for its ability to produce positive effects on alcoholic couples concerning the reduction of alcohol consumption and relationship adjustments (Fals-Stewart et al., 2002). The treatment approach seeks to reduce “substance abuse directly, and through restructuring of the dysfunctional couple interactions that frequently help sustain it” (Fals-Stewart, O’Farrell, & Birchler, 2004, p.30). Scholarly studies indicate that patients who undergo BCT record higher dependence reduction levels in comparison with partners who are only engaged in counseling therapy (Fals-Stewart et al., 2004).

BCT aims at breaking down destructive cycles of behaviors that lead to marital problems. Fals-Stewart et al. (2004) claim that marital challenges have known causes such as poor communication, poor problem solving, financial stressors, and engagement in habitual destructive arguments. Perhaps, this situation sets forth the possibilities of engaging in habitual alcoholism and psychoactive drugs. Mechanisms through which families respond to problems of drug abuse have implications on subsequent drug abuse and addiction. In recognition of this assertion, BCT aims at eliminating drug and substances abuse among partners. It engages families in supporting the identified patients in the recovery process and subsequent long-term maintenance of positive behaviors.

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The effectiveness of BCT rests on the need to harness and influence couples positively to embrace drug and alcohol abstinence. Thus, it is only effective for couples who are in stable relationships that involve partners who are either married or cohabiting for longer than one year. The BCT approach depends on the capacity of participants to accept new strategies of coping with marital problems and practice new strategies of living together.

Fals-Stewart, O’Farrell, and Birchler (1996) highlight the need for administering BCT to couples who are in stable relationships. For a sample of 80 patients who engaged in BCT treatment, “Couples who received BCT as part of individual-based treatment had better relationship outcomes in terms of more positive dyadic adjustment and less separation time than couples whose husbands received individual-based treatment only” (Fals-Stewart, et al., 1996, p.959). The longer time of separation implies the likelihood of emotional disconnection between partners.

Different methods of treatment of behavioral problems are effective in different extents. Stanton and Shadish (1997) conducted a meta-analysis study of different drug abuse treatment options, including the BCT approach. The study analyzed 1,571 cases that involved more than 3,500 patients and family members. The study found that the majority of the patients preferred family treatment options to individual remedy, individual psychoanalysis, peer rehabilitation, and family psycho-education (Stanton & Shadish, 1997). It concluded that family therapy was equally effective in the treatment of drug abuse in adults and adolescents. Based on this evidence for family therapy that includes the BCT treatment option, BCT is chosen in the next section as the most preferred treatment therapy for couples.

Identified Patient in the Couple that has Substance Abuse Problem

Mr. and Mrs. Collins have had a history of relationship discontents. Considering their history of intimate partner violence, the couple contemplated filing a divorce. However, after self-investigation, they decided to seek counseling aid from a relationship counselor in New Jersey. Mr. Collins was a regular drunkard. When asked why he abused alcohol, he replied, ‘I only drink all days in a week to forget and avoid by own failure in my relationship with my partner.’

Further inquiry of the relationship between the two reveals that they have had significant relationship challenges. Mrs. Collins accuses her husband of luring her into a dependency problem. She claims that she once considered drinking a good option out of dissatisfaction in the manner in which Mr. Collins executed his familial responsibilities. She thought it would help her overlook her husband’s weakness and failures to fulfill his obligations in the relationship. Nevertheless, she never tasted it.

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Physical aggression is the order of the day in Mr. and Mrs. Collins’ family. Mrs. In several incidences, Collins alleges that her husband has abused her emotionally, physically, intimidated her, and even tortured her economically by denying her freedom to work.

Mrs. Collins claims that this move was an effort to acquire her total control. This situation agrees with Mogford’s (2011) claim that the goal of abusers in battles of domestic violence entails deploying tactics of instilling fear, shame, guilt, and intimidation to wear down their targets physically and emotionally. The experience of Mrs. Collins in the relationship makes her believe that indulgence in alcohol abuse is not sufficient to address her problems. She asserts that divorce is the best solution, as she has no hopes for a better relationship with Mr. Collins. Alcoholism cannot help her out of the situation.

Mr. Collins is fully aware that he is guilty of initiating problems in his family. However, he feels that the situation is not hopeless. When asked whether he is ready to quit abusing alcohol, he replies diligently that he can abandon drinking, ‘if it only helps keep and improve my relationship with Mrs. Collins.’ However, when asked why he battles his wife, he says he is usually out of control in such moments. Mrs. Collins contends that there is no single moment that he has ever battled her in the absence of alcohol influence. However, it seems that he will never quit. Mr. Collins regrets the several beatings she has given his partner. He describes them as beatings that lack a noble or necessary cause.

Mrs. Collins complains that her partner gives her some allowances, although he closely monitors how she spends the money. Mr. Collins has also been using financial resources they have gathered without seeking her partner’s consent. Awang and Hariharan (2012) assert that in some situations, perpetrators of domestic violence may also make sure that all savings that belong to the victims are used in totality so that the victim has limited access to financial resources.

This situation is evident in the case of Mr. and Mrs. Collins since Mr. Collins has accessibility to all of Mrs. Collins’ financial resources. All earnings from the real estate are directly loaded into Mr. Collins’ bank account, yet Mrs. Collins contributed 60% in the investments. Even though Mrs. Collins sees divorce as the best solution, she insists that such an option might render her financially handicapped at least in the short run, yet she also values her husband, especially when she remembers the past good moments before alcoholism came into his life.

Goals of Treatment: Meeting the Needs of both Parties

Considering the case of Mr. and Mrs. Collins, a drug abuse treatment approach that enhances cessation is required. Based on facts from the case, the BCT approach can be an effective treatment option for the couple. Upon considering the high IPV prevalence levels between couples who engage in abuse of drugs and alcohol, Fals-Stewart et al. (2002) assert that attention in many studies focuses on the implication of physical aggression in long-term and cohabitation relationships.

This focus is critical since physical aggression, as witnessed in the case of Mrs. and Mr. Collins, increases when drug and alcohol abuse are involved and/or when there are communication problems that lead to poor interaction among partners. BCT also comprises one of the behavioral therapy techniques that have received incredibly high empirical evidence for their effectiveness (Fals-Stewart et al., 2004; Fals-Stewart, O’Farrell, Birchler & Cordova, 2005). However, for its effectiveness, partners undergoing its treatment process have to set certain goals.

The chief BCT goal concerning the case of Mr. and Mrs. Collins is to induce and enhance alcohol abuse abstinence. Fals-Stewart et al. (2004) observe that BCT is the most efficient treatment option where one partner engages in alcoholism or psychoactive drug abuse. Where two partners abuse drugs and alcohol, cessation becomes problematic since such couples report high satisfaction in their relationships when they are under the influence of alcohol or psychoactive drugs (Fals-Stewart, 2003).

Mrs. Collins does not abuse alcohol. Thus, it is possible that when Mr. Collins decides to engage in alcohol cessation as the primary long-term goal, Mrs. Collins will support him to induce abstinence behavior. Considering that Mr. Collins is interested in building a positive relationship with Mrs. Collins, abstinence constitutes the best goal that meets the needs of both parties. This goal can enable the partners to live economically, personally, and socially productive lives.

The couple must also set a goal to undergo the treatment process without relapse. This process entails the preparation for cessation, intervention, and maintenance. The objective of the preparation stage entangles inducing motivation of drug users to embrace cessation by acquiring confidence that they can quit successfully (Winters, 2009). The intervention phase deploys various evidence-based methodologies for achieving abstinence.

For the case of Mr. and Mrs. Collins, the methodology entails the BCT approach. In the maintenance phase, the focus is on enhancing retention of the acquired positive mechanism of quitting and abstinence as prescribed by the BCT approach. This plan requires the development of support, various coping mechanisms, and substitution of drinking behavior with other behaviors to foster permanent alcohol use abstinence.

Codependency

In the treatment of alcoholism problems using the BCT approach, a therapist treats the patient with the help of his or her cohabiting or married partner. The non-alcohol or psychoactive drug-abusing partner provides the necessary support to the patient in the cessation process (Fals-Stewart et al., 2005). This observation implies that the BCT is ineffective without codependency. This concept refers to a psychological condition in which a person who is experiencing a pathological condition such as drug abuse or alcoholism depends on another intimate person for control in an attempt to induce and/or maintain positive cessation behaviors (Moos, Finney & Cronkite, 2007).

To help Mr. Collins quit the behavior, Mrs. Collins needs to sacrifice her own needs and/or be preoccupied with helping her partner adopt a positive behavior. Mr. Collins needs to give up his self-esteem that is associated with having absolute control over his partner. This outcome is only possible if he can attribute the problems in his relationship to alcoholism as has done.

To reconstruct a positive relationship between Mr. and Mrs. Collins, both partners need to create cognition and the belief that they are sacrificing their self-esteem to meet the needs of each other. This strategy ensures that either party engages in a constant search for acceptance. Mr. Collins needs to accept his guiltiness in terms of contributing to the current problems that are experienced in their marital relationship to express his willingness to rectify his past mistakes, especially by quitting drinking, which Mrs. Collins claims is the cause of family woes. Although this situation presents Mr. Collins as the vulnerable party, he must accept such vulnerability to enhance codependency. However, the question of whether Mr. Collins can willingly lose his established position of control is relevant to determine his ability to become codependent on his partner.

The psychodynamic theory claims that alcoholic people possess low self-esteem and a narcissistic type of personality. Kaskutas (2009) adds that they are also characterized by omnipotence. They indulge in excessive drinking to medicate themselves as a mechanism of meeting certain unmet needs and aspirations. This situation leads to the development of poor psychological mental states. In this context, codependence is important to help in terms of recovery of the lost good psychological state. This plan can increase motivation for Mr. Collins’ alcoholism abstinence when he believes that his partner is in control of the situation.

However, having the belief that Mrs. Collins is in control of the situation that led to alcoholism without an internal drive to stop drinking cannot satisfactorily compel Mr. Collins to change his alcoholism behavior. This observation suggests that Mr. Collins can only develop codependence if he is motivated to engage in sensation. He is fully aware of the repercussion of his failure to complete cessation such as divorce, which he does not want.

Mrs. Collins depends on Mr. Collins to the extent that her emotional and psychological health relies on his behavior. For instance, she knows too well that she can only have a good relationship if her partner stops drinking. She also depends economically on her partner. For her to take control of her partner’s recovery process, she needs to recover from her current codependence. This situation requires the cultivation of strategies for dealing with the victim’s mentality (Moos et al., 2007). This plan enables her to feel empowered to take charge of the relationship, rather than being an agent that attracts external mercy and sympathy. This empowerment can help Mr. Collins develop the cognition that he is no longer in control of the relationship alone. Therefore, he can embrace codependence behavior, which is pivotal to the recovery process.

Enabling

Once cessation is initiated, its enabling is crucial. The BCT therapist has a noble role to create a platform for enabling cessation success. One way of achieving this goal is by helping partners agree on the daily recovery (sobriety contract). Under this contract, Mr. and Mrs. Collins need to agree on trust discussions on daily sobriety (Fals-Stewart et al., 2005). In the discussions, Mr. Collins needs to state the intention of not consuming alcohol within the day. This approach is one-day abstinence at a time (Kaskutas, 2009).

Mrs. Collins has the responsibility of enabling the recovery process. She needs to express her willingness to support her partner in terms of maintaining his abstinence goals every day. Where medication for supporting abstinence is administered, Mrs. Collins needs to declare that she will ensure the timely taking of the medication. This plan acts as an important enabling factor that is recurrent in the sobriety trust discussions. Mrs. Collins also needs to maintain a record of the performance of her partner concerning his sobriety targets. Both parties need to make an agreement that they will never engage in discussions that are reminiscent of past drinking habits during the treatment process unless when under mediation by their therapist. The objective here is to avoid relapse.

Other Dynamics that might occur with a Couple where a Substance Abuse Problem Exists

Apart from IPV and domestic violence, other dynamics occur among couples where the problem of substance abuse exists. For instance, Fals-Stewart et al. (2005) associate substance abuse with destructive communication, negative feelings, and lack of shared activities. It is important to note that these factors also have a negative relationship with the maintenance of sobriety (Kaskutas, 2009).

Substance use problem has a negative implication on family health and health promotion. For instance, smoking tobacco is harmful to the health of people of all ages. The smoke has an excess of 7000 chemical substances, with 70% of them posing the risk of contracting cancer (CDC, 2014). People who quit using tobacco experience a reduced risk of contracting many ailments that are associated with it. More importantly, they escape premature death. CDC (2014) confirms that stopping smoking is highly beneficial to people who make such decisions early enough, although those who stop at late ages also benefit. These benefits include a reduced risk of lung cancer, coronary heart disease, COPD, stroke, infertility among women, and low birth weight among others. In the case of alcohol, it is associated with liver cirrhosis and psychological problems.

Reference List

Awang, H., & Hariharan, S. (2012). Determinants of Domestic Violence: Evidence from Malaysia. Journal of Family Violence, 26(6), 459-464.

CDC. (2014). Smoking Tobacco and Tobacco Use. Web.

Fals-Stewart, W. (2003). The Occurrence of Inter-Partner Physical Aggression on Days of Alcohol Consumption: A Longitudinal Diary Study. Journal of Consulting and Clinical Psychology, 71(1), 41–52.

Fals-Stewart, W., Kashdan, T., O’Farrell, T., & Birchler, G. (2002). Behavioral Couples Therapy for Drug-Abusing Patients: Effects on Partner Violence. Journal of Substance Abuse and Treatment, 22(1), 87-96.

Fals-Stewart, W., O’Farrell, T., & Birchler, G. (1996). Behavioral Couples Therapy for Male Substance- Abusing Patients: Effects on Relationship Adjustments and Drug–Using Behavior. Journal of Consulting and Clinical Psychology, 64(5), 959-972.

Fals-Stewart, W., O’Farrell, T., & Birchler, G. (2004). Behavioral Couple’s Therapy for Substance Abuse: Rationale, Methods, and Findings. Science and Practice Perspectives, 1(1), 30-41.

Fals-Stewart, W., O’Farrell, T., Birchler, G., & Cordova, J. (2005). Behavioral Couples Therapy for Alcoholism and Drug Abuse: Where We Have Been, Where We Are, and Where We are Going. Journal of Cognitive Psychotherapy: An International Quarterly, 19(3), 229- 257.

Kaskutas, L. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal of Addiction Disorder, 28(2), 145-157.

Mogford, E. (2011). When Status Hurts: Dimensions of Women’s Status and Domestic Abuse in Rural Northern India. Violence against Women, 17(7), 835-857.

Moos, R., Finney, W., & Cronkite, C. (2007). Alcoholism Treatment Context, Process, and Outcome. New York, NY: Oxford University.

Schafer, J., Caetano, R., & Clark, C. (1998). Rates of Intimate Partner Violence in the United States. American Journal of Public Health, 8(8), 1702–1704.

Stanton, D., & Shadish, W. (1997). Outcome, Attrition, and Family-Couples Treatment for Drug Abuse: A Meta-Analysis and Review of Controlled, Comparative Studies. Psychological Bulletin, 22(2), 170-191.

Winters, J. (2009). Behavioral Couples Therapy for Female substance-abusing Patients: Effects on Substance use and Relationship Adjustment. Journal of Consulting and Clinical Psychology, 70(2), 344–355.

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