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AUDIENCE:
Addiction treatment specialists, clinical and counseling psychologists, clinical social workers, psychiatrists, and couple and family therapists; graduate students and trainees in these areas.

Book Description
This eminently practical guide presents an empirically supported approach for treating people with substance abuse problems and their spouses or domestic partners. Behavioral couple’s therapy (BCT) explicitly focuses on both substance use and relationship issues, and is readily compatible with 12-step approaches. Provided are all the materials needed to introduce BCT; implement a recovery contract to support abstinence; work with clients to increase positive activities, improve communication, and reduce relapse risks; and deal with special treatment challenges. Appendices include a condensed session-by-session treatment manual and 70 reproducible checklists, forms, and client education posters. The large-size format and lay-flat binding facilitate photocopying and enhance the book's clinical utility.

CONTENTS:
1. An Introduction to Behavioral Couples Therapy for Alcoholism and Drug Abuse
2. Engaging the Couple: Initial Couple Sessions
3. Building Support for Abstinence: The Daily Recovery Contract
4. Other Support for Abstinence
5. Increasing Positive Couple and Family Activities
6. Improving Communication, Part I: Listener and Speaker Skills
7. Improving Communication, Part II: Resolving Changes, Conflicts, and Problems
8. Continuing Recovery: Maintenance and Relapse Prevention
9. Challenges in BCT, Part I: Separated and Dual-Problem Couples
10. Challenges in BCT, Part II: Violence and Other Issues
11. Enhancements to BCT
12. Implementing BCT in the Real World
Appendix A. A 12-Session BCT Treatment Manual
Appendix B. Posters Used in BCT
Appendix C. Forms Used in BCT
Appendix D. Suggested Resources

Review
"This clearly-written, practical guide to behavioral couples therapy for addictive disorders will be useful to all addiction therapists. Couple-based work is extremely useful in evaluation and treatment of substance abuse; combined with behavioral and coping skills training, it can greatly improve treatment outcomes. Read this book and get better outcomes with your patients!"--Richard J. Frances, MD, New York University School of Medicine

"Behavioral couples therapy (BCT) is one of the most scientifically and clinically sound treatments available for alcohol and drug problems. It is a highly cost-effective intervention with beneficial effects on substance abuse recovery, relapse prevention, relationship and family adjustment, and intimate partner abuse. The authors present the conceptual rationale and clinical techniques of BCT in an accessible, practitioner-friendly manner. They provide case examples and clinical wisdom addressing many of the challenges to implementation in real-world settings, including integration with 12-step approaches. This book should prove tremendously helpful in disseminating BCT to educators, researchers, and practitioners, so that a wider segment of the population can experience the benefits of this exemplary treatment approach."--Christopher M. Murphy, PhD, University of Maryland, Baltimore County

"Written by the leading clinical researchers in the area, this book is the essential treatment manual for how to conduct behavioral couples therapy for alcoholism and drug abuse. Rich in detail and specific clinical direction, it should occupy a prominent place on the bookshelf of any clinician who treats people with substance abuse problems, or any clinical trainee who aspires to such work."--Andrew Christensen, PhD, University of California, Los Angeles

"This excellent, reader-friendly text presents an evidence-based approach that nicely complements and expands a family disease approach to addiction. The text thoroughly addresses drug- and relationship-related issues that emerge during engagement, early recovery, and abstinence maintenance. Readers will find clinical tools like the Recovery Contract particularly helpful. The authors are superb clinical researchers who provide a sound theoretical and empirical rationale for their choice of intervention strategies. Addiction professionals, other mental health professionals, and educators will find this book useful. Its many clear tables and examples of clinical forms make the book particularly suitable for graduate-level courses on addictions treatment."--Meredith Hanson, DSW, Fordham University Graduate School of Social Service

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Group Therapy for Substance Abuse: Rolling versus Closed Admissions
Abstract
A regional survey of outpatient alcohol and drug abuse treatment programs was conducted and program administrators were queried about their use of therapy groups and the methods used to enroll patients. Clinical directors and other administrators from outpatient programs (N = 57) in the northeastern U.S., listed in the SAMHSA National Directory of Alcoholism and Drug Abuse Treatment and Prevention Programs, were interviewed. Of these programs, 54 (95%) reported that they used some form of group therapy; 70% described group therapy as the primary milieu in which they delivered treatment. When given a description of closed versus rolling admission groups, 48 interviewees (84%) reported that most of their groups had rolling admission. The primary reasons reported for the preference of rolling admissions were economic (i.e., patients could be charged for participation soon after program entry) and clinical (i.e., rolling admissions dramatically reduced wait times for group entry, compared with closed groups).

Intimate partner violence and alcohol use: Exploring the role of drinking in partner violence and its implications for intervention
Abstract
A large and growing empirical literature reveals a robust relationship between alcohol use and the occurrence of intimate partner violence (IPV). However, the role of alcohol use and intoxication in episodes of IPV, particularly with respect to alcohol's potential causal or facilitative function in the occurrence of partner aggression, remains a source of much controversy and considerable debate. The purpose of this review is to (a) describe briefly IPV and the types of behaviors subsumed under this label, (b) examine evidence for the link between alcohol use and IPV, (c) explicate factors (e.g., antisocial personality disorder) that may moderate this relationship, and (d) discuss the primary conceptual models put forth to explain this association. Recommendations for interventions that consider the relationship between alcohol use and IPV are also provided.

Psychopathology: Foundations for a contemporary understanding (2nd Edition).
Book Chapter: SUBSTANCE USE DISORDERS
Substance use disorders are among the most pressing and intransigent mental health problems facing society today. Concerns about abuse of alcohol, tobacco, and other psychoactive substances date as far back as Biblical times: “He shall separate himself from wine and strong drink, and shall drink no vinegar of wine, or vinegar of strong drink, neither shall he drink any liquor of grapes, nor eat moist grapes, or dried” (Num. 6:3). Despite such a long history, scientific scrutiny of these problems is fairly recent. However, an impressive body of knowledge about the epidemiology, etiology, neurobiology, and treatment of addictive behavior has accumulated. These and other aspects of addictive behavior continue to be the focus of extensive clinical and experimental research.
            The study of substance use and misuse has been marked by extensive controversy and heated debate. The conflicts have been fueled by a fundamental disagreement among scientists, clinicians, social policy makers, and the public about whether to view addiction as a disease in need of medical treatment, as sin in need of punishment and containment, or as learned behaviors that can be modified by contingencies. The debate is not simply over semantics, but has implications for research, treatment, and social policy. For example, treatments that are shown to be effective in research settings are often ignored in the treatment community because the interventions are viewed as philosophically opposed to a conventional wisdom about what works best. Unfortunately, the conventional wisdom about what constitutes effective treatment is often not supported by the empirical research. Those who view alcoholism and other drug use as diseases are ethically and, in some instances, morally opposed to the use of controlled use treatments, which they view as irresponsible. Drug users fill our criminal justice system, while treatment providers lament the criminalization of these “diseases.” Yet, proponents of legalization of drugs, who are in the minority, note that legalization will help contain many of the social ills associated with substance use. Others see such a stance as irresponsible and immoral because it would increase the exposure of those with a genetic propensity for addiction to the substances that would activate the addictive process. In turn, they believe that such policies would contribute to greater social decay. Because the emotional, legal, and economic stakes in the debate are so high, no end to the debate is in sight.

Substance abuse and intimate partner violence: treatment considerations
Abstract
Given the increased use of marital- and family-based treatments as part of treatment for alcoholism and other drug disorders, providers are increasingly faced with the challenge of addressing intimate partner violence among their patients and their intimate partners. Yet, effective options for clinicians who confront this issue are extremely limited. While the typical response of providers is to refer these cases to some form of batterers' treatment, three fundamental concerns make this strategy problematic: (1) most of the agencies that provide batterers' treatment only accept
individuals who are legally mandated to complete their programs; (2) among programs that do accept nonmandated patients, most substance-abusing patients do not accept such referrals or drop out early in the treatment process; and (3) available evidence suggests these programs may not be effective in reducing intimate partner violence. Given these very significant concerns with the current referral approach, coupled with the high incidence of IPV among individuals entering substance abuse treatment, providers need to develop strategies for addressing IPV that can be incorporated and integrated into their base intervention packages.

Treating Paternal Alcoholism Using Learning Sobriety Together: Effects on Adolescents versus Preadolescents
Abstract
The purpose of this study was to determine whether or not Learning Sobriety Together (LST), a treatment for substance abuse that combines Behavioral Couples Therapy and individual counseling, had comparable secondary benefits on the internalizing and externalizing behaviors of adolescent versus preadolescent siblings living in homes with their alcoholic fathers (N = 131) and their nonsubstance-abusing mothers. During a 17-month assessment period, the association between parents’ functioning (i.e., fathers’ drinking as determined by percent days abstinent and parents’ dyadic adjustment) and children’s adjustment (as rated by mothers, fathers, and children’s teachers) was stronger for preadolescents than their adolescent siblings, particularly in terms of children’s externalizing behaviors. Interventions that reduce paternal drinking and improve couple functioning may serve as an important preventative intervention for preadolescents in these homes, whereas adolescents may need more intensive interventions to address internalizing and externalizing symptoms.

Intimate partner violence and alcohol use: Exploring the role of drinking in partner violence and its implications for intervention
Abstract
A large and growing empirical literature reveals a robust relationship between alcohol use and the occurrence of intimate partner violence (IPV). However, the role of alcohol use and intoxication in episodes of IPV, particularly with respect to alcohol's potential causal or facilitative function in the occurrence of partner aggression, remains a source of much controversy and considerable debate. The purpose of this review is to (a) describe briefly IPV and the types of behaviors subsumed under this label, (b) examine evidence for the link between alcohol use and IPV, (d) explicate factors (e.g., antisocial personality disorder) that may moderate this relationship, and (e) discuss the primary conceptual models put forth to explain this association. Recommendations for interventions that consider the relationship between alcohol use and IPV are
also provided.

Learning Sobriety Together: A Randomized Clinical Trial Examining Behavioral Couples Therapy with Alcoholic Female Patients
Abstract
Married or cohabiting female alcoholic patients (N = 138) and their nonsubstance-abusing male partners were randomly assigned 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 to 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.

"Co-Morbid Anxiety and Substance Use Disorders: Theoretical and Treatment Issues"
OCD is a surprisingly common co-occurring disorder among patients with substance abuse. However, it is a disorder that often goes undetected by those without specific background and training in OCD and its diagnosis, assessment, and treatment. With proper screening, however, OCD can be readily identified. More importantly, OCD appears to exacerbate substance abuse; thus, treating both concurrently is likely to lead to better outcomes than a sequential treatment approach. Although the behavioral treatments for OCD, particularly ERP, are quite different than those typically used for substance abuse, making their integration difficult, the good news is that there are effective treatments for both disorders. Moreover, there is evidence that a combined treatment approach for both disorders, as described herein, can effectively be used to treat substance-abusing patients with OCD. Thus, when clinicians find themselves confronted with these patients, there is good hope for a positive outcome, both in terms of OCD symptoms and substance use behavior.