Behavioral marital therapy (BMT) with alcoholics produces better outcomes In the year after treatment than methods that do not involve the spouse or other family members. However, outcomes vary considerably. Some couples get substantial and enduring benefits and some suffer serious relapses. The primary aim of this project is to identify pretreatment characteristics of alcoholic couples that predict response to BMT and that discriminate successful from unsuccessful outcomes after BMT. Two hundred alcoholics and their spouses will be treated with BMT and outcome data will be collected quarterly for a one year follow-up period. Analyses pertinent to the primary aim of this research will address three Interrelated sets of questions that are divided into three substudies for clarity. Study 1 will examine alcoholic patient characteristics, marital relationship and other factors as possible predictors of outcome after BMT. Prior research has not examined factors that predict response to BMT (or any other type of marital/family therapy). Patient characteristics have been studied extensively as predictors of response to alcoholism treatment, while marital relationship and other factors have not. Therefore, this study will examine specifically the extent to which marital and other factors contribute over and above patient characteristics. Unlike the alcoholism literature, studies relating marital/family factors to treatment outcomes for other types of psychopathology (schizophrenia, depression, mania) have a long history. Many studies have replicated the finding o a positive relationship between high levels of negative expressed emotion (EE) by relatives during an Intake interview about the patient and subsequent relapse. No work has been published on EE and alcoholism treatment outcome. Study 2 will examine whether high levels of spouses' EE at intake predicts relapse among alcoholics in the year after BMT. We also will examine whether high EE predicts relapse only for a particularly vulnerable subset of alcoholics, namely those whose drinking is associated with negative emotions and/or with interpersonal conflict and who are not protected by Antabuse or low levels of contact with their high EE spouses. Clinicians and program planners need to know whether or not an individual patient is likely to benefit from a given treatment method. Study 3 will examine what proportion of cases treated in BMT obtain clinically significant improvements in drinking and marital adjustment and which factors discriminate cases which obtain successful outcomes from those that do not. A secondary aim, pursued in Study 4, is to develop and test a longitudinal treatment process model that examines whether the extent of couples' use of BMT-targeted behavior during and after treatment explains outcomes after BMT more fully than pretreatment characteristics alone.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA008637-02
Application #
2044700
Study Section
Clinical and Treatment Subcommittee (ALCP)
Project Start
1991-09-01
Project End
1996-08-31
Budget Start
1992-09-01
Budget End
1993-08-31
Support Year
2
Fiscal Year
1992
Total Cost
Indirect Cost
Name
Harvard University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
082359691
City
Boston
State
MA
Country
United States
Zip Code
02115
O'Farrell, Timothy J; Schreiner, Amy; Schumm, Jeremiah et al. (2016) Do outcomes after behavioral couples therapy differ based on the gender of the alcohol use disorder patient? Addict Behav 54:46-51
Schumm, Jeremiah A; O'Farrell, Timothy J; Andreas, Jasmina Burdzovic (2012) Behavioral Couples Therapy When Both Partners Have a Current Alcohol Use Disorder. Alcohol Treat Q 30:407-421
Schumm, Jeremiah A; O'Farrell, Timothy J; Murphy, Christopher M et al. (2009) Partner violence before and after couples-based alcoholism treatment for female alcoholic patients. J Consult Clin Psychol 77:1136-46
Rotunda, Robert J; O'Farrell, Timothy J; Murphy, Marie et al. (2008) Behavioral couples therapy for comorbid substance use disorders and combat-related posttraumatic stress disorder among male veterans: an initial evaluation. Addict Behav 33:180-7
Panuzio, Jillian; O'Farrell, Timothy J; Marshall, Amy D et al. (2006) Intimate partner aggression reporting concordance and correlates of agreement among men with alcohol use disorders and their female partners. Assessment 13:266-79
O'Farrell, Timothy J; Murphy, Christopher M; Stephan, Sharon H et al. (2004) Partner violence before and after couples-based alcoholism treatment for male alcoholic patients: the role of treatment involvement and abstinence. J Consult Clin Psychol 72:202-17
Rotunda, Rob J; West, Laura; O'Farrell, Timothy J (2004) Enabling behavior in a clinical sample of alcohol-dependent clients and their partners. J Subst Abuse Treat 26:269-76
Chase, Kenneth A; O'Farrell, Timothy J; Murphy, Christopher M et al. (2003) Factors associated with partner violence among female alcoholic patients and their male partners. J Stud Alcohol 64:137-49
Murphy, C M; O'Farrell, T J; Fals-Stewart, W et al. (2001) Correlates of intimate partner violence among male alcoholic patients. J Consult Clin Psychol 69:528-40
Fals-Stewart, W; O'Farrell, T J; Freitas, T T et al. (2000) The timeline followback reports of psychoactive substance use by drug-abusing patients: psychometric properties. J Consult Clin Psychol 68:134-44

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