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.
Showing the most recent 10 out of 28 publications
