Alcohol Problems: Identification and Intervention
CHANGE THROUGH FAMILY-INVOLVED TREATMENT Two major approaches to family-based treatment for alcohol problems have been developed and tested in controlled research—alcohol-focused behavioral couples therapy (ABCT), and family systems approaches. ABCT is a structured therapy based on cognitive-behavioral principles of behavior change.51 Major components of ABCT include:
Cognitive-behavioral strategies that will help the drinker stop drinking and acquire coping skills to respond to both drinking-specific and general life problems;
Strategies that teach family members to support the drinker’s change efforts, reduce protection for drinking-related consequences, develop better skills to cope with negative affect, and communicate around alcohol-related topics;
Strategies to improve the couple’s relationship by increasing positive exchanges and improving communication and problemsolving skills;
Behavioral contracts between intimate partners to support the use of medication.52
Research suggests that ABCT results in greater marital happiness after treatment, fewer incidents of marital separation, and fewer incidents of domestic violence.53 Many also report that ABCT leads to greater improvements in drinking behavior than comparison treatments, although study results are mixed. One empirical study has tested the effectiveness of family systems therapy to treat alcohol problems in adults. Family systems therapy views drinking as one aspect of the marital/family relationship and focuses on altering couple interactions that might be sustaining the drinking, as well as each partner’s views of the meaning of the drinking. You may not require abstinence from drinking, but rather may prefer to help couples select and pursue a drinking goal of their own choosing. Both strategic and structural-family therapy techniques can be used to manage clients’ ambivalence about change. Preliminary results suggest that such approaches are more effective than cognitive-behavioral approaches in retaining resistant and angry clients in therapy.54
CHANGE THROUGH REFERRAL A second long-term strategy is to refer clients to community-based services for help with their drinking problems. Alcohol treatment services are provided at different levels of care—inpatient, residential rehabilitative, intensive outpatient, outpatient, or self-help.
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