Marital and family therapy in alcoholism treatment.

This synopsis of the outcome literature on marital and family treatment (MFT) drew three conclusions. First, intervening at the marital/family level with nonalcoholic family members can motivate an initial commitment to change in the alcoholic who is unwilling to seek help. Second, MFT alone, or with individual alcoholism treatment, produces better marital and/or drinking outcomes during the 6 months following treatment entry than methods that don't involve the spouse or other family members. The most promising MFT approach is behavioral marital therapy (BMT) that combines a focus on the drinking with work on other marital relationship issues via direct instigation of positive couple/family activities and teaching of communication and conflict resolution skills. Two BMT alcohol-focused methods have been used: a behavioral contract between alcoholic and spouse to maintain disulfiram ingestion; and "Alcohol-Focused Spouse Involvement," which rearranges reinforcement contingencies to decrease family behaviors that trigger or enable drinking and to increase positive reinforcement for sobriety. Third, studies of long-term maintenance suggest that BMT with an alcohol and relationship focus may reduce marital and/or drinking deterioration better than individual methods during long-term recovery. The following recommendations were made when to intervene at the level of the individual alcoholic only, at the marital/family level, or at both the individual and marital/family levels: (a) Intervene only at the individual level when the alcoholic refuses consent to contact family members or the family refuses involvement. (b) Include adult family members who live with the alcoholic in the assessment process for all who consent.(ABSTRACT TRUNCATED AT 250 WORDS)