Researchers See Positive Results From Behavioral Program For Treating Alcoholism With Marital And Family Therapy

RESEARCHERS SEE POSITIVE RESULTS FROM BEHAVIORAL PROGRAM FOR TREATING ALCOHOLISM WITH MARITAL AND FAMILY THERAPY

Harvard's Project CALM Show Better Sobriety Rates and Fewer Marital Separations Than Individual Alcohol Counseling Alone

WASHINGTON -- The idea of treating alcoholism in the context
of marriage and family (as opposed to seeing it solely as a problem
of the individual) has gained wider acceptance in the practitioner
community in recent years, but according to an article in the June
issue of Professional Psychology: Research and Practice, published
by the American Psychological Association (APA), "methods that have
shown promise in outcome research are not widely used by
practitioners who treat alcoholics and their families" and more
widely used methods have not been systematically studied. But
authors Robert J. Rotunda, Ph.D., and Timothy J. O'Farrell, Ph.D.,
of the Harvard Medical School also describe a clinical research
program that bridges the gap between research and practice.

The Harvard Counseling for Alcoholics Marriages (CALM) Project
(a.k.a. Project CALM) is a four-phase intensive treatment program
for alcoholics and their spouses, the overall purpose of which is
to increase relationship stability, which in turn helps clients
maintain sobriety. "We help couples reward abstinence from alcohol
and refrain from punishing sobriety [by dredging up past behavior],
increase positive feelings and activities and learn better
communication skills. These skills help reduce family stress and
the risk of relapse," the authors write.

Project CALM's four phases include initial engagement of the
identified patient and his or her partner, 10-12 weekly couple
sessions, then 10 weekly couples group sessions and quarterly
follow-up visits for another 24 months.

The couples in the program agree to three commitments: (1)
not to threaten divorce or separation during the course of therapy,
even when in a heated argument, (2) to focus on the present and
future, not the past drinking or negative events and (3) to
dedicate themselves to completing whatever weekly homework
assignments they agree to in session.

CALM is action-oriented and focused on behavior change, the
authors note. "Emphasis is placed on getting couples to renew
their relationship in a more positive way by changing their
behavior first and then assessing changes in feelings, rather than
waiting to feel more positively toward each other before initiating
changes in their own behavior."

Outcome studies on Project CALM have shown it produces better
sobriety rates and fewer marital separations than does individual
alcohol counseling alone. When a relapse prevention component was
added to the program, it had even better results, the authors say,
particularly for alcoholics who had more severe alcohol and marital
problems.

In terms of cost effectiveness, the authors say Project CALM
more than pays for itself by decreasing alcohol-related hospital
and jail costs markedly. In fact, they note, "cost savings
attributable to reduced hospitalizations after CALM are over five
times greater than the cost of delivering CALM." The incidence of
domestic violence after Project CALM also decreases significantly. "For CALM cases whose alcoholism is in remission, violence levels
after treatment are similar to nonalcoholic couples," the authors
say.
Article: "Marital and Family Therapy of Alcohol Use
Disorders: Bridging the Gap Between Research and Practice" by
Robert J. Rotunda, Ph.D., and Timothy J. O'Farrell, Ph.D., Harvard
Medical School and Veterans Affairs medical Center, Brockton and
West Roxbury, MA, in Professional Psychology: Research and
Practice, Vol. 28, No. 3.

(Full text available from the APA Public Affairs Office.)

Robert J. Rotunda, Ph.D., now with the University of West Florida,
can be reached at (904) 474-2294 or rrotunda@uwf.edu. Timothy J. O'Farrell, Ph.D., who heads the Harvard Families and Addiction Program can be reached at (508) 583-4500 Ext. 3481 or ofarrell@warren.med.harvard.edu.

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