SelfhelpMagazine

by Robert J. Rotunda, Ph.D. & Timothy J. O' Farrell, Ph.D.

The idea of treating alcoholism in the context of marriage and family has gained wider acceptance among psychotherapists.

The Harvard Counseling for Alcoholics Marriages (CALM) Project is a four-phase alcohol treatment center for alcoholics and their spouses. Their overall purpose 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. & 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.

This information received from the American Psychological Association (APA), in Washington, DC.