Drug and Alcohol Findings home page in a new window Background notes

Behavioral couples therapy for substance abusers: where do we go from here?

These notes expand on the findings of the featured review and other studies in respect of the cost-effectiveness and cost-benefits of behavioural couples therapy.

One of the two studies cited by the featured review was less a test of behavioural couples therapy than of the cost-benefits and cost-effectiveness of adding 15 relapse prevention sessions to this treatment.

In the other study, it was (as the featured review highlighted) the case that supplementing individual counselling with group behavioural couples therapy created greater per $ reductions From the year before to the two years after treatment. in the costs of hospital, treatment and jail stays than did adding an alternative group couples therapy. However, by far the most On this yardstick the difference between behavioural couples therapy plus individual counselling and the counselling alone narrowly missed (0.053 rather than the criterion of 0.05) the conventional criterion for statistical significance. cost-beneficial was doing without either and just counselling Described as supportive counselling from paraprofessional counsellors who encouraged Alcoholics Anonymous, Antabuse, and abstinence from alcohol. the problem drinking husbands. This was not only because it cost least, but also because it created the greatest cost savings. Lower cost also mean that per $ individual counselling created the greatest improvements in the number of days without drinking and in continuous abstinence. It was also not significantly less cost effective at improving marital adjustment. While cost-benefit and cost-effectiveness results did not favour adding couples therapy to individual counselling, such therapy did result in better drinking outcomes For example, half the behavioural couples therapy patients were drinking not all or non-problematically two years later, twice the proportion without any form of couples therapy. and to greater improvements in marital harmony and in the adverse consequences of drinking.

Published a year later, the tables were decisively reversed in favour of behavioural couples therapy in another comparison with an individual/group counselling programme, this for time for male users of drugs other than alcohol mainly referred to treatment via the criminal justice system. For randomly selected patients, over 12 weeks behavioural couples therapy sessions replaced weekly individual counselling sessions. Not only was therapy time equalised but the costs of the two options too were roughly equal. Criminal justice costs and the costs of substance use treatment were assessed for a year before starting treatment and a year after it ended. The reductions in these costs were significantly and substantially greater for patients assigned to behavioural couples therapy, who also reduced their illegal income significantly more. Across all these measures the net benefit of the interventions was nearly nine times higher for husbands who had been allocated to behavioural couples therapy. This seemed due to this therapy helping more patients stay abstinent from drugs for longer allied with the substantial social costs often consequent on relapse, a feature of this criminally involved caseload of illegal drug users. Per $ spent, the programme which included behavioural couples therapy was followed by significantly more days without drug use and led to significantly greater reductions in the severity of problems related to legal difficulties and family and social functioning. For the patients who joined the study, usual treatment was signally ineffective, but this was not the case for the single men who could not join the study. The authors reasoned that the married/cohabiting men who could join the study were generally enmeshed in highly distressed relationships which usual treatment failed to address.

Published in 2005, another analysis returned to men treated for drinking problems. Behavioural couples therapy replaced six individual counselling sessions; patients also had group therapy. The standard couples therapy of 12 sessions was one option, but another was a version shortened to just the six sessions it was replacing. In another option the six sessions were replaced by lectures on drink problems attended by both partners. In this study the shortened couples therapy cost about the same the other options of the same duration, but the longer couples therapy was substantially more expensive. Lower cost but equal impact meant that per $, heavy drinking days fell significantly more from a year before to a year after treatment with the briefer couples therapy than with the 12-session version. Both the couples therapy options retained improvements in drinking significantly better than the programmes which did not include couples therapy. The net result was that in curbing heavy drinking, per $ brief couples therapy was the most cost-effective of the four approaches, but the standard and longer version was the least cost-effective. Compared to individual/group treatment, both forms of couples therapy improved relationship functioning, and here was some indication that the longer therapy had greater benefits.

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