Behavioral Couples Therapy for Alcoholism and Drug Abuse (BCT)

Behavioral Couples Therapy for Alcoholism and Drug Abuse (BCT) is a substance abuse treatment approach based on the assumptions that (1) intimate partners can reward abstinence and (2) reducing relationship distress lessens risk for relapse. In BCT, the therapist works with both the person who is abusing substances and his or her partner to build a relationship that supports abstinence. Program components include a recovery or sobriety contract between the partners and therapist; activities and assignments designed to increase positive feelings, shared activities, and constructive communication; and relapse prevention planning. Partners generally attend 15-20 hour-long sessions over 5-6 months. A typical session follows this sequence: (1) the therapist asks about any substance use since the last session; (2) the couple discusses compliance with the recovery contract; (3) the couple presents and discusses homework assigned at the last session; (4) the couple discusses any relationship problems since the last session; (5) the therapist presents new material; and (6) the therapist assigns new homework.

The goal of Behavioral Couples Therapy for Alcoholism and Drug Abuse is to improve success rates for treatment of alcoholism and drug abuse by involving intimate partners in the treatment process.

Numerous studies of the program have shown positive outcomes in five areas: substance abuse, quality of relationship with partner, treatment compliance, intimate partner violence, and children's psychosocial functioning. BCT clients also reported more relationship satisfaction than non-participants.

Numerous studies of this program have shown positive outcomes in five areas: substance abuse, quality of relationship with partner, treatment compliance, intimate partner violence, and children's psychosocial functioning. Key results include the following:

In seven randomized controlled trials, BCT clients improved significantly more than clients in individual-based therapy and/or attention control groups on some measures of substance abuse. Men who used opioids had more drug-free urine samples (F = 6.09, p<0.05, eta-squared = 0.05) and more self-reported days abstinent from alcohol (F = 6.94, p<0.01, eta-squared = 0.05) and other drugs (F = 4.02. p<0.05, eta-squared = 0.03) than individual-based therapy clients over the course of treatment. BCT clients also reported more days of abstaining from alcohol (F = 4.02, p<0.05, eta-squared = -0.04) and other drugs (F = 4.89, p<0.05, eta-squared = 0.04) 1 year after completing treatment. Men who were in methadone maintenance had fewer cocaine- and opiate-positive urine samples during treatment (F = 3.01, p<0.05, eta-squared = 0.09 and F = 4.95, p<0.01, eta-squared = 0.13, respectively) and lower ASI drug use severity scores (F = 4.44, p<0.05) at the end of treatment than men participating in individual-based treatment.

In six randomized controlled trials, on average BCT clients indicated better intimate-partner relationship outcomes than clients in comparison conditions. Studies included men and women who abused alcohol or other substances, including men addicted to opioids or in methadone maintenance. In all studies, couples reported more relationship satisfaction at the end of treatment than couples in individual-based treatment.

BCT has been implemented at multiple outpatient facilities nationwide for over 30 years. Replications of BCT have been published in more than 100 studies.