Couples therapy can be the best choice for alcohol-dependent women with supportive spouses
Barbara McCrady and Elizabeth Epstein wanted to know whether cognitive behavior therapy worked better for alcohol-dependent women when delivered as couples therapy than when delivered as individual therapy. They reported recently that both treatment methods worked well, but women treated in couples therapy maintained their gains a bit better than those in individual therapy. Also, women suffering from depression in addition to alcohol-dependence did better in couples therapy. Their paper appeared recently in the Journal of Consulting and Clinical Psychology.
Epstein is an associate research professor at the Center of Alcohol Studies. McCrady, formerly a professor of psychology at Rutgers, now directs the University of New Mexico's Center on Alcoholism, Substance Abuse and Addictions.
Alcohol use disorders hit women particularly hard, physically and psychologically. Epstein and McCrady cite earlier studies' findings that between 4 and 8 percent of women under age 44 are alcohol-dependent, that as many as 65 percent of alcohol-dependent women have some additional psychiatric disorder, and that women are less likely to seek treatment for alcoholism than men. Alcohol-dependent women have high rates of distressed marriages and not much support from members of their social networks when they try to break that dependence. Until recently, there has not been much research on unique treatments for alcohol use disorders in women.
McCrady and Epstein recruited 102 women with newspaper ads and referrals from other alcohol treatment programs. They were looking for women who were alcohol-dependent, married or in a committed relationship with a man for at least six months, and whose male partners were willing to participate in therapy.
Both groups received 20 out-patient sessions of cognitive behavioral therapy over six months, for which the goal was abstinence from alcohol. Seven therapists, all trained both in individual and couples therapy, saw the clients. After the 20 sessions,, each participant received follow-up interviews on the phone and in person for another year. For each woman in each of the 18 months of the study, researchers calculated the percentage of days abstinent and the percentage of days of heavy (more than three drinks in a day) drinking.
Nearly half the women started abstaining before the first treatment session, the researchers wrote. For the first month of treatment, the abstinence rate for women still drinking in both groups rose sharply - more sharply for women in couples therapy, perhaps because they had a slightly lower rate of abstention to start with. During the year following treatment, the women in couples treatment reported fewer heavy drinking days than women in individual treatment.
The researchers concluded that there is a widespread need for specific treatments for alcohol- dependent women, and that social support for change is important. However, not all women have spouses, and not all spouses are supportive. Epstein and McCrady are currently recruiting women for another study comparing individual and group therapy.