Problem drinking and marital adjustment

Marriage Dissatisfaction and the Risk of Sudden Cardiac Death Among Men

Conflicts in marriage have been associated with potential risk of cardiovascular disease; however, there is lack of prospective evidence on the association between marriage satisfaction and sudden cardiac death (SCD). We aimed to assess the association between perceived level of marriage satisfaction and risk of SCD. This study employed the Kuopio Ischemic Heart Disease study, an ongoing prospective population-based study in Finland. Perceived level of marriage satisfaction was assessed in 2,262 men using a well-structured self-administered questionnaire. Multivariable adjusted Cox regression models were used to estimate hazard ratios (95% confidence interval [CI]) for SCD. During a median follow-up period of 25.9 years, 239 SCDs were recorded. The mean age of participants was 53 (SD 5.2) years. On adjustment for several conventional cardiovascular risk factors, hazard ratio (95% CI) of SCD was 1.90 (CI 1.09 to 3.32; p = 0.02) for men who were dissatisfied with their marriage, compared with men who were satisfied with their marriage. The association remained consistent on further adjustment for preexisting coronary heart disease, socioeconomic status, and years of education 1.86 (CI 1.07 to 3.25; p = 0.03). In conclusion, dissatisfied marriage is associated with an increased risk of SCD among middle-aged Caucasian men, independent of conventional cardiovascular risk factors.

Risky alcohol use in Danish physicians: Associated with alexithymia and burnout?

BACKGROUND

Alcohol abuse may be elicited by psychological problems and can influence physicians' health and patient safety. To act on it, we need knowledge on the prevalence of the disorder and its associations with psychological factors and physicians' well-being. The aim of this study was to explore whether burnout and alexithymia are associated with risky alcohol consumption in physicians and whether burnout mediates the association between alexithymia and risky alcohol consumption.

METHODS

In this cross-sectional study, 4,000 randomly selected physicians received an electronic questionnaire by email containing the Alcohol Use Disorders Identification Test (AUDIT), the Maslach Burnout Inventory Human-Services-Survey (MBI-HSS) and the Toronto Alexithymia Scale (TAS-20). A total of 1,841 physicians completed the questionnaire (46%).

RESULTS

18.8% reached the criteria for risky alcohol consumption. The likelihood of having risky alcohol consumption was associated with high levels of alexithymia (OR=1.93, 95%CI=1.37-2.74, P<0.001). Moreover, risky alcohol consumption was associated with burnout (OR=1.86, 95%CI=1.13-3.05, P<0.014) and each individual burnout dimension: emotional exhaustion (OR=1.89, 95%CI=1.33-2.69, P<0.001), depersonalisation (OR=2.23, 95%CI=1.53-3.25, P<0.001) and low levels of personal accomplishment (OR=1.66, 95%CI=1.14-2.41, P=0.008). Mediation analysis suggested that the association between alexithymia and risky alcohol consumption was partially mediated through depersonalisation.

CONCLUSIONS

The results emphasize a need for enhancing emotional self-awareness in physicians as psychological traits, work-pressure and alcohol dependence might be self-reinforcing aspects for the individual physician. As alcohol dependence and burnout may have consequences for patient safety separately, the aggregated influence of these factors has to be examined.

Behavioural Marital Therapy in the Treatment of Psychological Disorders

There is a well established relationship between marital discord and individual psychopathology in family members. This paper reviews evidence relating to patterns of marital interaction related to the co-occurrence of marital discord and three common psychological disorders: depression, alcohol abuse, and childhood conduct disorders. The effects of behavioural marital therapy (BMT) on dysfunctional marital interaction in such cases, and the impact of BMT on individuals' psychological disorders, are evaluated. It is concluded that BMT is often a useful component of treatment in each disorder reviewed. Further it is argued that it is important routinely to assess the relationship context in which these disorders occur. Finally, some of the difficulties and limitations of the application of BMT in cases where the presenting problem is an individual psychopathology are considered.

Evaluation of the Controlling Alcohol and Relationship Enhancement (CARE) Program With Hazardous Drinkers

We assessed the effects of the Controlling Alcohol and Relationship Enhancement (CARE) program, an early intervention combining reduction of hazardous alcohol consumption and enhancement of couple relationships. Thirty-seven hazardous drinking couples were randomly allocated to either the CARE program or to a control condition. CARE couples improved their communication more than controls, but couples in both conditions reduced hazardous drinking to a similar extent. CARE is a potentially useful means of promoting positive relationship communication in hazardous drinking couples.

The psychological impact of heavy drinking among the elderly on their co-residents: the 10/66 group population based survey in the Dominican Republic

BACKGROUND

There is very limited literature on alcohol use among the elderly and little is known about the impact it has on family and caregivers, especially in low and middle income countries.

AIM

To estimate the independent effect of heavy alcohol use among the elderly on the psychological health of their co-residents.

METHODS

This is a secondary analysis using data from the comprehensive cross-sectional survey of the 10/66 dementia research group population-based research programme in the Dominican Republic. The characteristics of the elderly participants as well as the co-residents were described. The independent association of heavy drinking among the participants with psychological morbidity in their co-residents was estimated. Different models were generated to rule out potential mediating effects of disability and behavioural symptoms.

RESULTS

Prevalence of heavy alcohol use in the elderly in Dominican Republic was 10.6%. There was a statistically significant independent effect of heavy alcohol use by the elderly on their co-residents mental health (PR=1.47; 95% CI 1.07-2.01) which was not accounted by disability (Sobel-Goodman test, p=0.15). Severity of psychological and behavioural symptoms partially (29.1% of the total effect) explained this association (Sobel-Goodman mediation test, p=0.006).

CONCLUSIONS

Health services for the elderly in low and middle income countries will have to be configured around detection of alcohol problems among the elderly as well as offering appropriate support to their co-residents.

Husbands' and wives' alcohol use disorders and marital interactions as longitudinal predictors of marital adjustment

In this longitudinal study, the relationships among wives' and husbands' lifetime alcoholism status, marital behaviors, and marital adjustment were tested. Participants were 105 couples from the Michigan Longitudinal Study (MLS), an ongoing multimethod investigation of substance use in a community-based sample of alcoholics, nonalcoholics, and their families. At baseline (T1), husbands and wives completed a series of diagnostic measures, and lifetime diagnosis of alcohol use disorder (AUD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), was assessed. Couples completed a problem-solving marital interaction task 3 years later at T2, which was coded for the ratio of positive to negative behaviors. Couples also completed a measure of marital adjustment at T4 (9 years after T1 and 6 years after T2). Results showed that husbands' lifetime AUD predicted lower levels of their wife's positive marital behaviors 3 years later but was not related to their own or their wife's marital adjustment 9 years from baseline. By contrast, wives' lifetime AUD had direct negative associations with their own and their husband's marital satisfaction 9 years later, and wives' marital behaviors during the problem-solving task predicted their own and their husband's marital satisfaction 6 years later. Findings indicate that marital adjustment in alcoholic couples may be driven more by the wives' than the husbands' AUD and marital behavior. Implications for intervention with alcoholic couples were discussed.

Husbands' and wives' alcohol use disorders and marital interactions as longitudinal predictors of marital adjustment

In this longitudinal study, the relationships among wives' and husbands' lifetime alcoholism status, marital behaviors, and marital adjustment were tested. Participants were 105 couples from the Michigan Longitudinal Study (MLS), an ongoing multimethod investigation of substance use in a community-based sample of alcoholics, nonalcoholics, and their families. At baseline (T1), husbands and wives completed a series of diagnostic measures, and lifetime diagnosis of alcohol use disorder (AUD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), was assessed. Couples completed a problem-solving marital interaction task 3 years later at T2, which was coded for the ratio of positive to negative behaviors. Couples also completed a measure of marital adjustment at T4 (9 years after T1 and 6 years after T2). Results showed that husbands' lifetime AUD predicted lower levels of their wife's positive marital behaviors 3 years later but was not related to their own or their wife's marital adjustment 9 years from baseline. By contrast, wives' lifetime AUD had direct negative associations with their own and their husband's marital satisfaction 9 years later, and wives' marital behaviors during the problem-solving task predicted their own and their husband's marital satisfaction 6 years later. Findings indicate that marital adjustment in alcoholic couples may be driven more by the wives' than the husbands' AUD and marital behavior. Implications for intervention with alcoholic couples were discussed.

Paternal alcoholism, negative parenting, and the mediating role of marital satisfaction

Given the documented association between paternal alcoholism and negative parenting behaviors, the purpose of this study was to examine longitudinally whether marital satisfaction mediates this relationship. Participants consisted of 197 families (102 without an alcoholic father, 95 with an alcoholic father) who were assessed at three time points: when children were 12, 24, and 36 months old. Results indicated that paternal alcoholism at 12 months was associated with decreased marital satisfaction at 24 months for both mothers and fathers. Marital satisfaction at 24 months in turn was associated with decreases in parental warmth and sensitivity at 36 months. Furthermore, marital satisfaction mediated the association between paternal alcoholism and parental warmth and sensitivity for both mothers and fathers. The implications of these findings for interventions for alcoholic families are discussed.

Partners of problem drinkers: moving into the 1990s

The literature on partners of problem drinkers is reviewed. Originally research and treatment viewed partners of problem drinkers from a pathological perspective. This paper suggests an alternative stress and coping perspective as less stigmatizing and more realistic in terms of the experiences of these individuals.

Paternal alcohol use and the mother-infant relationship

The purpose of this study was to examine the association between paternal alcohol use and the mother-infant relationship. A related goal was to investigate the role of maternal depression and marital satisfaction in moderating this relationship. Subjects were 55 mother-infant dyads (12–24-month-old infants) who were observed in the Strange Situation paradigm to assess infant attachment and in structured play interactions. There were 23 families with heavy drinking fathers and 32 with light drinking fathers. As predicted, infants of heavy drinking fathers were more likely to be insecurely attached compared to infants of light drinking fathers. Contrary to expectations, neither maternal depression nor marital interaction mediated the relationship between paternal alcohol use and mother-infant interactions. However, maternal depression did interact with paternal alcohol use to predict infant attachment security and maternal sensitivity. There was also an interactive effect of marital satisfaction and paternal alcohol use on maternal sensitivity. The results suggest that paternal alcohol use may influence family functioning and the mother-child relationship as early as infancy and suggest one possible pathway toward maladjustment among infants of heavy drinking fathers. However, in addition to investigating the impact of paternal alcohol use on the father-infant relationship, the influence of various familial factors associated with paternal alcohol use need to be more closely examined from a longitudinal perspective.

Adapted Couple Therapy (ACT) for pathological gamblers: a promising avenue

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.

Alcohol use, alcohol problems, and depressive symptomatology among newly married couples

BACKGROUND

Individuals married to heavy drinking spouses often have poorer health compared to those whose spouses are not heavy drinkers. This work examined how one spouse's alcohol involvement and alcohol-related problems affect his/her spouse's depressive symptomatology over time.

METHODS

Couples (N=634) were assessed for past year alcohol involvement and alcohol-related problems (marital and non-marital) and depressive symptomatology when they applied for a marriage license. They were reassessed at their first and second anniversaries. Multilevel models were used to analyze the association between one spouse's alcohol involvement and alcohol problems and his/her partner's depressive symptomatology over time.

RESULTS

Both husbands' and wives' marital alcohol problems were associated with wives' depressive symptoms. Neither spouses' alcohol consumption was associated with wives' depressive symptoms. Husbands' marriage-related alcohol problems and frequency of heavy drinking were related to husbands' depressive symptoms; however, wives' alcohol problems and alcohol use were unrelated to husbands' depression.

CONCLUSIONS

In a community sample of married couples, we found that husbands' and wives' marital alcohol problems affect wives' depressive symptoms, but only husbands' marital alcohol problems affect husbands' depressive symptoms. Future work should consider other subgroups of alcohol-related problems in one spouse and their relation to depression in his/her partner.

Alcohol involvement and marital quality in the early years of marriage: a longitudinal growth curve analysis

BACKGROUND

Previous research suggests that becoming married is associated with declines in drinking. The current study examines two potential influences on newly married husbands' and wives' drinking trajectories, the impact of the partner's drinking and the quality of the marriage.

METHODS

Couples (n=592) were assessed at the time of their first marriage, at the first anniversary, and at the second anniversary. Husbands and wives completed separate, self-administered questionnaires at home. Latent growth curve analysis was used to examine husbands' and wives' alcohol use and marital quality trajectories and to test the bi-directional relationships between alcohol involvement and marital quality both within and between couple members.

RESULTS

Husbands' and wives' alcohol involvement and marital quality declined over time and there was significant individual variability in these changes over time. Although we failed to find any longitudinal influence of greater alcohol involvement on declines in marital quality or vice versa, individuals' marital quality and alcohol involvement were correlated at the time of marriage and individuals' changes in drinking were significantly associated with changes in their reported marital satisfaction. There were also significant correlations observed between one partner's alcohol involvement slope and the spouse's marital quality slope, indicating that steeper declines in husbands' and wives' drinking were associated with less steep declines in their partner's marital quality.

CONCLUSIONS

There is clearly an association between husbands' and wives' alcohol use and marital quality. However, given the absence of longitudinal effects, we cannot discern the temporal precedence of this association. Additional research is needed to more fully understand this complex relationship.

Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample

The prospective association between marital dissatisfaction and alcohol use disorders (abuse and/or dependence) was evaluated in a randomly selected community sample. Married individuals (N = 1,675) from the New Haven Epidemiologic Catchment Area project who did not have a current alcohol use disorder at baseline were followed prospectively for 12 months. Results indicated that baseline marital dissatisfaction was significantly associated with alcohol use disorder diagnosis during follow-up, with dissatisfied spouses being 3.7 times more likely than satisfied spouses to have a diagnosis of current alcohol use disorder at follow-up. The longitudinal association between baseline marital dissatisfaction and current alcohol use disorder diagnosis at follow-up remained significant when controlling for baseline demographic variables and history of alcohol use disorders.

Heavy alcohol use and marital dissolution in the USA

Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (combined as divorced in the analysis) for 4589 married couples during up to four repeated 2-yr follow-up periods. We found that drinking status was positively correlated between spouses. The correlations did not increase over the follow-up period. Discrepancies in alcohol consumption between spouses were more closely related to the probability of subsequent divorce than consumption levels per se. Couples with two abstainers and couples with two heavy drinkers had the lowest rates of divorce. Couples with one heavy drinker were most likely to divorce. Controlling for current consumption levels, a history of problem drinking by either spouse was not significantly associated with an increased probability of divorce. Our findings on alcohol use and marital dissolution were highly robust in alternative specifications.

Coping skills training and 12-step facilitation for women whose partner has alcoholism: effects on depression, the partner's drinking, and partner physical violence

Women (N=171), distressed from their partners' untreated alcoholism, received either coping skills training (CST), 12-step facilitation (TSF), or delayed treatment (DTC). CST and TSF resulted in lower depression levels than DTC but did not differ from one another. Skill acquisition mediated the treatment effects of CST; Al-Anon attendance did not mediate the TSF effect. Lower depression levels were maintained at 12 months with no differences between groups. Partner drinking decreased from pretreatment to follow-up in the CST and TSF conditions. However, for partners with a history of relationship violence, drinking improved across follow-up in the CST condition but worsened in the TSF condition. Partner relationship violence was less in the CST condition. CST may be particularly useful for women experiencing physical violence from a partner with alcoholism.

Coping skills training and 12-step facilitation for women whose partner has alcoholism: effects on depression, the partner's drinking, and partner physical violence

Women (N=171), distressed from their partners' untreated alcoholism, received either coping skills training (CST), 12-step facilitation (TSF), or delayed treatment (DTC). CST and TSF resulted in lower depression levels than DTC but did not differ from one another. Skill acquisition mediated the treatment effects of CST; Al-Anon attendance did not mediate the TSF effect. Lower depression levels were maintained at 12 months with no differences between groups. Partner drinking decreased from pretreatment to follow-up in the CST and TSF conditions. However, for partners with a history of relationship violence, drinking improved across follow-up in the CST condition but worsened in the TSF condition. Partner relationship violence was less in the CST condition. CST may be particularly useful for women experiencing physical violence from a partner with alcoholism.

The Significant Other Checklist: measuring the problems experienced by family members of drug users

Historically, much attention has been given to the multifaceted problems experienced by drug abusers. Recently, greater attention has been given to the family members of drug abusers, but unfortunately, most of this attention has focused on family relationships and has overlooked the problems experienced by family members of drug users (DUs). To date, there is no psychometrically sound, multidimensional assessment tool available to systematically assess the economic, behavioral, and psychological problems encountered by these family members. This study presents the findings associated with the initial measurement development phase of such an assessment tool. The initial results are promising, suggesting that the Significant Other Checklist (a) has reasonable initial subscale reliability estimates, (b) assesses problem domains that are relevant to family members of DUs, and (c) is able to identify important group similarities and differences among family members of DUs.

For better or for worse? The effects of alcohol use on marital functioning

Two competing hypotheses propose opposite effects for the relation between alcohol use and marital functioning. One hypothesis conceptualizes alcohol use as maladaptive and proposes that it serves as a chronic stressor that causes marital dysfunction and subsequent dissolution. An opposing hypothesis proposes that alcohol use is adaptive and serves to temporarily relieve stressors that cause marital dysfunction, stabilizing the marital relationship, and perhaps preventing dissolution. Sixty studies were reviewed that tested the relation between alcohol use and one of three marital functioning domains (satisfaction, interaction, and violence). Results provide overwhelming support for the notion that alcohol use is maladaptive, and that it is associated with dissatisfaction, negative marital interaction patterns, and higher levels of marital violence. A small subset of studies found that light drinking patterns are associated with adaptive marital functioning; however, more research is necessary to replicate these effects and identify specific conditions under which they occur.

Reductions in marital violence following treatment for alcohol dependence

The impact of an intensive, individually based, partial hospitalization treatment for alcohol dependence on alcohol use, marital violence, psychological abuse, and marital satisfaction among 24 heterosexual male patients and their partners was assessed. Patients received 5 to 6 days of substance abuse treatment in a partial hospital. Patient and partner assessments were conducted at baseline and 6- and 12-month follow-up. Results revealed decreased alcohol use in patients and significant declines in husband-to-wife marital violence and psychological abuse from baseline to 6- and 12-month follow-up. Men reported no significant changes in their marital satisfaction. Results also showed significant decreases in wife-to-husband violence from baseline to 6- and 12-month follow-up. Female partners reported a significant increase in marital satisfaction from baseline to 6- and 12-month follow-up. Overall, the study suggests that marital violence perpetrated by male patients and their partners declined following the males' substance abuse treatment. The clinical implications of the findings are discussed.

Sources of distress among women in treatment with their alcoholic partners

We examined sources of psychological and relationship distress among 90 nonalcoholic women with alcoholic male partners seeking outpatient, conjoint alcohol treatment. Results indicated that greater psychological distress among these women was most strongly associated with lower satisfaction with the marital relationship, presence of domestic violence, lower frequency of male partner's drinking, lower perceived social support from family, and more frequent attempts to cope with the partner's drinking. Controlling for psychological distress, greater marital satisfaction was associated most strongly with greater attempts to reinforce positively the partner's abstinence and with less effort to detach from the partner's drinking. Severity of partner's alcohol problems was unexpectedly associated with greater marital satisfaction in multiple regression analyses, though not in bivariate analyses. Results highlight the close connection between psychological and relationship distress and potential relations between alcohol-related coping behaviors and both psychological and relationship distress.

Alcohol abuse

We reviewed 38 controlled studies of marital and family therapy (MFT) in alcoholism treatment. We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, (a) Al-Anon facilitation and referral help family members cope better; (b) Community Reinforcement and Family Training promotes treatment entry; and (c) the popular Johnson intervention apparently does not effectively promote treatment entry. Once the alcoholic enters treatment. MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. BCT also reduces social costs, domestic violence, and emotional problems of the couple's children. Future studies need to specifically evaluate: MFT with women and with minority patients, mechanisms and processes of change, and transportability of evidence-based MFT approaches to clinical practice settings.

Social adjustment of family members and significant others (FSOs) of drug users

This study investigated the social adjustment of female family members and significant others (FSOs) of illicit drug users in order to gain insight into the impact of drug use upon those close to the user. Using the Social Adjustment Scale-Self Report (SAS-SR), we examined the social adjustment self-ratings (overall and in seven specific role areas) of 41 female partners and 24 mothers of drug users. We compared these ratings to the ratings they reported for their drug-using partners or children, to each other, and to self-ratings drawn from community comparison samples. As expected, results showed that the female FSOs reported significantly better social adjustment than the drug users in most role areas. However, their social adjustment was compromised relative to the community samples. Partners of drug users reported poorer adjustment than parents of drug users overall and in the specific areas of marital and economic functioning. Further inquiry is needed to improve our understanding of the impact of drug use on the users' family members.

Correlates of intimate partner violence among male alcoholic patients

Male-to-female partner violence was investigated in heterosexual couples with an alcoholic male partner. Partner violent (PV) alcoholic patients (n = 183), when compared with nonviolent (NV) alcoholic patients (n = 120), had more antisocial personality characteristics, greater alcohol problem severity, greater use of other drugs, higher relationship distress, and stronger beliefs in the link between alcohol consumption and relationship problems. Demographic factors did not account for these PV-NV differences. Relationship distress and alcohol problem severity had independent associations with partner violence. Relationship adjustment and drug use remained significantly associated with partner violence, whereas alcohol problem severity did not, after controlling for patient antisocial traits. Beliefs in the link between drinking and relationship problems were associated with partner violence independent of other clinical factors.

Community reinforcement training for family and significant others of drug abusers: a unilateral intervention to increase treatment entry of drug users

We randomly assigned 32 concerned family members and significant others (FSOs) of drug users (DUs) to a community reinforcement training intervention or a popular 12-step self-help group. We measured problems arising from the DU's behavior, social functioning of the DU and FSO, and mood of the FSO at baseline and 10 weeks later. We also monitored the FSOs' treatment attendance and treatment entry of the DUs. The treatment groups showed equal reductions from baseline to follow-up in problems and improvements in social functioning and mood of the FSO. However the community reinforcement intervention was significantly better at retaining FSOs in treatment and inducing treatment entry of the DUs.

Individual psychopathology and marital distress. Analyzing the association and implications for therapy

This article is a review of the association of individual and marital problems. The focus is on depression, alcohol abuse, anxiety disorders, and the functional psychoses, each of which interact with marital distress in important ways. Although the causal connections between these disorders and marital distress are complex and only particularly understood, the available evidence shows that individuals' and couples' problems often exacerbate each other. Consequently, regardless of whether the initial presentation is individual or couple focused, there is routinely a need to assess both individual and relationship functioning. Couples therapy, and in particular behavioral couples therapy (BCT), is an important element of effective treatment of depression, alcohol abuse, anxiety disorders, and the functional psychoses. The integration of couple and individual therapy presents a number of clinical challenges, and in concluding this article the authors provide guidelines for managing these challenges.

Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment

Thirty-six newly abstinent married male alcoholics, who had recently begun outpatient individual alcoholism counseling, were randomly assigned to a no-marital-therapy control group or to 10 weekly sessions of a behavioral marital therapy (BMT) or an interactional couples group. The cost-benefit analysis of BMT plus individual alcoholism counseling showed (a) decreases in health care and legal costs in the 2 years after as compared to the year before treatment, (b) a positive cost offset, and (c) a benefit-to-cost ratio greater than 1 indicating that health and legal system cost savings (i.e., benefits) exceeded the cost of delivering the BMT treatment. None of the positive cost-benefit results observed for BMT were true for participants given interactional couples therapy plus individual alcoholism counseling for which posttreatment utilization costs increased. Thus, adding BMT to individual alcoholism counseling produced a positive cost benefit, whereas the addition of interactional couples therapy did not. Individual counseling both alone and with BMT added showed substantial and significant cost savings from reduced utilization that substantially and significantly exceeded the cost of delivering the treatment; and the two treatments did not differ significantly on these cost savings and cost offsets. Individual counseling alone did have a significantly more positive benefit-to-cost ratio than BMT plus individual counseling due to the lower cost of delivering the individual counseling which was about half the cost of delivering BMT plus individual counseling. Cost-effectiveness analyses indicated that BMT plus individual counseling was less cost effective than individual counseling alone and modestly more cost effective than interactional therapy in producing abstinence from drinking. When marital adjustment outcomes were considered, the three treatments were equally cost effective except during the active treatment phase when BMT was more cost effective than interactional couples therapy. Study limitations are discussed.

Comparison of Timeline Follow-Back and Averaging Methods for Quantifying Alcohol Consumption in Treatment Research

There is as yet no consensus regarding how best to quantify alcohol consumption as an outcome measure in treatment research. Two commonly used methods were compared: the timeline follow-back procedure which reconstructs daily drinking via a calendar, and the grid averaging method employed in the Drinker Profile system. A sample of outpatients being treated for alcoholism was interviewed using both approaches. Similar, though not identical, consumption patterns were obtained with each measure accounting for approximately half of the variance in the other. The relative advantages of these two assessment approaches are considered.

Sex differences in the marital functioning of treated alcoholics

Fifty-five treated alcoholics (31 males and 24 females) were matched with a control group of social drinkers on four dimensions: sex, age, level of education and number of children. Spouses of alcoholic and non-alcoholic respondents were also sampled (total n = 199). Respondents and spouses completed the following questionnaires: The Dyadic Adjustment Scale (DAS), the Areas of Change Questionnaire (AC), and the Marital Status Inventory (MSI). Major results were as follows: (1) Alcoholics reported poorer marital functioning than non-alcoholics. (2) Male alcoholics described less troubled relationships than did female alcoholics. (3) However, spouses of alcoholics described strained marriages in both cases. (4) Alcoholic couples were less congruent than control couples on conscious decisions regarding marital dissolution. (5) Alcoholic wives had taken more steps towards marital dissolution than their husbands had, whereas alcoholic husbands had taken fewer steps than their wives had. It was suggested that male alcoholics externalize their drinking and deny its impact on their marriages, whereas female alcoholics acknowledge their drinking and take the blame for their marital problems. Therapeutic and research implications were discussed.