Behavioral couples and family therapy for substance abusers.

Behavioral couples therapy (BCT) sees the substance-abusing patient with the spouse to arrange a daily "sobriety contract" in which the patient states his or her intent not to drink or use drugs, and the spouse expresses support for the patient's efforts to stay abstinent. For patients taking a recovery-related medication (eg, disulfiram, naltrexone), daily medication ingestion witnessed and verbally reinforced by the spouse also is part of the contract. Behavioral couples therapy also teaches communication and increases positive activities. Findings of the past few years have added considerably to the evidence base showing that BCT produces greater abstinence and better relationship functioning than typical individual-based treatment; BCT also reduces social costs and domestic violence. Noteworthy recent advances have extended the positive effects of BCT to women drug abusers, showed the indirect benefits of BCT for the couple's children, expanded BCT to include family members other than spouses, integrated BCT with pharmacotherapy, and started to address barriers to technology transfer.