Do outcomes after behavioral couples therapy differ based on the gender of the alcohol use disorder patient?

Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature

INTRODUCTION

Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a 'gold standard' treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT.

AIMS

The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment.

METHOD

A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators.

RESULTS

The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender.

CONCLUSIONS

The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.

The Role of the Family in Alcohol Use Disorder Recovery for Adults

Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination.

Sex and Gender Effects in Recovery From Alcohol Use Disorder

The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.