Marital interactions of alcoholic couples: Comparison with depressed and nondistressed couples

Alcohol Misuse, Marital Functioning and Marital Instability: An Evidence-Based Review on Intimate Partner Violence, Marital Satisfaction and Divorce

Alcohol use is a primarily social behavior, and marriage is an important aspect of social relationships. This article reviews alcohol use and its impact on several facets of the marital relationship, including the impact of alcohol use on intimate partner violence (IPV), marital satisfaction, marital functioning, and divorce. There is considerable evidence of the role alcohol plays in IPV and recent research identifies moderators of the alcohol-IPV relationship. These include personality constructs, social pressure, marital satisfaction, and traits, such as hostility and impulsivity. Marital satisfaction and alcohol use demonstrate bidirectional causality, whereas marital satisfaction predicts alcohol use behaviors, and alcohol use also predicts marital satisfaction. Longitudinal studies provide evidence that divorce is temporally associated with alcohol use, including Alcohol Use Disorder. Finally, there are a number of causative factors that interplay in the dissolution of marriage; alcohol use is one of these factors. Excessive alcohol consumption is a common reason for divorce among many couples. Across all associations between alcohol use and IPV, marital satisfaction, marital functioning, and divorce, sex and gender consistently appear as a moderator in these relationships. Another consistent finding is in respect to concordant drinking, such that marital partners who have similar patterns of alcohol consumption fare better than those with discrepant patterns of consumption. Future research should focus on greater inclusion of same-sex, LGBTQQ+, and socio-culturally diverse couples. Additionally, future studies should use Actor-Partner Interdependence Modeling (APIM) to effectively examine non-independent partner data.

The impact of alcohol on affiliative verbal behavior: A systematic review and meta-analysis

BACKGROUND

Language is a fundamental aspect of human social behavior that is linked to many rewarding social experiences, such as social bonding. Potential effects of alcohol on affiliative language may therefore be an essential feature of alcohol reward and may elucidate pathways through which alcohol is linked to social facilitation. Examinations of alcohol's impact on language content, however, are sparse. Accordingly, this investigation represents the first systematic review and meta-analysis of alcohol's effects on affiliative language. We test the hypothesis that alcohol increases affiliative verbal approach behaviors and discuss future research directions.

METHODS

PsycInfo and Web of Science were systematically searched in March 2023 according to our preregistered plan. Eligible studies included social alcohol administration experiments in which affiliative verbal language was assessed. We present a random-effects meta-analysis that examines the effect of alcohol compared to control on measures of affiliative verbal behavior.

RESULTS

Our search identified 16 distinct investigations (comprising 961 participants) that examined the effect of alcohol on affiliative verbal behavior. Studies varied greatly in methods and measures. Meta-analytic results demonstrated that alcohol is modestly associated with increases in affiliative verbal behavior (Hedges' g = 0.164, 95% CI [0.027, 0.301], p = 0.019). Study quality was rated using an adapted version of the Quality Assessment Tool for Quantitative Studies and did not significantly moderate alcohol's effects.

CONCLUSIONS

This study provides preliminary evidence that alcohol can increase affiliative verbal behaviors. This effect may be an important feature of alcohol reward. Given heterogeneity in study features, low study quality ratings, and limited reporting of effect size data, results simultaneously highlight the promise of this research area and the need for more work. Advances in language processing methodologies that could allow future work to systematically expand upon this finding are discussed.

Pathology in Relationships

Committed, long-term romantic relationships are ubiquitous among modern society. They are one of the most important contexts for the development, maintenance, and treatment of psychopathology. In this review, I first place psychopathology within the most commonly cited theoretical model of marital satisfaction and stability and then discuss how relationship satisfaction is conceptualized and assessed in this literature. In the second half of the review, I describe the theories regarding how romantic relationships may be connected to psychopathology. Relationship distress is easily incorporated into a diathesis-stress model as an important trigger for psychopathology. Next, I review cross-sectional research, longitudinal research, and treatment efficacy research linking relationship quality and psychopathology. I provide evidence for the robustness of these effects and areas where research must expand. I finish with a summary section that synthesizes what is known about the mechanisms linking relationship distress and psychopathology.

Alcohol Behavioral Couple Therapy: In-session behavior, active ingredients and mechanisms of behavior change

OBJECTIVE

Alcohol Behavioral Couple Therapy (ABCT) is an efficacious alcohol treatment. The purpose of the study was to describe patient and partner language and therapist behavior during therapy sessions and test a proposed causal model linking active ingredients of ABCT as measured by therapist behaviors, hypothesized mechanisms of behavior change as measured by in-session patient and partner language, and alcohol use outcomes.

METHOD

Data came from couples in four ABCT clinical trials (N = 188; 86 males, 102 females, and their partners). Patient and partner verbal behaviors in session one and a mid-treatment session were coded using the System for Coding Couples' Interactions in Therapy-Alcohol. Therapist behavior was coded using the Couples Treatment Integrity Rating System. Percent days abstinent was calculated from daily drinking data for the first and second half of treatment and six months post-treatment.

RESULTS

Therapists delivered an adequate level of the ABCT interventions during treatment. During treatment, couples increased positive behaviors, talked less about drinking, and decreased their amount of motivational language. Therapist behaviors did not predict patient or partner behaviors during treatment or drinking outcomes. Partner advice in the first session predicted poorer drinking outcomes. At mid-treatment, patient behaviors as a block, and specific behaviors of contemptuousness toward their partner and sustain talk, predicted poorer drinking outcomes.

CONCLUSIONS

During ABCT, patients decrease their drinking, and patient and partner behaviors change in predicted ways. Partner advice, patient contemptuousness, and patient sustain talk predicted poorer outcomes. Analyses of within-session verbal behavior did not support the hypothesized mechanisms for change for ABCT.

Out Drinking the Joneses: Neighborhood Factors Moderating the Effects of Drinking on Relationship Quality over the First Four Years of Marriage

Neighborhood quality has been cross-sectionally linked to both relationship behaviors and relationship well-being. Consistent with the Vulnerability Stress-Adaptation model of relationship functioning (Karney & Bradbury, 1995), we hypothesized that associations between social behaviors (e.g., drinking) and relationship quality could be moderated by neighborhood factors. Specifically, we characterized neighborhoods along multiple dimensions using multiple methods (self-report, census) to investigate how neighborhood factors might clarify ambiguous effects of alcohol use on marital functioning. A nationally recruited sample of 303 newlywed couples completed a baseline assessment around the time of marriage and was then assessed yearly across the first 4 years of marriage (94% retention). Three level HLM slope-intercept models were used to model changes in relationship satisfaction across the first 4 years of marriage. Results suggested that, for couples living in highly disordered neighborhoods, positive shifts in overall levels of drinking within specific waves of assessment were associated with corresponding negative shifts in satisfaction whereas in neighborhoods without perceived disorder, this effect was reversed. For couples living in neighborhoods with low levels of domestic structures (high census rates of single renters without children), within-couple discrepancies favoring higher rates of husband drinking in specific waves predicted poorer relationship quality for both partners in those same waves whereas those same discrepancies predicted higher satisfaction in high domesticity neighborhoods (high census rates of married homeowners with children). The findings provide insight into the different roles of alcohol use in relationship maintenance and highlight the importance of using external context to understand intradyadic processes.

The Proximal Effects of Acute Alcohol Consumption on Male-to-Female Aggression: A Meta-Analytic Review of the Experimental Literature

The current meta-analytic review examined the experimental literature to quantify the causal effect of acute alcohol consumption on self-reported and observed indicators of male-to-female general, sexual, and intimate partner aggression. Database and reference list searches yielded 22 studies conducted between 1981 and 2014 that met all criteria for inclusion and that were subjected to full text coding for analysis. Results detected a significant overall effect (d = .36), indicating that male participants who consumed alcohol evidenced greater aggressive behavior toward females while completing a subsequent laboratory aggression paradigm than male participants who received no alcohol. We found homogeneity across all categories of potential moderator variables. Results further indicated that alcohol resulted in comparable increases of male-to-female sexual (d = .32) and intimate partner (d = .45) aggression. Further research is required to draw meaningful conclusions about individual and situational factors that may interact with acute alcohol consumption to produce the highest levels of risk.

Typology of Couples Entering Alcohol Behavioral Couple Therapy: An Empirical Approach and Test of Predictive Validity on Treatment Response

This study aimed to examine whether classification of couples in which one partner has an alcohol problem is similar to that reported in the general couples literature. Typologies of couples seeking alcohol behavioral couple therapy (ABCT) were developed via hierarchical cluster analysis using behavioral codes of couple interactions during their first ABCT session. Four couples types based on in-session behavior were established reliably, labeled avoider, validator, hostile, and ambivalent-detached. These couple types resembled couples types found in previous research. Couple type was associated with baseline relationship satisfaction, but not alcohol use. Results suggest heterogeneity in couples with alcohol problems presenting to treatment; further study is needed to investigate the function of alcohol within these different types.

Adverse childhood events and current depressive symptoms among women in Hawaii: 2010 BRFSS, Hawaii

Research on the association between adverse childhood events (ACEs) and depression among women in Hawaii is scarce. ACEs have been linked to unfavorable health behaviors such as smoking and binge drinking which are more prevalent in the state compared to the US overall. The concomitant presence of ACEs with smoking or binge drinking may explain the excess depression prevalence in Hawaii compared to the national average. Using data of women residing in the state (2010 Hawaii Behavioral Risk Factor Surveillance System Survey), we examined the association between ACEs count or type (household dysfunction and physical, verbal and sexual abuse) and current depressive symptoms (CDS), in addition to modification by current smoking status (smoked >100 cigarettes in a lifetime and currently smoke) and binge drinking (consumed ≥4 alcoholic beverage within the past month and in ≥1 occasion(s)). Evaluation of ACEs before age 18 consisted of 11 indicators. Eight indicators of the Patient Health Questionnaire (PHQ-8) were used to assess CDS. All analyses utilized logistic regression taking into account sampling design. The odds ratio of having CDS between those with versus without ACEs increased per increasing number of ACEs (1 ACE: OR = 2.11, CI = 1.16-3.81; 2 ACEs: OR = 2.90, CI = 1.51-5.58; 3 or 4 ACEs: OR = 3.94, CI = 2.13-7.32; 5+ ACEs: OR = 4.04, CI = 2.26-7.22). Household dysfunction (OR = 2.10, CI = 1.37-3.23), physical abuse (OR = 1.67, CI = 1.08-2.59), verbal abuse (OR = 3.21, CI = 2.03-5.09) and sexual abuse (OR = 1.68, CI = 1.04-2.71) were all positively associated with CDS. Verbal abuse had the strongest magnitude of association. Neither current smoking status nor binge drinking modified the relationship between ACEs count (or type) and CDS. In conclusion, the presence of ACEs among women in Hawaii was indicative of CDS in adulthood, notably verbal abuse. Further, a dose response existed between the number of ACEs and the odds for CDS. The concomitant exposure to ACEs and current smoking status or binge drinking did not elevate odds for CDS.

DSM-IV alcohol dependence and marital dissolution: evidence from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

The purpose of this study was to examine the cross-sectional and longitudinal associations among alcohol use disorder (AUD), stressful life events, and marital dissolution in a probability sample of adults.

METHOD

The National Epidemiologic Survey on Alcohol and Related Conditions is a prospective, longitudinal study of a probability sample of 43,083 adults 18 years of age and older living in the United States. The interval between Wave 1 (W1) and Wave 2 (W2) was approximately 3 years. Cross-sectional analyses included 32,359 adults ages 18 and older who were ever married at W1, and longitudinal analyses included 17,192 adults who were currently married at W1 and who completed relevant W2 measures. Participants completed inhome surveys conducted with computer-assisted personal interviewing.

RESULTS

Rates of lifetime marital dissolution were significantly higher among those with lifetime AUD (48.3%) than in those with no lifetime AUD (30.1%). The incidence of marital dissolution from W1 to W2 was 15.5% for those with a past-12-month AUD at W1, compared to 4.8% among those with no AUD. Proportional hazards regression analyses showed that past-12-month AUD, tobacco use disorder, other substance use disorder, stressful life events, older age at marriage, being married more than once, and being married to an alcoholic at W1 predicted greater hazards of marital dissolution at W2. These associations were not moderated by gender.

CONCLUSIONS

AUD and stressful life events predict subsequent marital dissolution independently of other substance use disorders, mood and anxiety disorders, and personality disorders. Results were discussed within the framework of the Vulnerability-Stress-Adaptation model of marriage.

Behavioural Marital Therapy for Alcoholics: Effects on Communication Skills and Marital Satisfaction

Four married couples were recruited from an outpatient alcohol counselling centre. Four husbands and one wife had recently received therapy for alcoholism and all but one was abstinent during the study. All scored as distressed on the Marital Adjustment Test. They participated in ten sessions of behavioural marital therapy emphasising positive reinforcement, communication, expression of feelings and problem solving. Problem solving discussions were audio-recorded at each session and analysed using a behaviour code. Measures of marital satisfaction, conflict and depression showed modest gains which were generally maintained at follow-up. Communication skills improved most with training, problem solving less so and feelings expression declined below baseline levels. These changes did not appear to be very durable. The non-abstinent client reduced his drinking to a level satisfactory to his wife during therapy. These findings support other recent work, draw attention to the need to find ways of promoting the maintenance and transfer of therapeutic changes and suggest that behavioural marital therapy may usefully be employed in outpatient alcohol counselling settings.

PTSD and conflict behavior between veterans and their intimate partners

This study examined the influence of trauma history and PTSD symptoms on the behavior of veterans and their intimate partners (287 couples; N=574) observed during conflict discussions and coded using the Rapid Marital Interaction Coding System (Heyman, 2004). Dyadic structural equation modeling analyses showed that PTSD was associated with more frequent displays of hostility and psychological abuse and fewer expressions of acceptance and humor in both veterans and their partners. Findings provide new insight into the social and emotional deficits associated with PTSD and emphasize the importance of addressing the trauma histories and PTSD of both partners when treating veteran couples with relationship disturbance.

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.

Marital and family processes in the context of alcohol use and alcohol disorders

Alcohol use is often part of the fabric of marriage and family life, and although it is associated with certain positive effects, excessive drinking and alcohol disorders can exert a negative effect on the marital development and on the development of children in the context of the family. This review considers evidence that alcohol influences and is influenced by marital/family processes, including transitions into marriage and parenthood, marital satisfaction, marital violence, parenting, and child development. The review discusses the importance of antisocial behavior and the need to examine women's drinking, and the joint impact of men's and women's drinking on marital/family processes. The review highlights the lack of studies in certain key areas, including the link between discordant drinking and violence and marital satisfaction, the role of alcohol in child neglect, and the potential role of marital conflict as a mediator or moderator of the relationship between alcohol and child functioning.

Marital interaction in alcoholic and nonalcoholic couples: alcoholic subtype variations and wives' alcoholism status

The authors examined problem-solving marital interactions of alcoholic and nonalcoholic couples (N = 132). Four alcoholic groups (husband alcoholic with antisocial personality disorder or not, paired with alcoholic or nonalcoholic wives) were compared with each other and with a both-spouses-nonalcoholic group. Consistent with the alcoholic subtypes hypothesis, couples with an antisocial alcoholic husband had higher levels of hostile behavior regardless of wives' alcoholism status. In contrast, rates of positive behaviors and the ratio of positive to negative behaviors were greatest among couples in which either both or neither of the spouses had alcoholic diagnoses and were lowest among alcoholic husbands with nonalcoholic wives. Discussion focuses on possible mechanisms linking antisocial alcoholism and discrepant alcoholic diagnoses to poorer marital outcomes.

IMPACT OF FATHERS' ALCOHOLISM AND ASSOCIATED RISK FACTORS ON PARENT-INFANT ATTACHMENT STABILITY FROM 12 TO 18 MONTHS

This study examined short-term attachment stability and sought to identify predictors of stability and change within a sample characterized by fathers' alcoholism. Results suggest moderate stability of attachment classifications (60% for mothers, 53% for fathers) from 12 to 18 months. Higher paternal and maternal alcohol symptoms, maternal depression, and maternal antisocial behavior were found in families with stable insecure mother-infant attachment compared to those who were stable secure. Mother-infant stable insecurity was associated with higher levels of maternal negative affect expression during play. Father-infant stable insecurity was associated with lower levels of paternal positive affect expression and decreased sensitivity during play. Stable insecure children also had higher levels of negative affect during parent-infant interactions and higher negative emotionality during other episodes compared to stable secure children. Results indicate that infants who were insecure at both time points had the highest constellation of family risk characteristics.

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.

Alcohol use in adolescents whose fathers abuse drugs

This study examined the interrelation of several domains, including father attributes, father-child relations, peer influences, environmental factors, and youth personality, as they related to adolescent alcohol use. Several aspects of the father-child relationship were also examined as possible protective factors against adolescent drinking. Subjects consisted of 204 HIV-positive and HIV-negative drug-abusing fathers and their adolescent children between the ages of 12-20. Data were collected via individual structured interviews of both the fathers and the youth. Results indicated that several items from each domain were related to adolescent drinking, and that an affectionate father-child bond had a protective effect. Moreover, hierarchical regression analyses demonstrated that the youth's personality mediated between all other domains and adolescent alcohol use. There was also a direct effect of peer influences on adolescent drinking. Findings extend the literature on the specific mechanisms which link parental substance use with adolescent alcohol use in a high-risk population.

Observation of couple conflicts: clinical assessment applications, stubborn truths, and shaky foundations

The purpose of this review is to provide a balanced examination of the published research involving the observation of couples, with special attention toward the use of observation for clinical assessment. All published articles that (a) used an observational coding system and (b) relate to the validity of the coding system are summarized in a table. The psychometric properties of observational systems and the use of observation in clinical practice are discussed. Although advances have been made in understanding couple conflict through the use of observation, the review concludes with an appeal to the field to develop constructs in a psychometrically and theoretically sound manner.

Interpersonal processes and psychopathology among expectant and nonexpectant adolescent couples

This study examined the interpersonal and psychological functioning of expectant and nonexpectant adolescent couples. Interpersonal processes were assessed using the Structural Analysis of Social Behavior (L. S. Benjamin, 1974) and psychological functioning was assessed using the Diagnostic Interview for Children and Adolescents--Revised (W. Reich, 1991). Compared with their nonexpectant peers, expectant couples exhibited higher rates of negative interpersonal processes, including demand-withdraw behaviors and lower rates of positive interpersonal processes. Expectant males reported higher rates of behavior disorders, substance use disorders, and internalizing disorders than nonexpectant males. Higher rates of substance-use disorders mediated the effect of expectancy status on demand-withdraw behavior. Results help clarify the links between the psychological risks associated with adolescent pregnancy and the interpersonal functioning of young expectant couples.

TEMPERAMENT AND BEHAVIORAL PROBLEMS AMONG INFANTS IN ALCOHOLIC FAMILIES

This study examined the association between paternal alcoholism and 12-month infant temperament and 18-month behavior problems. The role of associated parental psychopathology and maternal drinking in exacerbating risk for maladaptive behavioral outcomes was also examined. Participants were 213 families (102 control families, 94 paternal alcoholic families, and 17 families with alcoholic fathers and heavy drinking mothers) who were assessed when their child was 12 months old and reassessed again when their child was 18 months old. Infants of alcoholics displayed marginally more stubborn/persistent temperaments at 12 months of age, but significantly more internalizing problems at 18 months. Analyses suggested that internalizing problems in the infants of alcoholics could be attributed to the paternal depression concomitant with paternal alcoholism. In addition, an interaction was observed, indicating that paternal alcohol problems predicted 18-month externalizing problems among families with low maternal depression, but not among families with high maternal depression. Children of depressed mothers exhibited uniformly higher externalizing scores, but were not further impacted by paternal alcohol problems. However, children of nondepressed mothers were adversely affected by fathers' drinking as reflected by higher externalizing behavior scores. The results highlight the necessity of addressing the overall contextual risks that occur with paternal alcoholism in studies of the development of children in alcoholic families.

Sequential interactions in the marital communication of depressed men and women

Despite studies showing patterns of sequential interaction between depressed wives and their husbands, no published research has contrasted sequential interactions of depressed husbands and their wives. This study compared problem-solving interactions of 49 couples with a depressed husband, 41 with a depressed wife, and 50 normal controls. Interactions were coded using the Marital Interaction Coding System. Although no clear patterns of sequential interaction distinguished couples with a depressed wife from normal control couples, results suggested a unique pattern of interaction between depressed husbands and their spouses, whereby positive communications from the husband resulted in decreased positivity and increased negativity from their wives. Given the importance of positivity for promoting effective problem solving, this pattern appears to have important implications for couples' long-term marital satisfaction and husbands' mood regulation.

Parent-infant interactions among families with alcoholic fathers

The purpose of this study was to examine the relationship between fathers' alcoholism and the quality of parent-infant interactions during free play. A related goal was to study the potential mediating or moderating role of comorbid parental psychopathology, such as depression and antisocial behavior, difficult infant temperament, and parental aggression. The sample consisted of 204 families with 12-month-old infants (104 alcoholic and 100 control families), recruited from New York State birth records. Results indicated that fathers' alcoholism was associated with a number of other risk factors (depression, antisocial behavior, and family aggression). Fathers' alcoholism was also associated with more negative father-infant interactions as indicated by lower paternal sensitivity, positive affect, verbalizations, higher negative affect, and lower infant responsiveness among alcoholic fathers. As expected, fathers' depression mediated the relationship between fathers' alcoholism and sensitivity, while maternal depression mediated the association between maternal alcohol problems and maternal sensitivity. Parents' psychopathology did not moderate the association between alcoholism and parent-infant interactions. The results from the present study suggest that the origins of risk for later maladjustment among children of alcoholic fathers are apparent as early as infancy and highlight the role of comorbid parental risk factors.

The nuts and bolts of behavioral observation of marital and family interaction

Despite considerable discussion in the literature about the advantages of observational research and the relative benefits of different coding systems and strategies, little is written about the actual implementation of this assessment strategy. This paper presents an overall framework as well as the essential components involved in collecting (selection of task, setting, unit of analysis, and coding system) and coding (transcribing, selecting and training coders, transforming data, and analyzing reliability) of observational data. To achieve success with observational methods, we emphasize several issues, including (a) the research question as the motivator for all decisions, (b) the interrelatedness of tasks, and (c) the implications of decisions early in the process for later stages of analysis and interpretation. Investigators are encouraged to communicate the details of their observational and coding procedures so that these methods are readily accessible for purposes of replication and comparison.

Parent-child interactions and child outcomes as related to gender of alcoholic parent

Parents and children from alcoholic and non-alcoholic families (N = 137) were compared in regard to quality of interactions (using the Marital Interaction Coding System), child outcomes (using the Child Behavior Checklist), and the possible moderating effects of parenting behavior on child outcomes. Alcoholic families were subdivided by gender (father-alcoholic, mother-alcoholic, both parents alcoholic) to assess for the effect that gender of alcoholic parent has on parent-child interactions and child outcomes. Results indicated that dual and mother-only alcoholic families exhibited the most impaired interactions, although child problem behavior was not significantly different across the three groups containing one or two alcoholic parents. Furthermore, father's behavior (both alcoholic fathers and those married to an alcoholic), as compared to mother's behavior, most clearly moderated child outcomes. The possible protective effect of having a non-alcoholic mother was also indicated. Results are discussed in regard to the negative and positive effects that parents from alcoholic households can have on children.

Marital interactions of male versus female alcoholics

This study assessed the interactions of 131 alcoholic and nonalcoholic couples as they engaged in discussions of personally relevant problems. For 50 couples, the husband was alcoholic; for 15 couples, the wife was alcoholic; for 16 couples, both spouses were alcoholics; and for 50 couples, neither spouse was alcoholic. Observations were conducted during sessions when alcohol was consumed and in nondrinking sessions. Female alcoholic couples (with nonalcoholic spouses) demonstrated high negativity in the "no-drink" session, which was normalized in the drink session, suggesting an adaptive function to alcohol use. Concordant couples (both members were alcoholic) also demonstrated high negativity in the no-drink session, but exhibited increased negativity in the drink session, suggesting that concordance has a maladaptive impact on marital interaction. All alcoholic groups demonstrated greater negativity and lower positivity and congeniality in their marital interactions compared to nonalcoholic couples. Couples with male alcoholics were the least divergent from normal control couples. Unique female patterns in alcoholism are discussed in terms of adaptive and reinforcing patterns and spousal influences.

Marital functioning in early versus late-onset alcoholic couples

Current knowledge about alcohol and marital functioning is limited by restrictive sample selection, inattention to the literature on individual-based alcoholic subtypes, and lack of research linking individual differences among alcoholics to marital functioning. The present study was designed to study marital functioning of alcoholics in light of current alcohol typologies. Subjects were part of a larger study on conjoint treatment of alcoholic males and their female partners. Four typologies-including Type 1/2, In-Home/Out-of-home, Steady/Episodic, and Early/Late Onset-were tested for replicability and discriminant validity before linking them to marital functioning. Discriminant validity was found only for the Early (59%)-versus Late (41%)-Onset typology;thus, further analyses linked only this typology with marital functioning. At baseline, Early-Onset couples reported more marital instability, and the females in these couples were more distressed. During treatment, Early-Onset couples reported higher daily marital satisfaction than Late-Onset couples. Regardless of age of onset, males reported higher marital satisfaction than their spouses during treatment, but their satisfaction did not increase during treatment. Female partners' marital satisfaction increased during treatment. Female partners of Late-Onset males reported particularly low marital satisfaction during treatment. Parsing the sample according to the early-/late-onset typology yielded different predictors of marital satisfaction for males and females within each subtype. For female partners of Early-Onset alcoholics, psychological distress unrelated to her partner's drinking severity was most associated with her own marital satisfaction, whereas marital adjustment of female partners of Late-Onset alcoholics was most associated with the male's level of perceptual accuracy regarding her needs. This pattern was reversed for the males; marital adjustment of Early-Onset alcoholics was most associated with his partner's perceptual accuracy of his needs, whereas marital functioning of Late-Onset alcoholics was best accounted for by his own psychological distress.

Alcoholism in adolescents and their families. Family-focused assessment and management

A family-focused approach is the most effective clinical method in the assessment and management of substance abuse in adolescents and their parents. The impact of alcoholism and substance abuse on parents and children, psychosocial risk factors, and indicators of alcoholism are important considerations when using this approach. Education regarding the family-focused approach to the treatment of substance abuse deserves a high priority in the training of pediatricians and other primary care physicians. As Doherty and Baird suggest," . . . the key to this training will not be . . . the development of a more sensitive liver function test, . . . but (rather) will be to help primary care physicians view individual patients as a part of a social context. The challenge will be to train the physicians to evaluate the patient in his or her social and family system for significant disturbances that commonly occur with chemical dependency. By evaluating the presenting patient in a family context, the primary care physician has the means to discover chemical dependency in early stages, when treatment options are less disruptive; when outcome is improved; and when the emotional and economic losses to patient, family and community are reduced."

An empirical classification of drinking patterns among alcoholics: binge, episodic, sporadic, and steady

Steady (daily, continuous) versus nonsteady (binge, episodic, bout, intermittent) drinking pattern have been influential Jellinek's (1960) formulation of delta and gamma drinkers, and are used as variables in various typological systems and drinker profiles. However, definitions of drinking patterns vary widely across studies, and most studies rely on one self-report item to establish a subject's pattern. To systematize and empirically test drinking-pattern schemas, we developed detailed definitions of binge, episodic, sporadic, and steady drinking patterns. A computer algorithm was written in SAS to classify 94 male alcoholics participating in outpatient conjoint therapy, using 6-month pretreatment drinking data from the Timeline Followback Interview. The final classification was: 3 (3%) binge, 33 (35%) episodic, 12 (13%) sporadic, and 40 (43%) steady drinkers. Six (6%) were unclassifiable (due to too few drinking days or too many interruptions to the pattern) by the computer. Episodic, sporadic, and steady drinkers did not differ in demographics, alcohol-related consequences, global psychological distress, or marital satisfaction. Steady drinking was associated with later onset of drinking problems (> 25), while episodic and sporadic drinking were associated with earlier onset. These results are contrary to current use of "binge drinking" as a variable associated with Type 1 alcoholism. Predictive validity analyses indicated that steady drinkers continued to drink more frequently than episodic and sporadic drinkers during treatment and 6 months posttreatment. Also, preliminary data indicate that pretreatment drinking pattern may be predictive of similar within-treatment urge-to-drink patterns. Implications for research and treatment are discussed.

Changes in family functioning during treatment and drinking outcomes for high and low autonomy alcoholics

Alcoholics' level of autonomy was hypothesized to have a moderating effect on the relationship between changes in family functioning and subsequent drinking behavior. Functioning of families of patients in outpatient alcoholism treatment was assessed prior to the onset of treatment and again 6 months later. For alcoholics who were low in autonomy, perceptions of improvements in functioning predicted better drinking outcomes during a subsequent 6-month follow-up, while changes in family functioning were unrelated to drinking behavior in high autonomy alcoholics. The areas of family functioning in which change was a significant predictor of later drinking primarily concerned the quality of interactions between family members. Alcoholics' gender, psychiatric comorbidity, and the type of treatment they received did not moderate the relationship between changes in family functioning and drinking outcomes. Implications for the treatment of alcoholic patients and the limitations of the research are discussed.

The California Family Health Project: VII. Summary and integration of findings

In a series of reports, we have observed the relationships between four domains of family life (World View, Emotion Management, Structure/Organization, Problem Solving), and the health of husbands and wives in a community-based sample of 225 families. In this final article of the series, we provide an overview and summary of the results, by gender, including the structure and patterning of variables both within each family domain and among all four family domains analyzed together. In addition, we review the associations between each family domain and adult health (unidomain analyses), and among all four family domains taken together and adult health (multidomain analyses). Prominent differences in family and health relationships based on gender are described from the perspective of socially and culturally supported sex-role expectations and behavior. The results support the use of a multidimensional family assessment framework in health research that can lead to the further development of empirically based models of family process.

Does adding conjoint therapy to individually focused alcoholism treatment lead to better family functioning?

This report examines functioning in the families of alcoholics undergoing outpatient treatment. Alcoholic patients were randomly assigned to two social-learning-based alcoholism treatments, one of which contained a conjoint therapy component. Patients (Pts) and significant others (SOs) provided ratings of family functioning before treatment and at a 6-month follow-up. According to the perceptions of both Pts and SOs, there were significant improvements in family functioning in a number of areas at posttreatment. Contrary to what was expected, however, the improvements were not greater in the conjoint condition. The usefulness of alcoholics' level of autonomy as a matching variable also was explored. According to the perceptions of both Pts and SOs, posttreatment family functioning was better when low-autonomy alcoholics were treated without other family members. There also was evidence that conjoint treatment was more effective with high-autonomy alcoholics and their families, although it was less convincing and limited to the SOs' perceptions. Implications for alcoholism treatment and the limitations of the findings are discussed.

The relationship of pretreatment family functioning to drinking behavior during follow-up by alcoholic patients

The relationship of alcoholics' perceptions of the pretreatment functioning of their families to drinking outcomes during an 18-month follow-up was examined. Family functioning was hypothesized to be predictive of drinking behavior, particularly in subjects with low assertion of autonomy scores. These individuals report greater dependency and attachment, and therefore might be more affected by the state of important relationships. The results indicated that with low autonomy male alcoholics, greater family dysfunction predicted significantly fewer days abstinent during Months 1-6 and 13-18 and more severe drinking episodes during the first year of the follow-up. In the high autonomy males, family dysfunction was unrelated to subsequent drinking behavior. In women, on the other hand, greater family dysfunction predicted more days abstinent in those high in autonomy and was unrelated to the drinking behavior of those low in autonomy. Implications for patient-treatment matching, differences between male and female alcoholics, and the need for additional studies of family functioning and drinking behavior in women are discussed.

Simultaneous depression

Five different strategies were used to detect cases in which depressed behaviour occurred in both spouses within the same time period (simultaneous depression). Among 7068 references on depression in the literature, only one referred to a case of simultaneous depression. Of 8008 registered individuals hospitalized in Norway from 1961-1971, none had simultaneous depression. A search of the total Scandinavian population (17.5 million) revealed only one case. The authors suggest that the result is caused by specific communication values attached to depressed behaviour and compensatory mechanisms in depressed couple relationships. The need for assessments that include the identified patient's family system in the planning of treatment for depression is discussed, with the aim to prevent cases of successful mistreatment in which the identified patient is cured while the spouse becomes depressed or commits suicide.

Psychologists and children of alcoholic parents

Clinical evidence has pictured children of alcoholic parents as vulnerable physically, emotionally, socially, academically, and at risk for alcoholism. Review of research indicated that some of these clinical insights have been validated, but much more is needed to fill out an accurate picture for psychologists who will be asked to work with them.

Psychologists and alcoholic women

Alcoholism among women often has been treated using a model based on research with alcoholic men. Women react differently to alcohol than men both physiologically and psychologically and their drinking patterns are different from men's. Treatment facilities for alcoholism have not been as available for women as for men and treatment must be individualized for the differences between men and women problem drinkers and for the differences among alcoholic women.

Alcoholism and family interaction: an experimental paradigm

The purpose of this paper is to describe the authors' ongoing investigation of alcoholism and family interaction--a large-scale observation study involving intact families assessed under a broad range of conditions. The methodology is characterized by the inclusion of two control groups, laboratory observations involving experimental drinking procedures, and naturalistic home observations focused on dinnertime interactions. Key issues addressed involve the impact of alcoholism on the process and structure of family life, the degree to which varying patterns of family interaction serve to potentiate or inhibit the development of alcoholism in children of alcoholics, and the degree to which observed patterns vary in relation to nature of dysfunction (alcoholism versus depression). The current status and initial outcomes of the project are described in detail.

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.