This file contains the text of part of the January/February 2003 issue of Research in Brief (ISSN 1047-8418), a newsletter published three times a year by the Research Institute on Addictions, a component of the University at Buffalo, The State University of New York. Permission to reproduce this material is granted with the condition that users identify the Research Institute on Addictions as the source. For more information, contact: RIA Public Communications, 1021 Main Street, Buffalo , N.Y. 14203-1016.

Behavioral Couples Therapy With Alcoholic Men and Their Intimate Partners: The Comparative Effectiveness of Bachelor’s- and Master’s-level Counselors

William Fals-Stewart, Ph.D.

Research Institute on Addictions
University at Buffalo, The State University of New York

Gary R. Birchler, Ph.D.

Veterans Affairs Medical Center, San Diego, and University of California, San Diego, School of Medicine

Abstracted from Behavior Therapy, 33, 123-147, 2002.

This investigation is the first to our knowledge to compare paraprofessionals’ and professionals’ delivery of Behavioral Couples Therapy (BCT) to substance-abusing patients. BCT is a treatment that aims to rebuild and strengthen relationships by use of a daily sobriety contract, the expression of positive feelings, sharing of activities, and the partner’s active support of the patient’s efforts to stay abstinent.

Researchers randomly assigned 48 alcoholic men between the ages of 20 and 60 and their intimate partners to receive BCT from either a bachelor’s-level or a master’s-level counselor.

Findings

• Bachelor’s-level counselors and master’s-level counselors were equivalent in terms of adherence to the BCT treatment manual and delivery of the specific components of the sessions.
• Couples who received BCT from the bachelor’s-level counselors reported equivalent levels of: (a) satisfaction with treatment; (b) marital happiness both during and following treatment; and (c) percentage of days abstinent during the year following treatment, relative to couples who received treatment from the master’s-level counselors.

Background Information

In BCT treatment studies with substance abusers and their partners, counselors with at least a master’s-level education have been employed as therapists. It had been implicitly assumed that BCT interventions are of such complexity that training in psychotherapy skills associated with the possession of a master’s degree was a basic prerequisite. However, most staff members who deliver services in community-based substance abuse treatment settings are bachelor’s-level alcohol and drug counselors, high-school-educated recovering substance abusers, or other allied healthcare providers who have not received postgraduate professional training (e.g., Christner, 1993; LoSciuto, Aiken, Aussetts, & Brown, 1984).

Study Particulars

• The four master’s-level counselors were licensed social workers and state-certified substance abuse counselors with an average of 8.3 years of experience treating substance-abusing individuals. In addition, these counselors had 4.8 years of experience providing manualized BCT to substance-abusing patients and their partners.
• The four bachelor’s-level counselors were state-certified substance abuse counselors who had an average of 8.7 years of experience treating alcoholic and drug-abusing patients. None of these counselors had any previous experience delivering BCT to either substance-abusing patients and their partners, or to other maritally-distressed couples. All of these counselors reported limited experience conducting general counseling sessions with substance-abusing patients’ families.

Results

In general, as shown in Table 1, bachelor’s-level counselors delivered BCT to alcoholic men and their intimate female partners as effectively as master’s-level counselors. The researchers only caveat to this conclusion was that when compared to the master’s-level counselors, bachelor’s-level counselors were not as flexible in deviating from the manual-specific content to address couples’ particular problems. This may well have been the result of the training provided. Competence ratings made by a psychologist from audiotapes of the BCT sessions were higher for the master’s-level counselors, but still satisfactory for the bachelor’s-level counselors.

Implications

• BCT is not widely used in community-based substance abuse treatment programs. If BCT can be effectively delivered by counselors whose training and experience are similar to the majority of clinical staff members in these programs (as was demonstrated in this study), BCT may be more readily adopted as an intervention for married or cohabiting patients.
• Delivery of equally effective BCT by bachelor’s-level counselors may be more cost-effective for treatment providers.
• Effective implementation of BCT in community settings would require the availability of BCT training for program staff and supervisors.

Study Considerations

• The BCT sessions were audiotaped. The effect of taping sessions on the behavior of counselors in unknown. This added scrutiny may have caused counselors to adhere more closely to the manual. The couples may have also responded differently because their responses were recorded. Therefore, the results may not generalize to settings in which treatment providers and counselors are not so carefully scrutinized and evaluated.
• This study examined bachelor’s-level counselors only. It would be interesting to see how state-certified substance abuse counselors who are recovering alcoholics with high school educations, nurses, etc., compare to masters’-level counselors.
• The supervisors for all of these counselors were extremely knowledgeable and experienced with BCT for substance-abusing patients. It is unlikely that supervisors with this level of BCT experience would be available in community-based treatment programs to provide regular supervision to front-line counselors or how intensive supervision may have influenced the observable outcomes.

Future

Although the results of the study indicate bachelor’s-level counselors adhere to BCT manual components as effectively as master’s-level counselors, substance abuse treatment programs employ a wide array of providers with varied professional and training backgrounds. Future research needs to explore whether other groups of paraprofessional counselors who work in community-based treatment programs, such as individuals in recovery and drug users with limited educational backgrounds, also deliver BCT effectively.

References

Christner, A. M. (1993). Reference guide to addiction counseling (2nd ed.). Providence, RI: Manisses Group.

LoSciuto, L., Aiken, L. S., Ausetts, M. A., & Brown, B. S. (1984). Paraprofessional versus professional drug abuse counselors: Attitudes and expectations of the counselors and their clients. International Journal of the Addictions, 19, 233-252.