M

DOCUIENT BESOMI

ED 155 531 , CG 012 479

AUTHOR O'Farrell, Timothy J.; Cutter, Henry S. G.TITLE Behavioral Marital Therapy ,(BMT) for Alcoholids and

Wives: Review of Literature and a ProposEd ResearchProgram.

PUB DATE ,Sep 77

.

.NOTE .-. .14p.; Paper presented at the Annual Conference on. ;Experimental and Behavioral Approachis tc Alcohclim.

(Bergen, NORWAY, AugUst 28-September 1, 1577); Tablesnot available-due to poor filminggualitY

_..ES PRICE MF-$0.8.3 HC-$1j.67 Plus Postage.DESCRIPTORS *Alcoholism; isSertiveneAsi. *Behavior Change;

*Drinking; Family Life; Interaction; Interpersonal.Bela4onship; Literature Reviews; *Males; *MarriageCounseling: Reinforcement; *Socialization

ABSTRACT .

-.--'After clescribing a social.learniag formulation of the

male albohoiic,s marriage, this paper reviews the few studies ofbehaiioral marital therapy (BMT) for alcoholics and their. wives.Although nose of these studies are as rigorouS as one igbt Wish and

1many of them are merely case studies, a review of the- iteratureshows that behavio al marital therapy in ccmbinatiiion w th social and

satvocational behavio alcoholism treatment produce's Letter resultswith State Hospital lcoholics than does a, less intensive traditionalalcoholism treatment!. When intensity of treatment is held constant,behavioral marital therapy for outpatient alcOhclics is net onlysuperior to three alternatiVe.behavicral treatments but clearly -

exceeds the outcome statistics in the nontehavitral lirature. Withthe exception 'of a study treating cnly the xifee, behavioral maritaltherapy hal had positive results in 29 of 31 cases. treated. A seriesof-issues and questions future studies should address are listed. Inaddition, i study to compare behaqiotal and non - behavioral couplesgroups-is proposed. (Author)

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***************************************$*******************************,.* Reproductions supplied by EDRS ire the,beAt that can be made .

from the original doeument.****44.*****************************************************************'

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BEHAVIORAL MARITAL-THERAPY (RMT) FOR.ALCOHOLICS AND WIVES:

itorw.oi LITERATURE AND A PROPOSED RESEARCH PROGRAM..

.

"PERMISSION TO REPRODU,CE THIS

MATERIAL HAS BEEN GRANTED BY

TO THE EDUCATIONAL .RESOURCESINFORM4TIONI CENTER (ERIC) ANDUSERS OF TIE ERIC SYSTEM

LC

U S, DEPARTMENT OF HEALTH,EDUCATION I, WELFARE .40'NATIONAL INSTITUTE OF

,,,E0i./CATION

THIS DOCUMENT HAS BEEN REPRO-DUCED EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZ4TIONORIGINMIND IT POINTS OF VIEW OR OPINIONSSTATED DO NOT 'NECESSARILY REPRE.SENT OFFICIAL NATIONAL INSTiTUTeOFEDUCATION POSITION OR POLICY

?A.

, Timothy J. O'Farrell and Henrx;S. G. Cutter

Veterans Administration Hospital

Brockton, Massachlaetts 02401 USA

Paper Presented .1

1 at

NATO INTERNATIONAL CONFERENCE

onEXPERIMENTAL AND BEHAVIORAL APPROACHES TO ALCOHOLISM

August 28 - September 1, 1977Bergen, Norway

X.

sit

,44

-;

,10

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1

fte

Today I would like to present a review of the literature and a preview'

.of a probosed research.program dealing with behavioralinarital thelapy (BIC)

for alcoholics and their 'wives. I had planned to lordsene,the first result%,o

of this-new research project but unforeseen

let

delays'Amake this iiposible.

is 'why I changed my title and why I am a biVem4rrassed. -ThOnetheless,.

f

start with a brief review of the literature which covers-the most

importaht features o past studies and the*eds they'reveal for future.

research; Mime limitations prevent detailed methodolog4a1 critique of each

study.

Behavioral marital then y,OPInWfor.the alco10614's marriage is based.....___ ".;. /

,--- ,

on a social-learning formulation. Xccording to-thpi'Modt the marriages of.,

male .alcoholics and their wives 4mgenerally conflicted; the couple fight.

4

repeatedly about-drinking and pOitivel reinforce each other, at a low 'rate,'

Marital interaction, under t ate condi ions,-isahardly a'viable alternative

to drinking. %

In,this behavioral view, certai4 antecedent. and consequent events are

assumed to maintain abusive drink(n An important antecedent to drinking

Aby married alcoholics mays their lack of. assertiveness in IntexacURRWith ,

their wives. Wives who attend pr rily to aWolic behaviors but virtually

igiore'Rositive nondrinking beha ors provide consequences likely4 increase

drink4ng. Wiveslit furthermore, often provide financial, emotional and sexual

$

support when alcoholid.husban are actively drinking. A .detailed)

consider-

ation, however, of .the evid e for and. issues involved in this behavioral

li

'll'ormulation of the alaholi marriage is beyond the scope of my paper today....,

. I want to tell:you bOefly.about the:few available reports of BMT for '

I'.

married male alcoholics. able 1 of your handout summarizes these studies.,

J

,Cheek, Franks, Laud updand Burtle (1971) tried toteach 24 wives and

relatives of treated al oholics to apply operant principles to. family

1

11 3

\

c' behavibr,

S

.

. . ..

interactions likely to threaten sobriety.' Their rather meager findings

Indicated that wives were unable consistently to apply this new learn g at

home.. The authors speculated that the ayes were so sensitized to t eir

alcoholic husbands' behavior that the'tensioU7and anger they felt when

dealing with

reinforcers.,

this study.

the joint tr

their ,husbands t{.nhibited the wives from changing ,Oieir emitted

It may also be significant that only the wives/were treated in*

_ .

Recent reviews of the marital therapy literature Suggest'that

tment of husbands and wives is more likely to sucoeed,than

dividual treatment.-/. ,

The effects of assertive training have been reported in a case study byI

Eisler, Miller, Hersen and Alford 11974). The results showed'that the

husband was more assertive in post'treatment videotaped interactions with his/

,wiieand, apparently as a. consequence, weeklyibreath alcohol levels (taken of

a random baiis fot 6 weeks before and after therapy) deoreaied. This imagina-

tive case study is noteworthy because it, applied. behavioral procedures

!?,

and demonstrated changes on object ive measures of marital and drinking

-

, Ao

Miller (1972); in another case study, found that ihe husband'? drinking

dropped to and remained at agreed-on limits following the establishment' of a

contingency contract between Spouses. At six monthe-follow-40the couple

also reported an improved Marital relstionship. This study iathe firsi in. 4

the literature to apply contracting to the:5relationship between analcohdlic

and his wife. oe,

o .

. Wilson. and -Rosen= <(1976)< , in <a ease study- -al.ao -employed :e.bont riot ..... .... <..._

.

. , :., ,I., .

'(specifying, the amount,and stimulus conditiOns for controlled deinking) as0

.,

part of a multifaceted behavioral treatinent,prograSI that.aiabinEiuded BAp

discrimition training, thought stopping, an: assertive training. .The. wifet

. . .

4

3

. k

observed treatment and provided feedback to, the husband "and to the therapists

during therapy Sessions. The couple, initially, teetering.on the brink of

divorce, reunited with both reporting 'greater happiness. The husband was0

contiolling'his drinking at 6 months fiollow-up.,

Miller and HerSen (1975).in an as yet unpublished case report provide a

41

model example of treatment-relevant assessment and the effectiveuse of a

direct observation of the couple during' interviews together, Videotaped-con=

more comprehensive marital treatment package. Ahsessment'contisted..of

versations in which the couple discussed various problem and non-problem

areas of their life, and audiotape recordings of mealtime,interacti6 ''at home

.

on two occasions. In some of these a

%essmeat sessions the counsel6rs were

absent to allow for more :'natural" in raction. On the basis of these assee-,

=ants, specific behavioral goals were set and achieved ,by. means of social'

skills trainipa, assertive trairktigand contracting: 'Follow -up_at 9 months

indicated that the husband had taken Antabuseeach'day and was completely

i abstinent. Improvements also were noted in the interactions of the couple, .

(videotaped An thei,clinic) and in their day-to-day behavior at hqme. I

Hunt'and Azrin (1973) and Azrin'(1976) included,a behavioral marital

i

counseling procedure as part of their commnnity-reinforcement program for-,t

)State Hosiital alcoholics. 'Rigorous evaluation of the treatment program. of

.1 / , .

. 'I ,

which the marital counseling procedures were a part, Showed it to be clearly... .

. superior to a less intendive, moe*traditional hospital

This is the first study in which marit 1 counseling was

i'treatment package previously used wit non-alcoholics.

ptogram for alcoholics.

based on a behavioral

Hftework dssignments

and various structured tasks taught couples to pinpoint pleasing and dis-

pleasing spouse behaviors and to request desired changes. Lastructipn in .

. .

negotiation, comPromise;,ana,informal contracting, was used to facilitate

behavior change at home.K.

5a

.e

c

Hedberg and Campbell (1974) in an 'experimental clinical study compared

J among outpatients the therapeutic.efficacY of behavi,oral marI.

counseling.,

systematic desensitization, covert-sensitization, andlaversion therapy. At .

.6 months folloW-up, behavioral marital counseling, was found to be the most

egfec)ive treatuent with 74i-;1-1.5 alCoholic patients achieving their goal

I 4

(either abbtinence or.cOntrolled drinking); an additional'in'thowed "much. .

.

improvement'." For thosewho chose abdtinence as their goal, behavforik.

marital counseling was, by far., superior to all other treatments. Cammunica-

4

tion training,'instructions-in.the principles of'10arninge_contraCtingi and0 Se

assertive training were all partAif the marital treatment. The sequencing,

frequency and.-total number of treatment sessions was the.same for all

1

.patients Irrespective of:the type of therapy received. .10c

.Althoue none..of these studies are as rigotous as one might wish and

s.f1 ,. ---\ .

many of them are merely case studies, we can see hop; o4r.review of the... .

. , : , ..

.

.

literature that behavioral marital therapy in combination With social and

A. .

vocaelonal behavioral alcoholism treatment producei better results with' State

Hospital alcoholios than.does traditional alcoholism treatment although

4

time in therapy was not equal for the two treatments). In addition, when,

intensity of- treatment is held constant, behavioral marital4therapy (BMT)

for outpatient alcoholics is not only superior to three alterndiive behav-/

. s%

ioral iriprients but'clearly exceeds the outcome statistics in the' nonbe-C

havioral-literature, 'Finally, BMT (with the eRcepty.on of a studyytreating

only the wife) lids had poSitive results-iv 29,of 31 rses treated. BMT for

alcoholics and their wiVes,,one must conclude, shows prombise and deserves

the further terious'atiention of behavior therapists: We should develop. and

'rigoiously evaluate-beha4ioral-parital treatment packages for alcoholics and

'their wives...-. Ocd such a package has been developed, there are atnumber of

questionsandisslies that should'beinvettigated. °1

'6A

-r

Now, before cohdluaing with questions relevant to'future research, I

. -would like to iell you about a research projec that my colleague, Dr.

, .

HenryoCutteri and / reCehtly submitted far fundin rried alcoholics.-L c

undergoihg inpatient'ireatment for alcoholism, in the sin'of this study,for.

,

,..

1 .

are randomly assigned-to (a no marital treatment cofitrol condition or to 12,

.

. .

.

weekly sessions of either,a behavioral couples gtoup ( Liberman, Levine, .

< -

5

Wheeler, Sanders E.' Wallace, 1976) or a nonbehaviora interabtion . couples

group. This latter.nonbehayioral treatment is included/in order to compare

the behavioral methods of marital therapy with !Ike most frequently. UsedN

)

alternative. Measures of marital, drinking, vodational'and emotional:adjust

ment'taken pre'and post therapy (and at 2, 6, and 12 month follow-ups).are

/ used to evaluate treatment outcome. The marital measures include sampies.cf

couple interaction videbtaped in the clinic and at home and a variety

self-report measures developed by 11MT researchers. Drinking behavio is

4p.

measured by standardized self-yeport instruments, collateral report , and

breath alcohol.tysts in ,the community..

A

Table 2 of your handout describes the behaYihral couples group in greeter _

detail; Table 3 lists the dependent vartablemeasureas.,,I look forwartto cdm-

s.municating the results of this proposed project to you'at a 'future date. '''

There are a series of questions and issues that fptures esearch must

address if this seemingly fertile field for treatment and research is to

w'i'_ ..

/.--,

\

bear fruit.- .0e

1. What does a RMT package add to-alcoholism treatment ?'

Rigorous studies which specifically evaluate marital treat-S

ment using random aseignment; equartide-*treatment for

experimental qnd control gr oups, appropriate outcome measures,

and sufficient follow-up are needed..

7O r.

, I

. 6

2. How does-a BAT package compare in terms of effectiveness to li

. .\. .

_, ..-.7

other frequently used marital treatments for.alcoholics and4.

al

their spouses? The,greater structure andpresumably.greater.. . . .

cost in. therapist and, client time and effort needed for BHT,

as compareto alternative marital,treatments'require the.use

of,additional appropriate treatment.codparisons.

3. For whom is BHT a sufficient treatment for alcoholism and for

1

whom are additional nonrmarital treatments needed? What are

these additional therapeUtic,inputs and,who needs them? -Job-,

'

finding help for the unemployed awl specific training in

4controlled drinking for those with such a goal may be two

such inputs. In addition, alcoholics whose drinking istrig-

gered.by uncomfortable thoughts and feelings related to events

outside the marriage may benefit from relaxation training and

stress inoculation training.

4. Individual differences in acceptance of and response to BHT.

should be studied.

5. After.riiorous evaluative studies demonstrate the efficacy.

of a BMT package, then the importance-of specffic.componentd

of the package can be evaluaild for specific sub- groups ofk

alcoholics and their wives-. When the literature reachea'this:

level of sophistication, the following may be significant

questions:

a. Is a treatment focused only on alcohol7related inter-

. "( ,adt pAttrtts-vithant :intensive-therapy- -for-otire

. 4t

areas of the marital relationship sufficient for some

alcoholics and their yives?

#

.4

I'NS

-. .

b.' ror which married alcoholics should col:Itrolled'dr'inking

r .ti

. -

be a goal? How important is the wife's full.accept-.

ance of such a goal? When should controlled drinking.

be,pursued through a,marital agreement an .when stiouid

it be pursued through a ielf=control program (with or

r".

I.

/

O

,

.without wifeinvolvAnent5 foPthe problem drinker.

c. How does.aMdingle coupleBMT intervention Compare to .

, .

a couples group format and arg there differences'in

,

whb does best in which type of therapy?

d.) Do some wives need desensItiiatiou or some other

intefvention/tohelp them adopt'a more positiver, a

attitude tadvard- the alcoholic lasband before BMT can

be used?.,,

, . , .

'e. Procedures need to be developed and evaluated to deal. . -

. i-

with Cbmmon objections to marital therapy found among

. some alcoholics 7ind.thei1

spouses (Htylt& Azrin, 1973,,

.94-95). 1.

i

Now, in closing, I will return to some general points that d6 not refer

. to the specific components of a EMT treatment package.

<

6. Investigators and therapists in this area should become and#

remain familiar with the literature on behavioral approaches

to marital conflict (cracobson & Martin, 1976), sexual

dysfunction (LoPiccolo & Lobitz, 1- 973), sexual enhancement,

(LoPiccolo &Miller, 1975), 4Ulli parent-child problems

(Patterson, 1974. These bodiesof literature may suggest

useful assessment and treatment procedures for BMT with

alcoholics. In addition, university 'clinic investigators

t.

9-

OP,

Oo

4

. . ... 0,

, in these other areas ckild benefit from the applicatiOn of7,,

their work to-the More problematic,alaoholic population.

- F

Now, BMT studiesphould uSetHe.assessment and evaluation

procedures Linda Sobell suggested yesterday (SobjelL 1977)

with the marital measures being, those suggested. by leading

BMT.rbsea;\eHert (Weiss &. Margolin., 1977). However, thesIN N.

4marital measures are`quite complex; time -cpnbuming and' of

L..

8

specifically tailored to marriages of problem drinkers.. I

Thus, we need to CleveloR simple, inexpensive, reliable and

valid measures of marital adjustment for problem drinkers.

One such measurers Hunt.and Azrin's (197,3) use of the number

of weekends sp4rit in a ,stiuctured socialactivity outside

the home during a dot.ow-up period; the behaviorally treaieck

group with overall superior butcome also did muair?petter on

this measu re. In addition, a.recent retrospectivelalco-

holism treatment outcbme evaluation found fa\mily participation

17n social and recreational activities to ,be one of the few

family environment characteristics associated with positive

tteafmen

8." Finally,

between

marital

II)

optcome (Moos, Bromet, Tsu & Moos, 1977).(1

we need extensive further study of the reAtionship

drinkirig behayior (controlled and uncontrolled) and

and family behavior.

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f

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N.H.

'References

ImroVemenis'iti the.conilunity-rdinforcebenSpproach to

_.

alcoholism. Behavi4 Rd-search and Therapy, 1976, 14, 339- 8

,Che4k, Franks; C.H., Laucius, J., & BUrtle, V. Behavior modificatio

training for iwives of alcoholics.

.

,

Alcohol, 19.71, 32, 456-461.

Eisfer;'R.M., Miller, P.M., . Herven,

Quarterly Journal of Studies on

M. & Alford', H. Effects ,of assertive ,j/. %

, .

. ' 7.., ,f

training on.marital interaction. 'Archives-of .Gelipral Psychiatry, 1974 .,,,a

-. ..

30i 643-649.

Hedberg, A.G. p Camptell, L. A c9aparison of four behavioral treatments of

It

alcoholism. Journal OfBehavior Therapy. And'Experimental Psychiatrp,

1974, 5, 251-256.

Hunt, Gal., & Azrin, N.H. A community-reinforcement approach to alcoolism.

*Behavior Research and Therapy, 1973, 11, 917104'.

Jacobson N.S. & Maitin, B.

Bul

lir

Behavioralimarlage therapy. Psycholoical

tin; 1976, 83(1); 540 -556.t

,

Liberman, R.P., Levine, J., Wheeler, E., Sanders, N., & C.J.

Marital therapy in groups: A comparative evaluation of behavioral and

interactional formats. Acta Psychiatrica, Scandinavica, 1916,)Supplement

266.

LoPiccolo, & Lobitz, W.C. Behavior therapy of sexual dysfunction. In

L.A. Miamerlynck, L.C. Handy, & E.J. Mash (Edt), Behavior change:

Methodology concepts, anti practice ClIampaign, llA.:Research Prss,

1973, 343-358.

44LoPiccolo, J. & Miller, V.

of normal -couples.- The

A program

Counseling

for enhancing the sexual relationship

Kychologist, .1.975,i5(1), 41-45.

.4

'

T

C-

1.4

'1Q

#

Miller, P.M. The use of.behavioral contracting in the treatment of

,alcoholism:, A case report. Behavior Therapy,. 1972, 3, 593-596f4

&. 4, A

Eiller,.P.M. & 'orHersen, M. tlbdification marital interaction patterns

between an alcoholic and his wife. Unputlished manuscript, 1975.

4

(Available frOtlPeter Miller, Weight, Control Center; Hilton Head

Hospitg4 41tow1Head. Island, South Carolina.),

Moos, tromet, E., Tsur V., & Mdos,,B. Fawn nhaticteristics and the

foutcome of treatment for alcoholism: Paper presented at the Eai*Lnir

.

Psychological Association meeting, New York, April, 1977.-

Patterson, G.R: Families:, Applications of social learning to family.life.

Champaign,l'Ill:: Research Press, 1971.

Sobell, L.C. Alcohol treatment outcome evaluation: Conttibutions iroM

.behavioial'research. Invited address presented at NATO International",

I

Conferehce on Experimental and Behavioral Approaches to Alcoholism,.fal

Hergen, Norway, August 31, 19771

, Weiss, R.L., & Margolin, Marital canAct and accord- In A.R.- Cimaro, i

,-K.S. Calh .H.E.Adams (Eds.<),Hantikfor behavior /assessment. ,

New York:'-'John Wiley &.Sons,.Int.,*1917.' .

.-,f

...

,

t : . ......._ , .

Wilson, G.T. tlosen, R.Co train .: contrdlled drinking in- an alcoholic

-., i 1.. f "

through a multifieted, behavior t,r me, .1. ,. ogram: A case study. In.

.

I1

J.D. Krumboltz & G.E..Thoresen (Eds.), Couns i : .-thods. New York:

- ., 0 ,

Holt; Rinehart & Winstpn, 1976. ..

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p

Yet

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COMPREHENSIVE READING LIST ON BEHAVIORAL APPROACHES TO MARITAL THERAPY iOR ALCOHOLICS AND WIVES

Aztin, N.H. Tmprovements in the community-reinferCement approach toalcoholism. Behavior Research and Therapy, 1976, 14, 339-348.

ginger, S. Zu neueren therapeutischen Ansatzen bet Alkoholkranken(New therapeutic approaches to the treatment of alcoholics).

f. ,Zeitscriftfur Psychothiapie and Medizinishe Psychologie, 1971,21(6), 239-2147.

Cheek; F.E., Franks, C.E., Laucius, Hurtle, V. Behavior -

modification training for wives of alcoholics. Quarterly Journalof Studies on Plcohol,'1971. 32, 456-461'

Eisler, R.M., Mille?, P.M., Hersen, & Alford, H.' Effects of,assertive training on marital interaction. Archives of GeneralPsychiatry, 1974, 20, 641-649.

LHedberg, CampbeY1, L. A comparison Of four,behavioral'trest -.1 ments'Of alcoholism. Journal of Ifehavlor Therapy and Experimental

,Psychiatry, 1974; ,, 251-256..

!

tHunt, & Atrin, W.W. community-reinforcement approach to\. alcoholism. havior R search and Therapy, 1973, 11, 91-104.

/ Knox, D. Alcohol.. Chapt r in D. inox,'Marriage- happiness: Abehavioral approach to counseling. Champaign, Illinois: Research ,

Press, 1911, 59-63:

Knox, D. When hard liquor or soft drugs are a problem. Chapter inD. Knox, Dr. Knox's marital exercise book. New York: DaVid McKay,

Co., 1975, 118-113.

Kranitz, L. Arealternatiie treatment ror alcoholism. Rewslettertibr

Researehin Psychology, 1971, 12.(4), 21.

L'Abate, L. Behaeforal program for families of Micoholics. In L.

L'Abate, Manual of family enrichment/programs. Atlanta: SocialResearch Laboratories, 1975, 265-2744

Miller, P.R. The use of behavioral contracting in the treaties* of

alcoholism: A case reporte Behavior Thera 1972, 593.596.

,..,

Miller, P.M. ,Marital interaction.* Chapte 'In P. Miller; Behavioraltreatment of alcoholism. New York: Perg Press, 1976, 116-130.

.

'tither,. P.M., & Elkin, T. Marital assertiveness, training'in-the

treatment of alcoholism. Presented at'the Association for the'.

Advancemen

)of Behavior Therapy, Miami, December, 1973.

r4,1

.00

./

f.

P.M..& Hersen, M. Modification of marital interaction patternsbetween an alcoholic and his wife. Unpublished manuscript 1975(Available from Peter Miller, Weight Control Center, HiltaReadHospital, Hilton Head Island, South Carolina.), 4

Miller, P.M. &WAstria, M.A. Sex counseling. Chapter in P. Miller'& M.A. Mastria, Alternatives to alcohol abuse: A social learningmodel. Chaipaign, Illinois: Research Press, 1977, 103,124. (a),

Miller, P.M. & Mastria, M.A. Social and marital' skills training. .

Chapter in P.M. Miller &M.ArMastria, Alternatives. to alcoholabuse: A social learninkisodel. Champaign, Illinois: ResearchPress, 1977, 83-102. ,7

Miller, P.M.; Stanford, A.G., & Hemphill, D.P. A comprehensivesocial-learning approach to alcoholism treatment. Social. Casework,

19714, Man 279-284.

OFarrelr,'T.J. Wanted: A behavioral couples- group model for ate° -holica and their wives. Pap& presented at the Eighth, AnnualBrockton Symposium on, Behavior Therapi, VA Hospital, Brocktod,Massachusetts, May, 1977.

O'Farrell, T.J. & Cutter, H.S.G. Behavioral and interactional couplesgroup therapy for alcoholics. ,Research-proix)se.1 submitted toVeterans Administration.rNovember, 1976.

O'Farrell, T.J. & Cutter, H.S.G. Behavioral marital therapy (BMT)for alcoholics and wives: Review of literature and a proposedresearch program. Paper4resented.at NATO International Conferenceon Experimental and Jehavioral Approaches to Alcoho}ism, Bergen,Norway, September 14'.1911.

Psalm, T.J. & McCradyi B.S. Joint admission u a treatment modalityfor problem drinkers: A case report. American Journal ofPsychiatry,. 1976, 121(3), 222i224.

& McCrady, B.S. The alcoholic marriage: Psychoanalytic,sociological, learning and systems theori perspectives. New YorksGrune and Stratton, in press.

Weiesr R.L. & Birchler, G.R. Adults with marital disfunction.Unpublished manuscript, University of Oregon, 1977.

/

Wilson, G.T. & Rosen, R.C. Training controlled drinking in an...;

04, alcoholic through a multifaceted behavior treatment programi A,

(A .., eagle etudy, In J.D. Krumboltz & C.L. Thoresen (Eds.), Counseling.

,

methods. New York: Nolt, Dinohert & Winstons.1976.P- 4t

.. r , ,

4