Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

538 V. TREATMENTS FOR ADDICTIONSfirm stand on this issue at the start of therapy, while at the same time acknowledgingthat it may not be an easy task and that there may be a number of slips beforeabstinence is achieved. (p. 343)On the other hand, Berenson, whose innovative work was described byStanton (1981a), believes that therapists should concern themselves withachieving substantial changes in drunken behavior instead of abstinence fromdrinking. Berenson considers it tactically unwise to take a resolute stand infavor of total abstinence, even though abstinence is usually the ultimate goal.This position on abstinence runs counter to the beliefs of several others, includingDavis (1987) and Bepko and Krestan (1985). It is consistent, however, withthe problem-solving models that have been applied to drug problems by Haley(1997), Stanton and Todd (1992), and others (e.g., Heath & Ayers, 1991),who often prefer to leave the decision about the importance of total abstinenceto parents or others. These authors believe that therapists who assume a lessadamant, less certain position on the necessity of abstinence enjoy moremaneuverability in therapy. For example, a therapist who states that he or she isnot sure whether abstinence will prove necessary may be able to stay out of acouple’s argument over the issue long enough to help them try out several newsolutions to the problems brought on by the substance abuse (e.g., Berg &Miller, 1992).Independent of the issue of abstinence, Berenson believes that the therapistmust exert a major effort to get the family system calmed down, ergo reducingthe emotionality and increasing the psychological distance between familymembers. Families at this stage of therapy are often overwrought and involvedin intense battles and patterns of over- and underresponsibility that lock memberstogether. (See Bepko & Krestan, 1985, for a thorough discussion of thetherapeutic process of assessing and interrupting overresponsible and underresponsiblebehaviors.)On another tack, behavioral couple therapy for substance abuse is directedtoward increasing positive behaviors as a means for countering the kind ofnegativity—particularly surrounding drinking or drug-taking—which usuallycreeps into, and may even predominate, the partners’ relationship. Early on intherapy each partner is encouraged to acknowledge pleasing behaviors in theother, such as through homework assignments to, each day, “catch your partnerdoing something nice” and record it on a special sheet provided by the therapist(O’Farrell, 1993; O’Farrell & Fals-Stewart, 2000, 2002). This exercise is eventuallyguided toward the implementation of “love days” (Weiss, Hops, &Patterson, 1973) or “caring days” (Stuart, 1980), in which each person plansahead to surprise their partner during the week “with a day when they do somespecial things to show their caring” (O’Farrell & Fals-Stewart, 2000, p. 52). Asexamples, Paolino and McCrady (1977) note the set of special behaviors“might include such minor actions as saying hello when the husband comes