1. Helping drug dependent parents and their children: Is Behavioural Couples Therapy a realistic option?
Research Team
Principal Investigator: Dr Anne Whittaker, University of Stirling
Co-investigators: Professor Elliott (Glasgow Caledonian), Professor Taylor (Birmingham), Dr Klostermann (Medialle College, USA), Andy Stoddart (Edinburgh),
Research Fellows: Heather Black, Dr Peter Hillen (Edinburgh Napier).
Steering Committee
Professor O’Farrell (Harvard, USA), Professor Weir (Edinburgh), Dr Littlewood (NHS Lothian), Dr Gill (Edinburgh Napier), 2 service users (mother & father).
Funder: Chief Scientist Office
Behavioural Couples Therapy (BCT) is a psychosocial intervention for the treatment of addiction recommended by NICE and the UK Department of Health.
Evidence from the USA shows that BCT, when compared to individual-based treatment, improves abstinence rates and alcohol and drug-related harms, reduces domestic violence and can indirectly benefit children living in the home.
However, evidence suggests that implementation of the intervention is limited within addiction services and BCT has not been evaluated in the UK.
So we conducted first study of BCT in the UK, which aimed to test the feasibility of implementing and evaluating the intervention with parent-couples on opioid substitution therapy (OST) living with children aged 0-16 years.

2. A feasibility study Behavioural Couples Therapy (BCT) as an adjunct to opioid substitution therapy for drug dependent parents
The intervention
Study design
Mixed methods
Baseline data
End-of-treatment data
Qualitative interviews
Couples
Other parents
Therapists
Referrers
The intervention itself is a 12 session manualised programme, delivered over a 3-4 month period.
Our study involved the delivery of BCT to a target 18 couples.
We collected baseline and end-of-treatment measures (substance use/couple functioning/parenting/child wellbeing/health economics) and uptake/attrition/completion rates.
We conducted qualitative interviews with BCT parents (n=26), other parents in receipt of OST (n=11), BCT therapists (n=6) and five focus groups with referring staff (n=24) to explore acceptability and barriers/facilitators to implementation.

3. Profile of the couples 13 couples (out of 28 referred)
Concordant=7, Discordant=6
OST (13 male, 7 female)
Years on OST: Range 5-29yrs; Mean 14yrs
Ages: 25-45yrs old; Mean 35yrs
Married=2; Co-habiting=9; Living apart=2
Length of relationship: 5-20yrs (Mean 11yrs)
Children living with parents=17
6 couples had 11 children living elsewhere
Age of youngest child: 3mths – 14yrs (Mean 5yrs)
Multiple and complex needs!

4. Is it feasible? Patient level Clinician level Structural level
Child protection agenda
Whole family approach not embedded
Service redesign/budget cuts/morale
Cultural ‘fit’
Assessment & signposting
Optional (‘Opt-in’) intervention
Accessibility/acceptability
‘Fit’ with model of care and other intervention approaches
Operational issues to overcome
Gatekeeping
Lack of buy-in
Caseloads, Targets, Staffing
Confidence/knowledge
Individual vs family-focused practice
Child Care, Transport, Money, Time
Reluctance to see ‘another’ professional
Resistance to drug testing
Daily contract ‘cheesy’ or irrelevant
Patient level
Clinician level
Structural level
Service level
Results: 13/18 couples enrolled (June 2016-June 2017) but only seven engaged in the intervention and none completed the programme. Average number of sessions attended was 3.4/12.
Barriers to implementation were multiple and inter-related.
Parent-level, clinician, service, operational, and structural-level obstacles to recruitment, engagement, retention and delivery of BCT.

5. For discussion - next steps?
Can BCT be adapted to become a realistic option for parents with children?
Can professionals and individual services adapt to make BCT a realistic option?
Can structural barriers be overcome to make BCT a realistic option?
Can BCT be adapted to become a realistic option for parents with children?
Potentially yes – shorter number of sessions, more flexible delivery, individually tailored/reviewed, wider family involvement
Can professionals and individual services adapt to make BCT a realistic option?
Potentially yes – shift in mind set/culture, routine treatment, accessible, training/support/supervision
Can structural barriers be overcome to make BCT a realistic option?
Potentially yes – whole family approach, adult/child services join working, child care/incentives, family support not child protection focus.