Demand-Withdraw Couple Interaction Moderates Retention in Cognitive-Behavioral Versus Family-Systems Treatments for Alcoholism

Individually focused Attribute × Treatment interaction (ATI) research has neglected attributes of couple and family relationships that may moderate response to different treatments. Sixty-three couples with a male alcoholic partner participated in up to 20 sessions of either cognitive-behavioral therapy (CBT) or family-systems therapy (FST). As hypothesized, couples high on pretreatment measures of demand-withdraw interaction (DWI) attended fewer sessions of CBT, whereas DWI made little difference in FST. A specific, alcohol-related wife-demand/husband-withdraw pattern moderated retention more than the opposite husband-demand/wife-withdraw pattern, although the general affective quality of a couple's relationship may have contributed to ATIs as well. Results illustrate the importance of relational moderators in ATI research and suggest possible benefits of matching alcoholics to treatments when the unit of treatment involves more than 1 person.