Lee, Bonnie

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    Characteristics of seekers of couple therapy for alcohol use or gambling disorder
    (Wolters Kluwer Health, 2023) Lee, Bonnie K.; Shi, Yanjun; Ofori-dei, Samuel M.; Miftari, Naser
    Objective: This study examined characteristics of individuals with alcohol use disorder (AUD) or gambling disorder (GD) who were seeking couple therapy based on screening data from a randomized controlled trial on Congruence Couple Therapy at 2 out-patient addiction service sites in Alberta. Method: Screening data of couple therapy seekers (N= 171) were analyzed. Results: Seekers cited various motivations for seeking couple therapy including addiction-related relationship breaches and issues, the desire to recover from addiction together, concerns for the well-being of their children, and the lack of available couple therapy in addiction services until this trial. Significantly more females than males were first to indicate interest, and 77% of the sample had attended other treatment and mutual help programs in the past 12 months. The majority of the treatment seekers met DSM-5 diagnostic criteria for AUD and/or GD scoring in the moderate-severe range with nearly half of the seekers reporting a mental health diagnosis at least once in their lifetime. In addition, 30% of treatment-seekers reported past-year suicidal thoughts, citing their own addiction and their partners’ addiction as reasons and 57% of those individuals reported having a method/plan to carry out their suicide. Suicidal attempts in the past year was 8% based on the entire sample. Finally, 19% of treatment seekers reported experiencing intimate partner violence within the past 12 months. Conclusion: Addiction and couple relationship problems are closely connected. Despite the serious multiple concurrent concerns of seekers identified in this study, there is a general lack of couple therapy availability in addiction services. This study highlights the importance for addiction and mental health professionals to note the complex interaction of couple distress and addiction, understand couple therapy as a treatment modality, and make timely referrals for this vulnerable group.
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    Changes in work status, couple adjustment, and recovery capital: secondary analysis of data from a Congruence Couple Therapy randomized controlled trial
    (Sage, 2022) Lee, Bonnie K.; Ofori Dei, Samuel M.
    Purpose: Employment and family/social relationships are 2 of the highest priorities among those in substance use recovery. This study examined the relationship of work status with couple adjustment and other recovery capital treatment outcomes among symptomatic alcohol, substance use, and gambling participants (N = 38) using data collected in a randomized trial comparing a systemic Congruence Couple Therapy (CCT) and individual-based Treatment-as-Usual (TAU). Method: Change scores and associations between work status and couple adjustment together with 8 other recovery outcome variables at post-treatment (5 months from baseline) and follow-up (8 months from baseline) in TAU (n = 17) and CCT (n = 21) were analyzed. Results: Number of those working increased with both CCT and TAU but without reaching significance in either CCT (Cochran’s Q = 5.429, P = .066) or TAU (Cochran’s Q = 2.800, P = .247). Relative to those not working in the combined sample, those working showed significantly improved scores in post-treatment and follow-up in addictive symptoms, couple adjustment, psychiatric symptoms, depression, and life stress. Separating the CCT and TAU groups, similar trend was found in the CCT group but was inconsistent in the TAU group. Conclusion: Significantly greater improvement in addictive symptoms and recovery capital of couple adjustment, mental health, and life stress was found in the working vs not-working group. Compared to individual-based TAU, exploratory findings indicate that the systemic treatment of CCT showed a clearer and more consistent difference in improved working days, addictive symptoms and recovery capital. Replication with larger samples is needed to generalize these results.
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    Employment stress and couple adjustment among clients with disorders of gambling and alcohol use: themes of transfers in Congruence Couple Therapy
    (Sage, 2022) Lee, Bonnie K.; Merali, Noor-Khanu
    Background: Individuals with problematic gambling, alcohol and substance use commonly report lower employment rates and more employment-related problems such as job loss, work conflicts and poor performance. Method: A thematic qualitative analysis was conducted to extract employment-related themes from 21 sets of addiction counselors’ case notes of couple therapy sessions (average 10 sessions per case) from a randomized controlled trial of Congruence Couple Therapy (CCT). Case notes were examined for the types of employment issues to answer the research question: What are the interconnections of employment, couple adjustment and addictive behaviors as revealed in the CCT counselors’ case notes? Results: Five key areas of employment-related stress were identified: (1) unemployment, (2) financial concerns, (3) history of crime, (4) overworking and workaholism, and (5) workplace conflict. These themes interacted negatively with couple adjustment and addictive behaviors. Using CCT as an intervention, clients gained skills in 4 areas transferred to employment: (1) awareness of self, other and family of origin, (2) congruent communication, (3) work-family balance, and (4) enlisting spousal support. These themes intersected with enhanced work functioning and reduced stress, alcohol use and gambling. Conclusion: Employment problems negatively impacted addictive behaviors, couple adjustment and well-being of partners and addicted clients. Skills and awareness gained in CCT promoted changes in addicted clients’ employment functioning and coping with employment stress. The domains of work and couple adjustment are mutually influential in increasing or reducing stress with implications for addiction recovery. CCT as a viable intervention for enhancing employment function should be further studied.
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    Congruence Couple Therapy for alcohol use and gambling disorders with comorbidities (part II): targeted areas and mechanisms of change
    (Wiley, 2022) Lee, Bonnie K.; Ofori Dei, Samuel M.; Isik, Erkan
    Study of change mechanisms is important to advance theory development and to reveal the active components that make a critical difference in treatment. Improved outcomes in a randomized controlled trial that favored Congruence Couple Therapy (CCT) vs individual-based Treatment-as-Usual (TAU) were correlated within each group. Partial correlations were used to test for mediation effects. The aggregate correlation coefficient of improved variables in addiction and mental health, couple adjustment, emotion regulation (ER) and life stress was moderate for CCT and weak for TAU. CCT showed greater number of mediating effects among improved variables than TAU. The prominence of the process mechanism of improved ER with its mediating effects for addiction and psychiatric symptoms evidenced in both groups is noteworthy, but ER improvement was significantly associated with improved couple adjustment only in CCT. Reduction in life stress in CCT was associated with a broader range of improvements in CCT compared to TAU. Correlation patterns were substantiated by CCT participants’ endorsement of treatment targets emphasizing relationship, communication, emotion, problem solving, addiction and intergenerational issues of trauma. TAU participants reported significantly lower endorsements for these treatment targets. The correlation of ER and couple adjustment suggested as a key process mechanism should be further elucidated in future studies to differentiate relationship-based vs individual-based models and their respective outcomes for primary clients and partners. These findings are considered preliminary, requiring larger samples and advanced modelling among variables to provide a more profound mechanism analysis.
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    Congruence Couple Therapy for alcohol use and gambling disorders with comorbidities (part I): outcomes from a randomized controlled trial
    (Wiley, 2022) Lee, Bonnie K.; Ofori Dei, Samuel M.; Brown, Matthew M. R.; Awosoga, Olu A.; Shi, Yanjun; Greenshaw, Andrew J.
    A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes—alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes—emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen's h = 0.74–1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27–1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14–0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14–0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16–0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.
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