sessions, which occurred at lengthening
intervals over the 6 months following
treatment, were designed to reinforce
the material presented during treatment.
Spouse-involved treatment has been
investigated as a treatment enhancement
for alcohol-dependent populations
(e.g., McCrady et al. 1991;
O’Farrell et al. 1992). Involving the
spouse in alcoholism treatment has
been found to produce better outcomes
than has individual treatment that
excludes the spouse (e.g., Bowers and
Al-Redha 1990; McCrady et al. 1991).
Spouse-involved therapy can remain
focused on the alcohol problem and
the spouse’s appropriate role in supporting
the client, or it can include
direct attempts to improve marital
functioning through behavioral marital
therapy—a well-researched and effective
technique for alleviating marital
distress (e.g., Hahlweg and Markman
1988). Walitzer and Connors are conducting
a research program that focuses
on heavy drinkers and their spouses,
the “Couples Drinking Reduction
Program.” The program evaluates the
additive effects of teaching spousal support
of drinking moderation and of
behavioral marital therapy in a drinkingmoderation
program.
People living in rural areas—representing
approximately 25 percent of
the U.S. population—face a variety of
barriers to health care services. Those
barriers include geography, no or little
insurance, poverty, and limited access
to public transportation (Rodrigue et
al. 1996). Furthermore, the scarcity of
health care professionals and agencies
complicates the delivery of health services
to rural areas. In fact, two-thirds
of rural Americans live in areas identified
as having insufficient psychological
and psychiatric services (Wagenfeld
1990). One approach to providing
greater health care access to people in
rural areas is to develop programs that
reduce or avoid traditional barriers to
service access. To that end, the authors
are conducting a research-based rural
outreach program that is examining
bibliotherapy and telephone therapy
interventions as strategies for helping
rural heavy drinkers reduce alcohol
consumption.