Journal of Substance Abuse Treatment, Vol. 10, pp. 17-21, 1993 Printed in the USA. All rights reserved. 0740-5472/93 $6.00 + .OO Copyright 0 1993 Pergarnon PressLtd. ARTICLE Differences Between Alcoholics and Spouses in Their Perceptions of Family Functioning JAMES R. MCKAY, PhD,* STEPHEN zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA A. MAISTO, PhD,t$ MARTHA zyxwvutsrqponmlkjihgfedcbaZYXWVU C. BEATTIE, PhD,$$ RICHARD LONGABAUGH, EdD, 111AND NORA E. NOEL, PhD** *Department of Psychiatry, University of Pennsylvania; TVA Medical Center, Brockton, Massachusetts, and $Brown University, Providence, Rhode Island; $Center for Health Care Evaluation, Palo Alto (California) VAMC; [IDepartmentof Psychiatry and Human Behavior, and TCenter for Alcohol and Addiction Studies, Brown University; **University of North Carolina Abstract - The present study is an investigation of differences between alcoholics and significant others in their perceptions of the functioning of their zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJ families or households. A sample of 80pairs of alcoholic patients (PTs) and their spouses or spouse equivalents (SOS) who were living together in the same household evaluated family functioning by completing the Family Assessment Device (FAD). Agreement between PTs and SOS was moderate on the Affective Responsiveness, Commu- nication, Problem Solving, Roles, and General Functioning scales. However, there was little or no agreement on the Behavior Control and Affective Involvement scales. These results indicate that although PTs and SOS tended to agree about how well family members work together and share thoughts andfeelings, they disagreed about how well boundary issues were dealt with in theirfami- lies. Implications for treating alcoholic families are discussed. Keywords - family functioning; alcoholism; family therapy; family boundaries; couples therapy. PROBLEMATIC FUNCTIONING in families has been asso- ciated with the etiology and course of alcoholism and drug addiction (McCrady, 1986; Moos &Moos, 1984; Steinglass, Bennett, Wolin, & Reiss, 1987). Difficulties with communication, problem solving, boundaries, roles, and behavior control are frequently observed in these families (McCrady, 1986; Moos & Moos, 1984; Stanton&Todd, 1982). In an effort to address dysfunc- tion within the family system that may contribute to alcohol or drug abuse, couples or family therapies are now frequently used in the treatment of addictions, ei- ther in conjunction with other therapeutic interventions or by themselves. One of the difficulties in working with families is that members frequently do not agree on what is wrong. Preparation of this manuscript was supported, in part, by NIAAA Grants AAOl812, AA07459, and AA08443 to Richard Longabaugh, Edn, Principal Investigator, and in part by a NIDA Center Grant DA05186, Charles O’Brien, PIID, PLD, Principal Investigator. Requests for reprints should be addressed to James R. McKay, PhD, University of Pennsylvania, Treatment Research Center, 3900 Chestnut St., Philadelphia, PA 19104. In a study of families in treatment, Epstein, Baldwin, and Bishop (1983) reported that members sometimes differed in their perceptions of various aspects of fam- ily functioning. Family members may have different opinions about who is to be blamed for their difficul- ties (Kaufman & Pattison, 1981). Or, they may disagree about which aspects of the family structure or patterns of interaction are problematic. Differences of this sort could contribute to the dysfunction in alcoholic fami- lies by increasing tension and conflict and causing mem- bers to feel alone or misunderstood. Such differences could also impede progress in therapy by making it more difficult for members to agree on the aspects of family functioning that need attention. Epstein et al. (1983) suggested that differences in per- ceptions of family functioning are “worthy of empiri- cal study” (p. 172) because of their implications for the family treatment of various disorders. However, al- though dysfunction in families of alcoholics has been extensively studied, differences in perceptions of fam- ily functioning by members of alcoholic families have not received much attention. The empirical research that has been done has focused largely on beliefs about 17