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Addiction Treatment for Couples

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Substance abuse is a serious issue when it affects just 1 member of the family, but it can be even more problematic when it affects 2 people who are in a relationship, live together, or are married. Treating substance abuse when both partners are addicted is crucial for recovery, the well-being and health of the individuals, and the future success of the relationship. Many treatment centers offer couples’ addiction treatment to help you and your loved one start on the path to recovery and begin leading clean, sober, and happier lives.


Couples and Substance Abuse

Substance abuse occurs when a person uses substances—including alcohol, illicit drugs, and prescription medications—in a way that is detrimental to their health and well-being and the health and well-being of those around them. Addiction is a chronic disease, with a potential for relapse, that involves compulsive use of substances and uncontrollable drug or alcohol-seeking behaviors despite the negative consequences to a person’s mental and physical health.1

Codependency is a learned behavior that is a common phenomenon in addicted couples. It is sometimes referred to as relationship addiction because codependent people often become involved in (and stay in) one-sided, destructive, or emotionally abusive relationships.2 Codependency is a psychological problem where a person is “controlled or manipulated by another who suffers from a pathological condition,” such as alcohol or drug addiction.3 It involves caretaking, rescuing, and enabling behaviors that keep each partner dependent on the other.

Couples who are addicted are often codependent because of underlying, unconscious issues and unhealthy dynamics that play out in the relationship. Codependent people usually have low self-esteem so they seek out ways to make themselves feel better, which often manifests in substance abuse or compulsive caretaking behaviors to help them feel as though they are needed or wanted by the other person. For example, a codependent person may make excuses for their partner, such as calling in sick for them when they are hungover. These compulsive and ultimately destructive behaviors only serve to perpetuate the addiction because each partner continuously rescues or makes excuses for the other, with the result being that neither partner has to take responsibility for their actions.2

Warning Signs of Codependency and Substance Abuse in Couples

People aren’t often aware that they are codependent until they learn about codependency. They may think they are acting in ways that are helpful to their partner without realizing that what they are doing is harmful to them both. Signs of codependency include:2,3

  • Caretaking behaviors.
  • Taking too much responsibility for others.
  • Feeling that you always have to do more than your share.
  • Feeling hurt when your partner doesn’t recognize your attempts to “help.”
  • Being dependent on the relationship or feeling that you can’t do things on your own.
  • Feeling an extreme need for recognition or approval.
  • Poor self-esteem.
  • Repressing emotions.
  • Obsessive behaviors or thoughts.
  • Attempts to control your partner.
  • An intense fear of abandonment.
  • Denying the existence of a problem.
  • Poor communication.
  • A lack of trust.
  • Anger.
  • Lying or being dishonest.
  • Sexual problems or issues with intimacy.
  • Poor boundaries.

Signs of substance abuse in couples include:4

  • Using higher amounts of or more frequent doses of the substance than originally intended.
  • Failing to meet obligations at work, home, or school because of substance use.
  • Giving up activities you once enjoyed to use drugs or drink.
  • Using substances in situations where it’s unsafe to do so (such as while driving or while taking care of children).
  • Frequent arguments about drinking or drug abuse, or things that can be related to substance use, such as financial problems, not meeting responsibilities at home, staying out late, or not coming home at all.
  • Feeling the need to use drugs or drink to alleviate the distress you feel from fighting with your partner.
  • Feeling that drinking or using drugs are the only activities you and your partner enjoy doing together.
  • Hitting (or being hit by) your partner while drunk or high; experiencing episodes of domestic violence (which can include pushing, shoving, or threatening the other with physical harm).
  • Feeling that you or your partner need to be drunk or high to be affectionate or feel comfortable talking about the problems you’re experiencing in the relationship.
  • Feeling as though you’ve had to isolate yourself from others to hide the addiction and its effects.

Couples Addiction Treatment

Couples can seek treatment together to not only help eliminate substance abuse but also to begin the process of repairing the relationship. Many recovery centers offer treatment that is specifically geared toward couples and addressing the unique issues that are encountered when both partners are addicted to drugs or alcohol. Depending on the couple’s circumstances and the particular approach of the treatment center, couples may engage in different types of treatment both as individuals and together. For example, a couple that enters a rehab program together may be encouraged to attend both individual counseling and couples therapy to address the issues that occur in the relationship.

The couple must already have a strong, safe, and committed relationship for treatment to be successful. People who are in relationships that are abusive or deemed to be dangerous may not be allowed to enter treatment as a couple.6

Interventions used to treat addiction in couples include:4,7

  • Individual counseling.
  • Group therapy.
  • Self-help meetings like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
  • Couples counseling, particularly in the form of behavioral couples therapy (BCT).

Behavioral Couples Therapy (BCT)

BCT is an effective form of treatment that focuses on changing dysfunctional behaviors and is specifically designed to treat couples suffering from addiction. The goal of BCT is to reduce substance use in couples through “restructuring the dysfunctional couple interactions that frequently help sustain [the addiction].” Couples who receive this form of treatment have reported significant benefits, such as higher rates of relationship satisfaction and reduced substance use and improvement in other areas of functioning, such as reduced partner violence and improved family life.7

BCT involves a set of interventions that may include:8

  • Agreeing to a recovery contract, in which both partners commit to their intention to stay sober that day, thank each other for staying abstinent, and agree not to argue about substance abuse.
  • Medication to help recovery, if applicable. If either partner is taking medication, then the other partner witnesses the ingestion of the medication and expresses support for doing so.
  • Becoming involved in self-help groups, like AA or NA.
  • Agreeing to weekly urine tests.
  • Keeping a progress record on a calendar.
  • Crisis intervention by the therapist if a relapse occurs.
  • Increasing positive activities within the relationship (such as sharing rewarding activities or increasing caring behaviors).
  • Learning improved communication skills.
  • Maintenance and relapse prevention planning once treatment has ended.

Pros and Cons of Couples Treatment

The benefits of couples treatment include recovering from addiction, better overall relationship functioning, reduced domestic violence, improved compliance with medications, and fewer separations/reduced risk of a family breakup than with individual treatment alone.8

However, there may also be potential risks of couples treatment, such as if one partner is more motivated and the other partner isn’t as willing to engage in treatment. This can make it more difficult for either partner to remain abstinent and complete the treatment process.9


Couples Recovery after Treatment

Recovery is a lifelong process that doesn’t end once treatment has been completed. A couple will need to continue to work on their recovery for the rest of their lives, which means that you’ll need to have an aftercare plan in place to help prevent relapse and ensure your ongoing sobriety together. An aftercare plan is designed to guide you in early recovery by helping you abstain from substance use and supporting you in your other life goals.10

Aftercare can include support groups like AA, NA, or Recovering Couples Anonymous, individual and couples’ therapy, and sober living homes if living in the home environment is not an option or the couple needs a supportive structure as they transition back to regular life.

Seeking couples’ addiction treatment may be one of the best choices you can make to heal your relationship, recover from substance abuse, and ensure the stability and integrity of your home and family life. It’s never too late to turn things around, regardless of how disheartened, frustrated, or hopeless you might feel. Engaging in treatment can help you take back control of your life and save your relationship.

 


Sources

  1. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction: DrugFacts.
  2. Mental Health America. (n.d.) Codependency.
  3. St. Louis, S. (2019). Addiction in the family system.
  4. Fals-Stewart, W. (n.d.).  Substance abuse and intimate relationships.
  5. American Psychiatric Association. (2017). Addiction and substance use disorders: What is addiction?
  6. Simmons J. (2006). The interplay between interpersonal dynamics, treatment barriers, and larger social forces: an exploratory study of drug-using couples in Hartford, CTSubstance Abuse Treatment, Prevention, and Policy, 1, 12.
  7. Fals-Stewart, W., O’Farrell, T. J., & Birchler, G. R. (2004). Behavioral couples therapy for substance abuse: rationale, methods, and findingsScience & Practice Perspectives2(2), 30–41.
  8. O’Farrell, T. J., & Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism and drug abuseJournal of Substance Abuse Treatment, 18(1), 51–54.
  9. Simmons, J., & McMahon, J. M. (2012). Barriers to drug treatment for IDU couples: the need for couple-based approachesJournal of addictive diseases31(3), 242–257.
  10. Patton, D. and McDowell, T. (n.d.). Substance abuse aftercare treatment. Arizona State University, Center for Applied Behavioral Health Policy.
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Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series of in-depth articles on Community Paramedicine programs across the country that go beyond transporting patients to emergency rooms and connects specific patients, such as repeat system users, the homeless and others with behavioral health issues and substance use disorders, to definitive long-term care and treatment. In his current capacity as Medical Editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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