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Couples Addiction Treatment Rehab Guide

Drug and alcohol addictions are incredibly common in the United States. In 2019, the National Survey on Drug Use and Health (NSDUH) estimated that over 20 million Americans over the age of 12 (7.4%) had a substance use disorder (SUD) in the past year.1

Addiction affects the person struggling with this chronic brain illness—and their friends and family as well.2 Although being partnered in a relationship is generally a protective factor from developing a substance use disorder, the impact that addiction has can be detrimental when it is experienced by two people who are in a romantic relationship, live together, or are married.13-15

Fortunately, SUD is a treatable illness.2 For couples who are suffering from addiction, it can be beneficial for both individuals to participate in couples’ addiction treatment, which is provided at many rehabilitation facilities.


Couples and Addiction

Addiction is a chronic disease that affects the way the brain works, characterized by an individual’s compulsive use of  drugs or alcohol despite negative consequences on their health, career, mind, and relationships.3

When a family member is addicted to drugs, it often affects the entire household. The situation may foster a codependent relationship between family members and someone with an SUD. Codependency involves a loved one becoming overinvolved with an individual’s addiction process in a way that is detrimental.4 This overinvolvement consists of behavior patterns that enable the drug or alcohol addiction to continue. It also often decreases the loved one’s health and participation in life.4 Enablers, another name for codependent loved ones, may often be in conflict with each other over the best way to “help” the addicted individual, and while these disagreements persist, the substance abuser continues their addiction behavior without obstacles.

Not all people who are in an intimate relationship with someone who has a substance abuse problem would be considered codependent, but there are instances where both partners struggle with SUDs. One study found that a co-occurring substance use disorder was five times more common among the spouses of husbands who had an SUD vs. spouses of husbands who did not have an SUD.17 In these situations, it is vital that both partners seek treatment simultaneously. When only one of two partners attempts sobriety, it often causes conflict that threatens both the relationship and the patient’s recovery.6

What is Codependency?

There is some debate as to how codependency should be categorized—either as a disease, a personality type, or through an interactionist perspective.5 Ultimately, codependency is a condition that should be diagnosed by a mental health professional. However, several main elements are frequently used to describe codependent individuals. These include:5

  • Desire to control others and interpersonal conflict.
  • Constantly focusing outward.
  • Self-sacrifice.
  • Restricting emotions.

These criteria lack clear definition, but there are many warning signs of codependent behavior to look out for. Characteristics of codependency may include the following:7

  • Feeling guilty when being assertive.
  • Difficulty trusting oneself or others.
  • Consistently doing more than one’s fair share.
  • Fear of abandonment.
  • Constantly seeking approval and being hurt when it is not given.
  • Feeling responsible for other’s actions.

Codependency and Substance Abuse Warning Signs in Couples

In a codependent relationship where substances are abused by one person, the presence of substance abuse and subsequent enabling behavior are the warning signs. It’s very important for a couple to identify the enabling behaviors. Loved ones acting as enablers typically fall into two categories: supportive or hostile.18

A supportive enabler often exhibits the following behaviors:18

  • Rescuing the individual from the consequences of their behavior.
  • Providing assistance including bail, lodging, and money for rent.
  • Lying to others for the individual, including bosses and landlords.

While these behaviors may appear to help the individual in the short term, they can cause long-term harm and permit the user to continue their substance abuse without facing any repercussions.18

 A hostile enabler often exhibits the following behaviors:18

  • Treating the individual with anger, disrespect, or aggression.
  • Communicating unexpressed resentments about past failures and other feelings connected to the addiction.

These behaviors may be regretted by the enabler, but they may also create additional feelings of guilt, embarrassment, and shame in the substance abuser—feelings that may further motivate addictive behavior.18

While the two types of enablers may exhibit different behaviors, neither helps a person who is struggling with addiction start and participate in treatment and recovery.18


Couples Addiction Treatment

For many years, addiction was seen as an individual problem; however, evidence shows treatment for an individual is more effective when it involves the family in some capacity.6

There are three approaches toward treating drug or alcohol abuse in families:6

  • The family disease approach. In this approach, an SUD is a disease that causes the whole family to suffer. Through therapy, each family member individually confronts their issues with either substance use or codependency and enabling behaviors..
  • The family systems approach. This approach is driven by an understanding that behavior is influenced by the interaction of various factors working together within the family unit. Treatment explores the ways the patient’s drug or alcohol use becomes part of the family dynamic and seeks to eliminate or modify these factors.
  • Clustered behavioral approaches. This final approach assumes that interactions within the family support behaviors associated with drug or alcohol use . With therapy, all family members work to recognize and change these behaviors to ones that nurture abstinence.

These behavioral conceptions of substance use provide the foundation for behavioral couples therapy (BCT).6

Dually Addicted Couples

Of course, there are also situations in which both individuals in a relationship have a substance use problem, and research is somewhat lacking on effective methods in treating “dually addicted” couples.8

An exploratory 2006 study identified three obstacles in the way of sobriety for dually addicted couples. These include:8

  • In addition to the difficulties individuals face when trying to get sober, dually addicted couples often collude with each other to acquire substances.
  • Many facilities do not allow couples to enter detoxification or residential treatment together.

Dually addicted couples tend to have less conflict related to drug use when compared to relationships where only one person has a drug or alcohol problem. Because these couples tend to report higher relationship satisfaction when they both use drugs together, when one partner attempts to quit without the other it can cause conflict, resulting in a breakup or relapse.8

To combat the failings of conventional, individual-targeted rehabilitation in treating dually addicted pairs, some rehabilitation facilities offer inpatient or outpatient treatment programs couples can join together.

Behavioral Couples Therapy

Behavioral couples therapy (BCT) and alcohol behavioral couples therapy (ABCT) have become the standards for treating drug and alcohol abuse among couples who live together, where one of the two individuals has a substance abuse problem.6

The primary goals of BCT are to encourage abstinence from substance use and the healthy functioning of the relationship. BCT functions on the assertion that an addicted person’s family member can reward the patient’s abstinence.9

BCT is successful at:9

  • Reinforcing the cessation of drug or alcohol abuse.
  • Improving how a relationship functions through healthy communication.
  • Reducing instances of domestic violence.
  • Mitigating the emotional harm done to children.

Each day, the addicted individual and their spouse or live-in partner draft a “Recovery Contract.” This contract involves the patient in recovery making a daily promise to abstain from using alcohol or drugs while the partner promises to support their efforts.8 The contract may also involve specifics, such as:9

  • Taking prescribed medicine.
  • Attending self-help meetings.
  • Submitting urine toxicity tests.
  • Applying communication techniques.

Is Couples Treatment Effective?

While BCT, ABCT, and couples’ rehabilitation programs have many proven benefits, these methods aren’t appropriate for everyone.

There are many benefits of BCT for cohabitating couples, including:9

  • Long-term abstinence supported by positive behavioral changes.
  • Reduced chances of separation or divorce.
  • The elimination of many other negative behaviors in their relationship caused by substance abuse.
  • Improved communication, which in turn leads to happiness and satisfaction in the relationship.
  • Learning to enjoy new non-destructive activities that don’t involve substance use.

BCT is successful in treating heterosexual couples and gay and lesbian couples by both reducing substance intake and increasing relationship satisfaction.11

When is Couples Rehabilitation Appropriate?

Drug or alcohol rehabilitation for couples is only beneficial when:8

  • Both patients are committed to recovery. If only one person is ready to get sober, it can threaten both the relationship and their partner’s recovery.
  • Both patients are committed to the relationship. Recovery requires a supportive, nurturing environment during and after formal treatment ends.
  • The rehabilitation facility recognizes the intricacies of interpersonal dynamics and how they can support or threaten sobriety.

Risks involved with couples’ rehabilitation include:8

  • Being denied acceptance. Not all facilities accept couples. Unfortunately, pervasive stereotypes about all relationships between two substance-addicted people being unhealthy and non-conducive to sobriety remain.
  • Possible dissolution of the relationship. When one person is committed to recovery and their partner isn’t, it can cause irreconcilable conflicts.
  • A partner becoming a significant obstacle toward a patient’s recovery. Just as one non-committed member of a couple can threaten a relationship, they can also impede long-term recovery.

Continued Recovery for Couples after Treatment

Aftercare is an important part of recovery for most people with SUDs. Addiction is a chronic illness, meaning people with this disorder are prone to relapse.2 Aftercare is vital to reduce the chances of relapsing.11 However, it’s important to note that relapse does not equal failure—it is often just part of recovery. In many cases, a relapse means treatment needs to be adjusted.1,18

The most common forms of aftercare relapse prevention programs are mutual help groups. These groups take several different forms:

  • 12-step programs. Perhaps the best-known form of aftercare, 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) require the patient to:12
    1. Acknowledge their substance use problem and its control over their life.
    2. Trust in a greater power to help them stay sober.
    3. Accept responsibility for their past mistakes, admit their faults, and attempt to make amends.
  • Secular support groups. Because 12-step programs require patients to acknowledge a higher power, they may not work for individuals with a different set of beliefs. There are many secular programs that still provide peer support for people in recovery. These include:
  • Alumni networks. Many treatment centers foster a network of peers who completed treatment at the same facility. Alumni networks allow individuals and couples to reach out to one another for support after their formal rehabilitation treatment at an inpatient or outpatient facility ends. Often, these networks will throw events and meetings where former patients can meet up. Some events encourage former patients to bring their friends and family.

A substance use disorder is a serious problem for individuals as well as their romantic partners and family. Fortunately, it is treatable, and many patients and their loved ones live fulfilling lives together after completing a rehabilitation program.

There are several methods for treating substance abuse in couples and in families that have proven success. If you and your partner are interested in addiction treatment for couples, consider reaching out to one of our admissions navigator. They are available 24/7 and can provide the support, guidance, and information you need to help you or your loved one start on the path toward recovery.


Sources

  1. Substance Abuse and Mental Health Services Administration. (2020). 2019 National Survey on Drug Use and Health.
  2. National Institute on Drug Abuse. (2018). Principles of effective treatment.
  3. National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction DrugFacts.
  4. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  5. Bacon, I., McKay, E., Reynolds, F. The Lived Experience of Codependency: an Interpretative Phenomenological Analysis.Int J Ment Health Addiction (18):754–771.
  6. Birchler, G. R., Fals-Stewart, W. & O’Farrell, T. J. (2004). Behavioral couples therapy for substance abuse: rationale, methods, and findingsScience & practice perspectives2(2): 30–41.
  7. Mental Health America. (2020). Co-dependency.
  8. Simmons J. (2006). The interplay between interpersonal dynamics, treatment barriers, and larger social forces: an exploratory study of drug-using couples in Hartford, CT. Substance abuse treatment, prevention, and policy.1-12.
  9. Fals-Stewart & W. O’Farrell, T. J. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of substance abuse treatment. 18(1): 51–54.
  10. Fals-Stewart, W., Lam, W. K. & O’Farrell, T. J.(2009). Behavioral couple therapy for gay and lesbian couples with alcohol use disorders.Journal of substance abuse treatment. 37(4): 379–387.
  11. McKay J. R. (2009). Continuing care research: what we have learned and where we are going.Journal of substance abuse treatment, 36(2): 131–145.
  12. Medola, A. & Gibson, R. L.. Addiction, 12-Step Programs, and Evidentiary Standards for Ethically and Clinically Sound Treatment Recommendations: What Should Clinicians Do? AMA J Ethics. 18(6): 646-655.
  13. Homish, G.G., Leonard, K.E., Kearns-Bodkin, J.N. (2006). Alcohol use, alcohol problems, and depressive symptomatology among newly married couples. Drug Alcohol Depend, 83(3): 185-192.
  14. Fleming, C.B., White, H.R., Catalano, R.F. (2010). Romantic Relationships and Substance Use in Early Adulthood: An Examination of the Influences of Relationship Type, Partner Substance Use, and Relationship Quality. J Health Soc Behav, 51(2): 153-167.
  15. Starks, T.J., Robles, G., Bosco, S.C., Doyle, K.M., Dellucci, T.V. (2018). Relationship functioning and substance use in same-sex male couples. Drug Alcohol Depend, 201: 101-108.
  16. Cornelius, J.R., Kirisci, L., Reynolds, M., Homish, G.G., Clark, D.B. (2008). Husbands’ SUD is associated with higher levels of co-occurring but not non-co-occurring psychiatric disorders among their wives. Addict Behav, 33(9): 1231-1234.
  17. Miller, S.C., Fiellin, D.A., Rosenthal, R.N., Saitz, R. (2018). The ASAM Principles of Addiction Medicine, Sixty Edition. Lippincott Williams & Wilkins.
  18. O’Farrell, T.J., Choquette, K.A., Cutter, H.S., Brown, E.D., McCourt, W.F. (1993). Behavioral marital therapy with and without additional couples relapse prevention sessions for alcoholics and their wives. J Stud Alcohol, 54(6): 652-666.
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