If you are a couple with addiction issues, you may wonder if you can do treatment together. It was once thought that couples with substance use disorders (SUDs) should be treated individually because having both partners together in rehab would be distracting and could cause problems in treatment.
Now that’s not always the case. With addictions affecting over 46 million Americans in 2021 (16.5%) according to the National Survey on Drug Use and Health [1], some treatment centers have begun offering recovery programs for couples, whether they are married or living together.
Couples struggling with substance abuse often have difficulties expressing feelings, making decisions, finances, parenting, and boundary setting.
Couples can successfully participate in addictions treatment together, under certain circumstances. Some approaches only work with couples where one person has an SUD.
But there are others that can work when both people have an SUD. It all depends on how severe the addiction is, the nature of the couple’s relationship, and the treatment center’s policies and therapy styles. Learn more about who this might work for and what that might look like.
Rehabilitating as a Couple
Alcohol and drug addiction in relationships is complex, with each partner influencing the other’s substance abuse. In relationships where only one partner has a SUD, the other may have developed a co-dependent relationship, enabling the substance abuse of their partner.
And when both partners have an SUD, they typically reinforce each other’s addictive behaviors. In either case, the relationship suffers. Often, there are increased levels of instability, dissatisfaction, and even aggression. Unresolved problems in the relationship are typically linked to continued substance abuse and an increase in rates of relapse.
Couples who use substances together frequently find it difficult to quit without support from the other. However, attending rehab together can also be challenging if one partner is not ready to quit or does not take the treatment seriously.
Whether couples should attend rehab together is a complex decision. Therapies with couples in rehab focus on improving communication, building trust, and addressing their co-dependency issues. But both partners must be ready to commit to do the work. This, of course, means not only being sober, but also willing to share openly about their issues and commit to mutually satisfactory resolutions of these.
Types of Addiction Treatments Available for Couplés
Not all addictions treatment centers offer couples therapy or permit couples to attend together. If you are considering going to rehab together you need to research which treatment centers offer what you are looking for.
There are several approaches to treating addiction in couples [2].
Family Disease Approach
This is the best known model and views substance abuse as illnesses of the family, suffered not only by the substance abuser, but also by family members who are co-dependent. Treatment focuses on an individual approach for the person with SUD and for the family members to address this individually.
Family Systems Approach
This is the second most widely known model and applies family system theory. It focuses on how family interactions become organized around alcohol and drug use and maintain a dynamic balance between substance use and family functioning. It involves the couple or entire family [3].
Family therapy is used to understand the role of substance use in the family system. When family members change their thinking about and response to substance misuse, the entire family system changes. The goal is to modify family dynamics and interactions to eliminate the family’s need for the person with SUD to use substances.
This approach includes:
- Understanding the complexities of SUDs and the importance of working with couples or families
- Recognizing the therapeutic value of working with family members, not just the person with SUD
- Using a non-blaming collaborative approach instead of an authoritative confrontational one
- Having harm reduction goals instead of abstinence
- Expand the outcomes to include the health and well-being of the entire family, not just the person with the SUD
- Acknowledge the value of relationships within the family and with social networks as critical sources of support and positive reinforcement
Behavioral Approaches
These approaches assume that family interactions reinforce alcohol and drug-using behavior. Therapy attempts to break this negative reinforcement and instead encourage behaviors that support the goal of abstinence. This model was based on treating one person with an SUD in the relationship, although it has been extended to include both partners if they have SUDs.
Behavioral Couples Therapy (BCT)
The BCT model is a structured counseling approach for people with SUDs and their intimate partners. It focuses on the partner’s ability to reward abstinence and other efforts to change and promote continuing recovery for the person with an SUD.
A daily “Recovery Contract” is agreed to in which the drinking person states his or her intention not to drink or use drugs, and the spouse or partner expresses support for the person’s efforts to stay abstinent. This creates a virtuous cycle where addressing both sets of issues together reinforces positive behaviors [3][4].
This promotes:
- The quality of relationships
- Teaches communication skills
- Positive reinforcement within the relationships
- Lowered risk of return to use for the person with the SUD
BCT aims to:
- Lessen relationship distress
- Improve partners’ patterns of interaction
- Build more cohesive relationships to reduce the risk of return to use
- Support abstinence
- Improve relationship functioning
- Reduced interpersonal violence and other problems in the relationship
Alcohol Behavioral Couples Therapy (ABCT)
This approach is a variant of BCT specifically focused on alcohol abuse. It assumes that multiple factors maintain the patient’s drinking, including individual, dyadic (two-person), familial, and other social and environmental factors [5]. It focuses on:
- CBT to target the person’s drinking
- CBT to enhance the drinking person’s and other family members skills to support change
- BCT to enhance relationship functioning
Other Approaches
Gottman Method Couples Therapy
This is a widely used approach to couples therapy that focuses on supporting and strengthening couples using the Sound Relationship House concept.
PACT Institute: Psychosocial Approach to Couples Therapy
This is a very powerful approach to couples counseling that focuses on the root of adult attachment. It views the people in a couple as not just individuals but a unique entity with its own dynamics and patterns. It emphasizes the importance of secure functioning principles: mutual respect, equity, and fairness, as well as shared responsibility
Benefits of Couples Rehab
There are many benefits to couples rehab, including:
- A unifying approach can teach couples to recognize each other’s triggers, underlying causes that drive each of their addictions, and strategies to help each other prevent relapse
- Healing for the whole family is involved in couples rehab. When couples struggle with substance abuse, it is common that the entire family unit is affected, especially when children are involved
- Improving communication can increase the quality of the overall relationship by building empathy, trust, and understanding between partners
- Builds a foundation for trust by addressing past problems in a healthy and structured setting
- Mutual support allows partners to lean on each other for physical, emotional, and spiritual support
When Couples Rehab is Not Recommended
Couples therapy is not for everyone. Some may benefit more by attending treatment separately to work on individual issues. If both partners have an SUD and one partner relapses, it can be hard for their partner to stay sober. If one partner is farther along their recovery journey than the other, tensions can arise. It’s important to weigh the pros and cons and discuss this with a qualified addiction treatment therapist.
Inpatient Couples Rehab in Los Angeles
If you or a loved one is seeking a way out of substance abuse, private, confidential help is just a call away. Reach out to our Admissions team at The Encino now.
At the Encino Recovery & Detox Center in Los Angeles, we don’t just treat addiction. We nurture the spirit, heal the mind, and help you and your spouse or partner regain your life—all in a safe space.
Residential couples rehab will help you and your partner understand the root of addiction and the role it plays in your relationship. Therapy approaches may include CBT, DBT, Family Therapy, Dance and Movement Therapy, and Internal Family Systems Therapy.
We provide medically supervised detox. After detoxing, you may enter our residential treatment center. Trained staff are equipped to offer clinical care. They will provide the support, guidance, and interventions necessary for you to reach your treatment goals. Participating in residential care greatly enhances your success rate at avoiding relapses.
Sources
[1] Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
[2] Fals-Stewart Wet al. 2004. Behavioral couples therapy for substance abuse: rationale, methods, and findings. Sci Pract Perspect. 2004 Aug;2(2):30-41.
[3] Substance Use Disorder Treatment and Family Therapy: Updated 2020 [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2020. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 3—Family Counseling Approaches.
[ 4] O’Farrell TJ, Fals-Stewart W. 2000. Behavioral couples therapy for alcoholism and drug abuse. J Subst Abuse Treat. 2000. Jan;18(1):51-4
[5] McCrady B. et al. 2016. Alcohol-Focused Behavioral Couple Therapy. Fam Process. 2016 Sep;55(3):443-59
