Counseling for Couples and Families with Addiction

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  1. Prevalence of Addiction
  2. The Relationship or Family That Includes Drugs
  3. What Treatment is Available for Couples with an Addiction?
  4. How Therapy Might Improve the Relationship

Alcohol and Substance Use Disorders

Alcohol and substance use disorders can severely undermine the foundation of healthy relationships. Spousal relationships often are the first to suffer when someone is struggling with alcohol or drug dependence. Yet, treatment responses frequently focus on the individual who is struggling with addiction, with less support for couples. Fortunately, a variety of couples and family-based treatment options are available. Understanding the existing types of care is a first step towards receiving the help needed Learn more about your substance abuse with our comprehensive substance abuse screening tool.
Alcohol and Substance Use Disorders

Prevalence of Addiction

Given the prevalence of addiction, it is very likely that drugs and alcohol affect many families and households. It is estimated that more than 26 million Americans age 12 or older are struggling with alcohol or illicit drug dependence or abuse.i Moreover, a study conducted by the Substance Abuse and Mental Health Services indicate that more than 10% of U.S. children live with a parent who has alcohol problems.ii Couples who marry early are especially likely to use substances -- cigarettes in particular.iii

The Relationship or Family That Includes Drugs

  • Living with ongoing alcohol or substance dependence can create and aggravate a variety of social, psychological and physical conditions. With addiction in the household, domestic life frequently becomes chaotic and at times even dangerous for its members.
  • A person's need to satisfy their habit can wreak havoc on finances as money for household expenses become allocated towards alcohol or substances. The person may begin to sell or pawn items of value. People with dependencies often experience problems at work, and even lose their jobs, exacerbating financial concerns.
  • When a spouse or other members of the family confront the person about their dependence, it is not uncommon for the person with an alcohol or drug problem to try to hide it or become angry. Arguments can escalate quickly into violence. "Researchers have found that 25 to 50% of men who commit acts of domestic violence also have substance abuse problems."iv
  • Other household members may begin to accommodate another's addiction in order to avoid conflict. Family members often resign themselves to the idea that the person struggling with an addiction cannot and will not fulfill his obligations and responsibilities, so they begin to cover for him or her.
  • The relationship often becomes one of codependency, with the sober individuals in the family supporting or enabling addictive behaviors. Some people find that they become more socially isolated as they let other relationships go in an attempt to meet the ever growing demands of the family. Such a situation can also create a feeling of loss not dissimilar from a period of grieving as a relationship based on sharing, mutual support, and love deteriorates.
  • Additionally, addiction has adverse effects on physical health. This proves most obvious in the case of the person addicted. Both alcohol and drugs attack organs and the neurological system. The risks are especially great if the user is pregnant. Alcohol and substances -- especially stimulants -- can provoke disruptions in sleep habits.
  • Sober family and household members also suffer health consequences when dealing with addiction. The increased burdens placed upon them as well as the emotional pain can increase stress levels. Adequate amounts of rest may also be hard to obtain if the person with addiction is restless during the hours that other household members would normally be asleep.

What Treatment is Available for Couples with an Addiction?

A number of therapies have been proven to be helpful for couples and families dealing with addiction. They can be divided into several categories:

  1. General couples therapy.
  2. Addiction-focused couples therapy.
  3. Family therapy.
  4. Individual therapy.

General Couples Therapy

A national survey of outpatient substance abuse treatment programs indicated 27% of the programs provided some type of couples-based treatment.v

Therapies for couples may include the following:

  • Cognitive Behavioral Couples Therapy (CBCT):
  • Integrated Behavioral Couples Therapy (IBCT):
    • Recognizes the importance of both acceptance and change within a relationship, and integrates principles of behavioral therapy.
  • Emotionally-Focused Couples Therapy:
    • Focuses on emotions as the primary agent of therapeutic change. Couples learn to better identify, experience, regulate, and express their emotions.
  • Group Therapy:
    • Brings together groups of couples to support relationship challenges with facilitation by a mental health professional.
  • Inpatient recovery centers:
    • Some inpatient unit might offer couples therapy. Call 1-888-993-3112Who Answers? to find out if a center near you offers this option.

Addiction-Focused Couples Therapy

  • Alcohol Behavioral Couples Therapy (ABCT):
    • An outpatient treatment for individuals with alcohol use disorders and their intimate partners.
    • Based on two assumptions: 1) Couple interactions can be triggers for drinking, and 2) positive intimate relationships are key in enhancing motivation to change drinking behavior.vi
  • Behavioral Couples Therapy for Alcoholism and Drug Abuse (BCT):
    • Based on the assumptions that (1) intimate partners can reward each other's abstinence and (2) reducing relationship distress decreases the risk for relapse.
    • The therapist works with both the person who is abusing substances and their partner to create a relationship that sustains abstinence.vii

Community/Family Approaches

  • Community Reinforcement Approach/Community Reinforcement and Family Training (CRA/CRAFT):
    • Helps family members who want to help a person (e.g., child) who is addicted, by assisting them in developing strategies for their exchanges with that person; for example, helping them to communicate or to set up rewards for positive behavior.
    • This approach can also prove beneficial for couples.
  • Matrix Model:
    • Intensive outpatient treatment that integrates several approaches based off of principles of CBT, Motivational Enhancement, couples therapy, group therapy, and 12 steps.
    • Approaches include individual and conjoint therapy, relapse prevention, opportunities to learn about the ways that the brain responds to substances and withdrawals, development of coping skills, and participation in community-based mutual help groups.viii
  • Brief Strategic Family Therapy (BSFT):
    • Addresses adolescent drug use accompanied by other behavioral problems.ix

Individual Therapy Options

Sometimes individual therapy is the best option. It might be especially helpful if there is a dual-diagnosis (two co-occurring disorders, like depression and substance use). Clients may decide to work on mental health alone or with their partner. Different types of individual therapy include:

  • Cognitive Behavioral Therapy (CBT):
    • The therapist helps the client to identify thought and behavioral patterns that undermine healthy relationships and decision-making.
  • Psychodynamic:
    • Helps the client identify past experiences, unconscious feelings and beliefs, and interpersonal interaction styles that shape behaviors.
  • Motivational Interviewing:
    • A non-confrontational approach that highlights the costs and benefits of using, and allows the client to come to a natural decision of if, and how, they would like to change their behavior.
  • Mindfulness-Based Relapse Prevention (MBRP):
    • Teaches clients to relate to their cravings differently through the use of mindful awareness. By mindfully observing one's cravings, one begins to better tolerate their discomfort, recognize that they are only temporary, and make a conscious decision to choose a different behavior.

How Therapy Might Improve the Relationship

A couple's mutual commitment to treatment helps to initiate the healing process needed when dealing with an alcohol use or substance abuse disorder. Therapy facilitates each person's ability to better understand and cope with the difficulties they face. Additionally, appropriate treatment equips the couple to make and effectively navigate changes. Couples in treatment enjoy the opportunity to establish appropriate roles and mutual support within the relationship as well as improved psychological and physical well-being.

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References:

  1. i. Totals calculated from 2013 data on substance dependence/abuse and treatment. Data available at: http://www.drugabuse.gov/publications/drugfacts/nationwide-trends.
  3. ii. SAMHSA. 2012. Data spotlight: Over 7 million children live with a parent with alcohol problems. Available at: http://media.samhsa.gov/data/spotlight/Spot061ChildrenOfAlcoholics2012.pdf
  5. iii. http://onlinelibrary.wiley.com/doi/10.1111/j.0022-2445.2004.00018.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=
  7. iv. Center for Substance Abuse Treatment. Substance Abuse Treatment and Domestic Violence. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1997. Treatment Improvement Protocol (TIP) Series, No. 25. Chapter 1--Effects of Domestic Violence on Substance Abuse Treatment. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64441/
  9. v. Fals-Stewart, William et al. 2001. A national survey of the use of couples therapy in substance abuse treatment. Journal of Substance Abuse Treatment, Volume 20, Issue 4, 277 - 283. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11672643
  11. vi. SAMSHA. 2009. SAMSHA's National Registry of Evidence-based Programs and Practices. Alcohol Behavioral Couple Therapy. Available at: http://legacy.nreppadmin.net/ViewIntervention.aspx?id=3
  13. vii. SAMSHA. 2006. SAMSHA's National Registry of Evidence-based Programs and Practices. Behavioral Couples Therapy for Alcoholism and Drug Abuse. Available at: http://legacy.nreppadmin.net/ViewIntervention.aspx?id=134
  15. viii. Substance Abuse and Mental Health Services Administration (US). Center for Substance Abuse Treatment. Rockville (MD). 2006. Treatment Improvement Protocol (TIP) Series, No. 47.Available at: http://www.ncbi.nlm.nih.gov/books/NBK64102/
  17. ix. Jessor and Jessor 1977; Newcomb and Bentler 1989; Perrino et al. 2000. Cited in Brief Strategic Family Therapy: An Overview. National Institute on Drug Abuse. Available at: https://archives.drugabuse.gov/TXManuals/BSFT/BSFT2.html