Couples Therapy For A Substance Use Disorder

Addiction doesn’t just impact the individual; it affects their family, friends, co-workers, and, perhaps more than anyone, their romantic partner. Whether couples are married, cohabiting, or just in a relationship, if 1 or both persons in the relationship have a substance use disorder (SUD), it can be destructive to both parties and make it very challenging to have a healthy and supportive partnership. Even if the partner with the SUD has sought treatment and is maintaining their sobriety, it does not take away maladaptive patterns of communicating, broken trust, and emotional pain in the relationship. Trust must be rebuilt, and both people in the relationship need to realize their shortcomings and work to overcome them individually and together. This can be difficult without professional guidance. Attending couples therapy can provide both partners a safe place to share how they have experienced each other and their feelings related to those experiences in an effort to work toward rebuilding a loving and healthy relationship.

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What Is Couples Therapy?

Couples therapy is a type of psychotherapy that aims to recognize and resolve conflicts in intimate relationships. It is often also referred to as marriage counseling, but the partners do not need to be married to receive this therapy. Licensed marriage and family therapists help the couple to understand each other, work on open communication, and resolve the problems in the relationship. Some couples seek therapy on a short-term basis. For example, pre-marital counseling or to simply iron out small issues. For more serious issues in the relationship, like substance abuse or infidelity, it may take longer depending on the couple, the therapy approach, and the therapist. Before, during, or after, one partner may choose to seek additional individual counseling as well.

One benefit of working with a licensed therapist is creating a safe and nonjudgmental space to express your emotions and frustrations with your partner. If conversations typically turn into loud arguments, the therapist can de-escalate the situation so that both parties can have their thoughts and feelings heard. Couples therapy may provide a couple with homework, such as communication exercises, and tools to develop healthy communication skills that can have long-term benefits. It’s important to remember that to make a relationship work, both partners must be honest, open, and willing to put in the effort. In some cases, couples therapy may help 2 people realize that ending the relationship is the wisest option, and they can work in therapy to determine the best way possible to separate, especially if finances are linked and children are involved.

Navigating a relationship where addiction is present can test even the strongest couples. Fortunately, couples therapy has been shown to have positive results for people struggling with a drug or alcohol use disorder (AUD). Multiple studies published by the National Institutes of Health found that people who engaged in behavioral couples therapy (BCT) had greater reductions in substance use than those who only received individual counseling. They also had improvements in intimate partner violence and children’s psychosocial adjustment.

Couples receiving BCT also have reported higher levels of relationship satisfaction and more improvements in other areas of relationship and family functioning.

There are a few situations in which couples’ therapy is not appropriate. If there is a court-ordered restraining order for partners to not contact each other, they should not see each other in therapy until the order is lifted. Also, couples are excluded if there has been severe domestic violence in the past 2 years or if one or both persons are afraid that therapy will result in violence. Severe domestic violence is defined as an injury requiring medical attention or hospitalization. Domestic violence is a progressive cycle where the violence and emotional abuse becomes worse over time. Anyone in a domestic violence situation can get support and help 24/7 by contacting The National Domestic Violence Hotline at 1-800-799-7233 (SAFE) or local community resources.

Overall, research on behavioral couples therapy has demonstrated that this practice produces greater abstinence from drugs or alcohol and better relationship functioning. When beginning treatment, it may be necessary to meet with multiple licensed therapists to find someone that is the right fit for the couple. It is important to note that couples therapy may not be effective if 1 person is actively abusing drugs or alcohol. Some programs will not start therapy until partners with a substance use disorder have completed 90 days of sobriety. However, it is still possible to begin therapy in other programs while still being treated for an SUD. The intention to quit using is vital for successful therapy sessions.

How Does Addiction Impact Intimate Relationships?

If 1 or both partners are abusing drugs or alcohol in a relationship, it can cause several serious issues and harmful consequences. Couples may experience financial problems, housing issues, job loss, health related concerns, poor communication, a lack of trust, and patterns of codependency. There is also an increased risk for verbal and emotional abuse and physical violence. Substance abuse co-occurs in 40% to 60% of intimate partner violence. A parent with a drug or alcohol problem is 3 times more likely to abuse their child. Addiction can also impact sexual functioning, resulting in one or both partners feeling rejected, unsatisfied, or unloved.

Addiction And Sex Life

Drug and alcohol abuse negatively affects physical and mental health and are likely to have a negative effect on sexual performance, functioning, and intimacy. Men who are dependent on alcohol have a 60% to 70% chance of suffering from sexual problems, such as loss of sexual desire, erectile dysfunction, and premature ejaculation. Even short-term heavy alcohol use can cause temporary erectile dysfunction. Researchers have found that heavy alcohol use can have permanent effects on a man’s sexual health, even after long abstinence periods. While some cocaine users feel an increased sexual desire during drug use, cocaine use has been found to decrease sexual pleasure in the long term. A study from the University of Granada in Spain found that the sexual functioning of men who abused cocaine, heroin, alcohol, and marijuana were impaired by all drugs. The two areas that were most significantly impaired were pleasure and orgasm.

Not only is sexual functioning impacted by substance abuse, so is the emotional bond between partners that leads to feelings of closeness and desire. Feelings of resentment may interfere with the attraction that one partner previously felt for the other. Couples therapy may help resolve these negative feelings and help couples regain the intimacy that their relationship once had.

Addiction And Infidelity

While abusing drugs or alcohol does not necessarily mean that a person will be in unfaithful to their partner, it increases the risk of them being in a vulnerable position and making poor decisions. Alcohol impairs judgment and lowers inhibitions, potentially causing someone to entertain relations outside of their marriage or relationship when they would not do so sober. However, infidelity often stems from a deeper-rooted issue and someone with a drug or alcohol problem may use their addiction as an excuse to justify the cheating. Infidelity can greatly damage relationships and it takes time and work to restore the trust. Couples therapy may be able to help couples begin the journey to rebuild a fulfilling and honest relationship.

Infidelity generally comes from the same inner emptiness as alcohol and drug abuse.

- Margaret Paul, PhD

What Do I Do If My Partner Has An Addiction?

It can be difficult to find the line between being supportive to your partner while they are in active alcohol and/or drug addiction, without being an enabler. Even though your intention may be to help, protecting someone from the consequences of their substance abuse is considered enabling, such as taking over their responsibilities, making excuses for them, and saving them from legal consequences. It may be difficult to set boundaries and limits. Al-AnonNar-Anon, and Recovering Couples Anonymous are non-judgmental self-help groups for the partner who is not using substances; however, is often addicted to their loved ones behaviors, to find support and suggestions from others that have dealt with similar issues themselves. During and after treatment, couples therapy can help people get back to a healthy place of understanding, love, support, and trust.

For more information, contact a treatment provider today.

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