It’s challenging enough when one person is struggling with addiction, but it can be even more difficult when substance abuse affects two people, whether they are in a relationship, live together, or are married. Addiction has the potential to harm not just your mental and physical health, but your personal relationships as well. Seeking treatment at a couples drug treatment center can be a beneficial option for attaining and maintaining sobriety, and repairing or rebuilding your relationship.
Couples and Addiction to Drugs or Alcohol
Individuals with an addiction (i.e., a substance use disorder) may exhibit compulsive drug seeking behavior and have difficulty quitting use of drugs or alcohol despite the negative consequences of such use.1
When both members of a couple are struggling with addiction, it can be even more challenging to break the cycle of abuse because the problematic behaviors of one person may reinforce those of the other. Couples may also enable another person’s addiction without realizing it by constantly helping them, rescuing them, and thus, allowing harmful behaviors to continue.
Codependency and Addiction
In some cases, enabling behavior may be a sign of codependency, in which a person feels that they need to take care of a person to feel loved and valued, and rely on that other person as a source of identity.7 Codependence can involve a variety of rescuing and caretaking behaviors that can result in one or both partners growing increasingly dependent on the other. Anyone can be impacted by codependency, although many who struggle with codependent behaviors grew up in environments where substance abuse was present and their emotional needs were not met.7
Codependents may view themselves as victims who are unable to break away from caretaking and manipulative cycles and may be drawn to others who feel the same way.2 Codependency can be reinforced in couples struggling with addiction because they don’t know how to set appropriate boundaries or how to express their own needs, leading them to sacrifice those needs to please the other person. This vicious cycle can allow addiction to thrive in the relationship because they both become dependent not only on the substance but on the caretaking and attention of the other.2
Patterns and Characteristics of Codependence
Potential characteristics of codependent people include:2, 8
- Denial patterns that may include minimizing feelings, expressing feelings in passive ways, and not accepting help from others.
- Low self-esteem patterns such as difficulty making decisions, needing to seem right all the time, or not believing they’re lovable.
- Taking responsibility or making excuses for your partner (such as calling in sick for them when they are hungover).
- Controlling behavior that such as manipulating outcomes, freely offering advice to get people to do certain things, or pretend to agree just to get what they want.
- Poor boundaries (such as being unable to say no).
- Avoidance patterns such as withholding affection or appreciation, judging others, or avoiding vulnerability.
Warning Signs of Substance Abuse in Couples
Signs of substance abuse in couples include:3
- Drinking or using drugs is one of the only things couples enjoy doing together.
- Arguing about substance use or issues related to the use of drugs or alcohol (such as financial issues, social or work problems, etc.).
- Feeling the need to drink or use drugs to alleviate stress or tension caused by these arguments.
- Episodes of domestic violence after drinking or using drugs.
- Needing to drink or get high to show affection or be intimate with your partner.
- Isolating yourselves from family or friends in order to hide the addiction.
Can Couples Go to Rehab Together?
Couples who are motivated to stop using drugs or alcohol may benefit from seeking addiction treatment together. Keep in mind, however, that not all facilities offer couples treatment and, if they do, you may need to meet certain requirements, such as not being physically violent with your partner.
You and your partner must be committed to the relationship and sobriety for treatment to be successful. If only one of you wants treatment or sees a problem, treatment is not likely to work. Remember that you can’t force someone to admit to a problem. Although you can provide encouragement and keep the discussion going, you can’t make them go to treatment if they don’t want to.
With that in mind, different types of treatment can help addicted couples, including:3,4
- Individual counseling.
- Group counseling.
- Self-help support groups, such as 12-step meetings like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) and non-12-step groups like SMART Recovery.
- Behavioral couples therapy (BCT).
- Recovering Couples Anonymous (RCA): based on 12-step recovery, RCA provides a space for couples to share their common experiences with other recovering couples and help restore relationships.9
Behavioral Couples Therapy (BCT)
BCT is a form of behavioral therapy for treating couples struggling with addiction. It aims to address both the substance abuse and the accompanying relationship issues. Three important goals of BCT are:4
- Eliminating the substance abuse.
- Engaging the family to help support the couple’s efforts to change.
- Restructuring the couple’s dynamic and interactions in ways that promote long-term sobriety.
BCT uses a variety of interventions and may be conducted as a “standalone” treatment or as an add-on to other forms of treatment. In the first instance, a therapist will meet with the couple together for 15-20 outpatient sessions over 6 months. In the second case, a therapist may meet with several couples in a group format over the course of 9-12 weeks. You will participate in different interventions, such as skills training, conflict resolution, and behavioral assignments that are meant to increase your positive feelings for your partner, help you enjoy shared activities, and teach you methods for constructive communication.4
Studies have shown that BCT is effective at reducing substance abuse in couples when compared to couples who only receive individual counseling. It has been demonstrated to increase a couple’s levels of relationship satisfaction and improve other areas of relationship and family functioning.4
Advantages and Disadvantages of Couples Addiction Treatment
The benefits of rehab for couples can include:5
- Recovery from addiction.
- Reduced risk of relapse.
- Reduction in domestic violence.
- Increased happiness and health of the relationship.
- Overall improvement in family functioning, such as better communication and less emotional problems in the couple’s children.
There can also be potential risks involved with drug treatment programs for couples; for example, if both partners are not equally committed to the relationship or recovery. Treatment won’t be successful in these cases because abstinence and recovery require a commitment on the part of both partners. If the couple has a history of or continues to engage in physical aggression, couples therapy may not yet be appropriate until the partners have had treatment for domestic violence.4
Continued Couples Addiction Recovery
Recovery is an ongoing journey that doesn’t stop when treatment ends. You and your partner will need to continue to work on remaining abstinent for the rest of your lives. For this reason, it’s crucial to have an aftercare plan, which is designed in conjunction with your family, referring therapist, other providers, and support members.
It helps to ensure that you have adequate support and tools at your disposal to avoid relapse and stay sober. These tools can include 12-step groups, continuing counseling, and other measures, such as educational programs to support relapse prevention.6
If you and your partner are struggling with addiction, it’s never too late to seek help. Engaging in couples’ substance abuse treatment can be one of the most important steps you take to ensure your physical and mental health, and the health and happiness of your relationship.
- National Institute on Drug Abuse. (2018). Understanding drug use and addiction: DrugFacts.
- Mental Health America. (n.d.) Codependency.
- Fals-Stewart, W. (n.d.). Substance abuse and intimate relationships.
- Fals-Stewart, W., O’Farrell, T. J., & Birchler, G. R. (2004). Behavioral couples therapy for substance abuse: rationale, methods, and findings. Science & Practice Perspectives, 2(2), 30–41.
- O’Farrell, T. J., & Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of Substance Abuse Treatment, 18(1), 51–54.
- Patton, D. and McDowell, T. (n.d.). Substance abuse aftercare treatment. Arizona State University, Center for Applied Behavioral Health Policy.
- CoDA.org. (2010). Welcome to Co-Dependents Anonymous.
- CoDA.org. (2011). Patterns and Characteristics of Codependence.
- Recovering-Couples.org. (n.d). Welcome to Recovering Couples Anonymous.
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