Addiction Guide for Spouses and Partners

Addiction Guide for Spouses and Partners

Our intimate relationships are supposed to be safe havens, and our homes places that provide shelter from danger. Yet for many Americans, a close relationship with an addicted partner can become a source of chaos, emotional upheaval, and even violence. Substance abuse can eventually destroy a couple by undermining trust, which weakens the bond between partners. If children are part of the relationship, conflicts over parental responsibilities, neglect, or abuse often occur as a result of one partner’s – or sometimes both partners’ – drinking or drug use.

Drug and Alcohol Use Data

Drug and alcohol abuse affect millions of adults ages 18 and older in the United States. The results of the 2014 National Survey on Drug Use and Health provide the following data on drug and alcohol use:

  • About 22 percent of young adults ages 18-25 (about 7.7 million Americans in this age group) reported current use of illicit drugs.
  • Among adults ages 26 and older, 8.3 percent (about 17 million people in this age group) reported current illicit drug use.
  • About 10.8 percent of adults ages 18-25 (about 3.8 million people) and 6 percent of adults age 26 and older (about 12.3 million people) reported that they were heavy alcohol users.
  • Among adults ages 26 and older, 6.6 percent of adults (about 13.5 million people) reported that they were current users of marijuana.
  • Approximately 1.6 million adults ages 18-25 and 4.3 million adults age 26 and older were currently using psychotherapeutic drugs, including prescription pain relievers, tranquilizers, and stimulants, for nonmedical reasons.
adults and drug use

Many of these adults are involved in some type of cohabiting relationship, and these partners are feeling the painful repercussions of alcohol or drug abuse. Whether this relationship involves marriage, a domestic partnership, or a more informal living arrangement, substance abuse affects everyone in the home, not just the individual who is addicted. Effective therapeutic interventions involve both partners as well as their children.

How Substance Abuse Affects Relationships

cycle of conflict

The American Association for Marriage and Family Therapy describes a cycle of conflict that occurs in domestic partnerships, in which substance abuse leads to verbal and physical conflict, which in turn leads to further disagreements about the substance abuse itself. Before long, addiction becomes the focal point of the couple’s conflicts, and other sources of tension may be temporarily suppressed. However, these sources of disagreement will come back to the surface eventually, especially if the couple denies the problem and refuses therapy.

Other concerns that touch many couples affected by substance abuse include:

  • Financial difficulties resulting from the costs of alcohol and drugs
  • Legal conflicts over child custody, drunk driving, or illicit drug use
  • Sexual dysfunction caused by drug or alcohol abuse
  • Shame or embarrassment in social situations
  • Profound distrust arising from repeated lies, broken promises, and denial of substance abuse
couple effects

Alcohol and drugs can impair judgment, arouse feelings of anger and resentment, and create an atmosphere that leads to conflict at home. In the worst cases, these unmanageable emotions lead to violence, verbal and physical abuse, harm, and even death. The National Resource Center on Domestic Violence estimates that approximately 50 percent of men who are in treatment for substance abuse have a history of physically abusing their wives or partners, and that a significant number of women in treatment programs have been the victims of domestic violence.

Any experiences of abuse or potential signs of abuse must be taken very seriously in recovery. Individuals who have verbally abused or physically attacked their partners will require anger management courses and may face legal consequences, depending on the severity of the assault. Anyone who feels that they are in danger because of an abusive partner should seek help immediately from legal authorities, a healthcare provider, or a substance abuse treatment professional. Online resources and support services on partner abuse are available through the National Domestic Violence Hotline.

Supporting a Partner without Enabling

couple enabling What is the most effective way to support a partner who’s going through rehab? How can you act as a source of strength to a loved one who’s caught in the cycle of addiction without enabling the addiction and losing sight of your own needs?

These are key questions for anyone who has a spouse or partner in recovery. Offering support to an addicted partner can take a tremendous toll on your physical energy and emotional health. On top of this, the needs of the rest of the family, such as children and aging parents, and the demands of work and social commitments can quickly become overwhelming.

Enabling Behaviors

“Enabling” occurs when one partner, usually without conscious intention, makes it possible for the other to continue drinking or using without having to face the consequences. Examples of enabling behavior might include:

  • Going out to bars with a spouse, even though staying out late is harming your health or career, so they don’t have to risk driving drunk
  • Making excuses for an absent partner at family gatherings because they were too intoxicated or hungover to attend
  • Paying some or all of a spouse’s bills so they don’t have to steal to have money for drugs
  • Telling your children that “Mommy’s sick” or “Dad has the flu” when they are really in drug withdrawal or hungover from drinking

How can you tell if you’re supporting a partner versus enabling?

If you find yourself lying, making excuses, or creating explanations for a partner that allows them to remain in denial, you are probably enabling rather than supporting. Enabling behavior is a red flag of codependency, a form of addictive behavior in which one partner relies on the other partner’s problem for a sense of purpose in life, a feeling of self-worth, or a sense of power. The codependent loses their sense of self in the overwhelming effort to “save” the partner from addiction; however, when that partner gets close to recovery, the codependent may undermine the process in order to retain feelings of power or self-esteem.

The checklist below includes guidelines that can help you provide support in a healthy and meaningful way. If you feel that you are losing yourself in another person’s struggle, or you’re overwhelmed by the responsibilities of family life, work, and recovery, these “reality checks” can help you reorient yourself and redirect your energies:

  • REALITY CHECKS FOR PARTNERS AND SPOUSES

Am I setting healthy boundaries for myself? (e.g., not letting my boyfriend’s bad mood affect my outlook on the day)

Am I letting the people in my life take responsibility for themselves? (e.g., letting my kids arrange their own transportation to afterschool activities, letting my boss pick up her own dry cleaning)

Am I seeking help from professionals outside the home? (e.g., calling a loved one if I feel overwhelmed, talking with a family therapist if I can’t manage a conflict with my spouse)

Am I taking time to eat healthy foods and get physical exercise? (e.g., taking 10 minutes before work to make a healthy homemade lunch, walking the dog for a half-hour in the evening)

Am I giving myself time for my own stress management activities? (e.g., going to a yoga class, meditating for 10 minutes, listening to an inspirational audiobook, meeting a supportive friend for coffee)

Am I making time for my own recovery activities? (e.g., going to an Al-Anon meeting, reading recovery literature, attending an individual session with a counselor or therapist)

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Approaches to Couples Therapy

In the past, addiction was viewed as an individual problem that was best resolved by focusing attention on the person abusing alcohol or drugs. However, the mental health community now views the Family Systems Model as a more accurate reflection of the way addiction develops. In the Family Systems Model, substance abuse arises as a result of dysfunction among the members of a family unit. Likewise, the most effective way to resolve addiction is to work with all the members of the household to improve their communication patterns and create a healthier home environment. According to the journal Science & Practice Perspectives, therapies that focus on treating both members of a couple have a higher success rate at maintaining long-term abstinence than therapies that address only the individual with the substance use disorder.

Behavioral Couples Therapy

Behavioral Couples Therapy, or BCT, has evolved as an approach to treating substance abuse within a cohabiting partnership. BCT, which is typically offered to committed couples who have a strong emotional investment in improving their relationship, helps partners address the dysfunctional patterns that sustain addiction. The therapeutic goals of BCT include enhancing relationship function and promoting recovery through the following steps:

  • Improving problem-solving skills
  • Improving communication skills
  • Increasing caring behaviors
  • Developing a program for treatment and recovery
  • Creating a recovery contract
  • Supporting self-help in both partners

BCT can be applied as part of an inpatient substance abuse treatment program or through outpatient therapy sessions. The core strategies of BCT have been applied through other therapeutic approaches to provide similar benefits.

Emotionally Focused Therapy

Emotionally Focused Therapy, or EFT, has also been applied successfully to help couples recover from the distress caused by addiction. In EFT, the therapist works with the couple to help them regulate their emotions, strengthen their attachment, and ultimately deepen their emotional bond. Through this approach, partners learn how to replace negative behaviors, such as criticism, hostility, or defensiveness, with positive interactions that promote caring and mutual support.

Support for Couples in Rehab

couple enabling Support groups can be a critical source of emotional strength for the spouse of a person in recovery. By connecting with other individuals who have gone through the same experiences, partners can learn new coping strategies and acquire a sense of hope for the future. Some of the members of the group will be working through the same challenges, while others will have already completed the work of rehab and be working on long-term abstinence.

Support groups like Al-Anon and Nar-Anon are based on the 12-Step principles of Alcoholics Anonymous. Through these confidential groups, members gather and work on a one-on-one basis with a sponsor to build inner strength and learn how to detach lovingly from the struggles of others. Twelve-Step groups meet at rehab centers, in outpatient programs, and throughout most major communities. Membership is free; participants are asked only to make a small monetary donation and to contribute some of their time to group activities.

Al-Anon and other 12-Step groups are based on a spiritual approach to recovery, and members are encouraged to seek support from a higher power of their own choosing. These groups are nondenominational, and no preference is shown for any organized religion.

For those who prefer a secular approach to recovery, support groups like SMART Recovery, Rational Recovery, and Secular Organizations for Sobriety (SOS) offer nonreligious programs that are available in many communities. In addition, nondenominational self-help groups or group counseling services are available through community centers, mental health services, and private therapists. Many rehab facilities offer support groups and other services through their alumni programs, for clients and their loved ones who have been through treatment.

Maintaining Long-term Abstinence

Regardless of the approach you and your partner take to recovery, seeking support from others is one of the primary ways to maintain long-term abstinence. In a study of individuals who had maintained their sobriety for a median of 12 years, the Journal of Psychoactive Drugs cites the following as the most important factors contributing to their abstinence:

  • Participation in support groups within the community
  • Membership in a 12-Step fellowship
  • Help from partners, spouses, family, and friends
  • Having negative consequences for relapse, such as losing a job, going to court, or facing marital separation
In order to gain the maximum benefit of self-help support groups, both members of a partnership should participate actively. Participation can take the form of attending meetings with a partner, attending meetings alone, or volunteering for activities with the group within the community. Regardless of which approach to recovery you and your partner choose — secular or spiritual — consistent participation and commitment to the process of recovery are essential for maintaining the benefits of rehab.

Creating an Environment that Sustains Recovery

recovery When a partner or spouse comes home from rehab, it is probably unrealistic to expect that they will find a completely “addict-proof” environment. Even if all traces of alcohol, illicit drugs, or potentially addictive prescription medications are removed from the house, images of alcohol or drug use in magazines, TV shows, or movies can trigger cravings. Friends may inadvertently appear at the house with beer or wine, unaware that someone in the home has just completed substance abuse treatment. Most significantly, the partner of the recovering addict may not be ready to give up alcohol or drugs. Partners of individuals in recovery must be very honest with themselves and with their partner about their readiness to join them in sobriety.

The following checklist can be used as a guide to creating a home that supports long-term recovery after rehab:

  • CHECKLIST FOR A RECOVERY-FRIENDLY HOME
no alcohol No alcohol, including wine or beer, in the home (If removing alcohol is not possible, keep it out of visible areas like refrigerators or kitchen cupboards.)

No drug paraphernaliaNo illegal drugs or drug paraphernalia

prescription pills No easy access to prescription drugs with a high abuse potential, like narcotic pain relievers, sedatives, and stimulants (These should be locked in secure areas if they are necessary, or they should be removed if they are not being used with a valid prescription for medical reasons.)

No posters, wall hangings, or other decorative items that suggest or advocate substance abuse

healthy eating Healthy snacks, such as fresh fruit, yogurt, or popcorn, to provide energy

non alcoholic beverages Lots of nonalcoholic liquids, such as bottled water, juice, tea, or carbonated soft drinks, to provide hydration

clean environment A clean, uncluttered environment, with lots of light and fresh air

Comfortable pillows or beanbags for rest, relaxation, and a sense of security

recovery literature Recovery literature in easily accessible places, like bedside tables or bookshelves

Inspirational calendars or posters to remind you and your partner of your recovery goals

House plants or fresh flowers on windowsills and tables, to signify new growth

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If providing a sober environment is not possible immediately after rehab, or if the recovering partner needs more structure or supervision, a sober housing program can provide an effective transition from rehab back to the home. In sober living programs, housing is provided within the community, in a home that is structured by rules and expectations about maintaining sobriety.

In sober living programs, residents generally live in houses that are located in mainstream neighborhoods, where they have easy access to meetings, clinics, counselors, and jobs.

Residents are expected to follow specific rules in order to maintain their residency, such as:

  • Remaining clean and sober
  • Observing a curfew
  • Attending house meetings
  • Performing assigned chores
  • Spending a specified amount of time each week working outside the home or searching for a job
  • Attending therapy or counseling sessions as scheduled
  • If an individual who has completed rehab is to maintain long-term abstinence, their partner should be equally committed to the recovery process. Ideally, this commitment should include the intention to remain sober. However, if the other partner is not ready to be completely abstinent, a sober living program could provide a safe haven for the recovering partner to practice the coping strategies learned in rehab without the triggers or stressors of life at home.

    When both members of a relationship are committed to recovery, it is possible to regain lost trust and repair the bonds that were broken by addiction. In order to do this, couples need the guidance and support of professional marriage counselors, therapists, or social workers who have specialized training and credentials in substance abuse treatment. These professionals can address not only the issue of drug or alcohol abuse, but the sources of conflict that have been suppressed through years of focusing on addiction.

    Resources for Partners and Spouses

    Al-Anon: One of the most widely respected 12-Step programs worldwide, Al-Anon offers strength and hope through mutually shared experiences. This 12-Step group is open to spouses, partners, parents, children, friends, and other individuals who have been affected by the disease of addiction.
    Couple Recovery from Addiction: Based on a recovery philosophy known as CARE (Couples Addiction Recovery Empowerment), this support organization provides a holistic model for couples seeking to overcome the damage and dysfunction caused by addiction.
    Nar-Anon: Nar-Anon is a sister program to Al-Anon, with a focus on individuals affected by narcotic abuse. Like Al-Anon, Nar-Anon applies the 12-Step principles to recovery to the loved ones of individuals struggling with substance use disorders.
    National Domestic Violence Hotline: This online collection of informational materials and resources was developed to empower the victims and survivors of domestic abuse. The telephone hotline provides immediate access to support services and crisis intervention: 1-800-799-SAFE (7233).
    Recovering Couples Anonymous: This organization is not affiliated with Alcoholics Anonymous, but it is based on the principles of 12-Step recovery. The goal of this fellowship is to create committed, lasting relationships through the shared experience, strength, and hope of members.
    SMART Recovery Family & Friends: SMART Recovery (Self-Management and Recovery Training) is a nonreligious support program for individuals who have a problem with drugs or alcohol and prefer a secular approach to recovery. A nonreligious alternative to Al-Anon, Family & Friends is a group within the SMART Recovery system that supports the loved ones of individuals in recovery.
    Substance Abuse and Intimate Relationships: This informative article from the American Association for Marriage and Family Therapy provides an overview of the effects of addiction on marriages and other intimate partnerships.
    VAWnet: The National Online Resource Center on Violence Against Women: Created in 1995 by the National Resource Center on Domestic Violence, this online network provides educational materials and resources on domestic abuse against women and gender-based violence.
    What to Do if Your Adult Friend or Loved One Has a Problem with Drugs: This screening questionnaire from the National Institute on Drug Abuse includes 11 questions that can help you determine whether a loved one has a problem with alcohol, illicit drugs, or prescription drug abuse. Resources are also provided to help your loved one find treatment.

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