Relationships and Substance Abuse
According to researchers, relationships that include someone who is abusing substances are often characterized by poor communication patterns, relationship instability, high levels of partner violence, risky sexual behaviors, and poor adjustment of children who reside in the homes. These characteristics often lead to low overall relationship quality and low relationship satisfaction.
It is important to note that relationship discord and substance abuse or substance relapse are intertwined, so that each causes the other in a kind of vicious cycle. Partners often feel helpless and frustrated when a significant other is abusing substances and failing to respond to requests to decrease or eliminate use. The partners end up stuck between enabling and confronting reactions to the substance abuse. For instance, partners enable the abuse when they make excuses for the addict or when they try to avoid creating any problems that might trigger a substance abuse episode, leading the partner to “walk on eggshells” around the addict.
Sometimes partners will join Al-Anon family groups, self-help groups for the partners of addicts. Al-Anon is focused on helping the partner only and does not usually engage the addict in treatment. Also, the partner will sometimes become so injured or upset by the substance abuse that they become angry and confront the addict with a demand to change.
Many addicts have learned to pull back or walk away when confronted to avoid the problem; this is termed the demand-withdraw interaction, and it rarely engages the addict successfully in change. Alternatively, some addicts will promise change when confronted, but will quickly revert to old behaviors once the partner’s anger has passed. This pattern of enabling or demanding change can go on for years before the partner seeks outside assistance.
Encouraging Treatment
Partners can play a significant role in encouraging substance abusers to enter treatment, assisting in treatment progress, and helping the addict to avoid relapse. However, concerned significant others are often not included in treatment or they are included only in minor ways, such as participating in an occasional family night or a special session just before the conclusion of treatment.
It is notoriously difficult to engage substance abusers in treatment to change their addictive behavior. Research has shown that the majority of addicts who seek treatment were motivated by their partner or family member to do so. Intervention is one method used to engage addicts in treatment. It has received much media attention, but studies indicate that it is successful less than 25 percent of the time, primarily because many families cannot handle the high level of confrontation involved in the procedure and so decide not to do it.
The Community Reinforcement and Family Training (CRAFT) model is another approach that teaches significant others how to change their own behavior to motivate substance abusers to enter treatment. Jane Smith and Robert Meyers conducted research that indicates that CRAFT can successfully engage the substance abuser in treatment in 64 to 86 percent of cases. The CRAFT model was featured on a recent HBO television series on addiction.
Once in joint treatment, partners function as collaborators with the therapist because they can provide or withhold positive reinforcement from the addict to encourage decreased use. The partner can provide personal information about the addictive behavior that the addict may not recognize or think to share in treatment. Behavioral couples therapy works on the couple’s relationship and the substance abuse behavior in tandem. It keeps the couple focused on the present and the future using weekly activities (such as “catch your partner doing something nice”), self-help group involvement, drug testing, and a “daily sobriety contract” in which the substance abuser directly commits to abstinence for the next twenty-four hours as a promise to the partner. This model has had great success in reducing substance abuse.
Avoiding Relapse
One key aspect of couples treatment for substance abuse is the role the partner can play in helping the addict avoid relapse once he or she is clean and sober. Relapse prevention is recognized as an important aspect of substance abuse treatment because there is such a strong temptation to use again while in recovery. Partners can facilitate the identification of high-risk situations because they know from experience when the addict is tempted to use. Once the high-risk situation is identified, the partner can help the recovering addict plan coping responses that avoid relapse when the addict faces temptations. Finally, the partner can reinforce the addict’s perception of his or her ability to manage challenges through compliments after successful management of temptation.
Treatment Success
Research has shown that spouses or partners can contribute in important ways to treatment success. More so than the standard individual treatment that includes only the substance abuser, couples treatment has demonstrated more positive treatment success, such as a reduced amount of substance use, increased periods of abstinence, decreased substance-related arrests and hospitalizations, and reduced violence toward partners.
A decrease in domestic violence is one important outcome of couples therapy for addiction. Substance abuse often lowers inhibitions and increases violent episodes. Domestic violence is approximately twice as frequent in substance-abuse-treatment populations as in the general population. Couples therapy that improves relationship dynamics and lowers substance abuse significantly decreases the rates of domestic violence.
Bibliography
Fals-Stewart, William, et al. “Behavioral Couples Therapy for Alcoholism and Drug Abuse.” The Wiley-Blackwell Handbook of Family Psychology. Eds. James H. Bray and Mark Stanton. Malden: Wiley, 2009. Print.
O’Farrell, Timothy J., and William Fals-Stewart. Behavioral Couples Therapy for Alcoholism and Drug Abuse. New York: Guilford, 2006. Print.
Smith, Jane E., and Robert J. Meyers. Motivating Substance Abusers to Enter Treatment: Working with Family Members. New York: Guilford, 2004. Print.
Stanton, Mark. “Motivational Interviewing and the Social Context.” American Psychologist 65 (2010): 297–98. Print.
Stanton, Mark. “Relapse Prevention Needs More Emphasis on Interpersonal Factors.” American Psychologist 60 (2005): 340–41. Print.
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