Substance Abuse and Couple Therapy

“It’s the alcoholic’s denial of his need for people that leads to his eventual denial that he’s an alcoholic.”  — Ernest Kurtz

I often work with couples struggling with issues related to substance abuse. I firmly believe that connection is the best remedy for addiction. The question is, how can we get to the point of connection where the need for the substance is no longer needed?

There is a tried and true model that illustrates how one changes. It is called the stages of change. The action and maintenance stages of change are where the connecting begins, and they will be discussed below.

I have been heavily influenced by Philip Flores, PhD., who wrote Addiction as an Attachment Disorder. He writes:

“Until every addiction is relinquished, addicts or alcoholics will never be forced to develop the only source of healthy affect regulation that is available to them: healthy interpersonal attachment.”

Let’s unwrap this statement for a bit. What is most successful for recovery is to have a healthy interpersonal attachment with another person. This can also be called having an internalized secure base, or better yet, “feeling felt.” This is why having a sponsor in a 12-step program can be so effective, or a therapist, or someone you can connect with about your struggles. We are social beings and we need to feel that someone is on our side, knows what we are going through, and wants the best for us. This is the best way to regulate our affect.

The good news is that partners are in the best position to provide such healthy interpersonal attachment. If your relationship is riddled with substance abuse, there is a good chance you two are unable to sufficiently provide healthy affect regulation. This can be due to several factors which can be illuminated in couple therapy.

Below are the stages of change and examples of what the substance user may be thinking in that stage.

The stages of change are:

  1. Precontemplation: “I don’t have a problem. My problem is that my partner has a problem.”
    • Often, non-using partners ask me what they should do. I respond by saying they need to move this issue forward. This can be done with direct, assertive communication that is not aggressive or passive-aggressive, stating that the status quo is not working for you. How does the status quo make you feel? Sometimes, partners feel it is better to have this conversation in couple therapy. However, it is important to keep in mind, that couple therapy does not assign good guys and bad guys. A question may be asked of how have you added or enabled their substance use?
  2. Contemplation: “Maybe I do have a problem. Maybe I should make this change for myself and my marriage.”
    • If your partner is here, let them know what you envision your relationship to be. What would it mean to you if he or she was sober? How has substance abuse caused both of you pain? (Use discretion with that question).
  3. Preparation: “I have a problem, it is time to do something.”
    • At this stage, hopefully, your partner is looking at lifestyle changes. However, it is not enough to just stop the substance, it is important to add things that are positive. An example of this would be to commit to sober outings together during the week or weekend. Sobriety is easier with just the two of you at say, dinner, a movie, or on a hike. Remember, social situations where there is more than just you two adds a whole other dynamic.
    • At this stage, it would be wise to consider couple therapy and/or individual drug and alcohol therapy. If the substance using partner attends individual or group drug and alcohol therapy, it can be very beneficial if permission is given to speak with the drug and alcohol counselor.
  4. Action: “It is time to take the actions I have prepared for, for myself and for my marriage.”
    • Partners can express to the substance user what taking action means to them. It will be helpful to convey that you are feeling better about the relationship, that their efforts are not unnoticed.
  5. Maintenance: “I am going to stick with it, there are too many benefits of sobriety.”
    • This is where the two of you can begin to understand how substance abuse has affected your relationship. In couple therapy, you two can understand how you two allowed this to happen, and what purpose the substance was serving. It is also where you two can learn to provide healthy affect regulation to each other.

positive change