Counseling for Couples and Families with Addiction
- Prevalence of Addiction
- The Relationship or Family That Includes Drugs
- What Treatment is Available for Couples with an Addiction?
- How Therapy Might Improve the Relationship
Alcohol and Substance Use DisordersAlcohol and substance use disorders can severely undermine the foundation of healthy relationships. Spousal relationships often are the first to suffer when someone is struggling with alcohol or drug dependence. Yet, treatment responses frequently focus on the individual who is struggling with addiction, with less support for couples. Fortunately, a variety of couples and family-based treatment options are available. Understanding the existing types of care is a first step towards receiving the help needed.
Prevalence of Addiction
Given the prevalence of addiction, it is very likely that drugs and alcohol affect many families and households. It is estimated that more than 26 million Americans age 12 or older are struggling with alcohol or illicit drug dependence or abuse.i Moreover, a study conducted by the Substance Abuse and Mental Health Services indicate that more than 10% of U.S. children live with a parent who has alcohol problems.ii Couples who marry early are especially likely to use substances -- cigarettes in particular.iii
The Relationship or Family That Includes Drugs
What Treatment is Available for Couples with an Addiction?
A number of therapies have been proven to be helpful for couples and families dealing with addiction. They can be divided into several categories:
- General couples therapy.
- Addiction-focused couples therapy.
- Family therapy.
- Individual therapy.
General Couples Therapy
A national survey of outpatient substance abuse treatment programs indicated 27% of the programs provided some type of couples-based treatment.v
Therapies for couples may include the following:
Cognitive Behavioral Couples Therapy (CBCT):
- Uses principles of Cognitive Behavioral Therapy (CBT) to improve couples' interpersonal interactions.
Integrated Behavioral Couples Therapy (IBCT):
- Recognizes the importance of both acceptance and change within a relationship, and integrates principles of behavioral therapy.
Emotionally-Focused Couples Therapy:
- Focuses on emotions as the primary agent of therapeutic change. Couples learn to better identify, experience, regulate, and express their emotions.
- Brings together groups of couples to support relationship challenges with facilitation by a mental health professional.
- Inpatient recovery centers:
Addiction-Focused Couples Therapy
Alcohol Behavioral Couples Therapy (ABCT):
- An outpatient treatment for individuals with alcohol use disorders and their intimate partners.
- Based on two assumptions: 1) Couple interactions can be triggers for drinking, and 2) positive intimate relationships are key in enhancing motivation to change drinking behavior.vi
Behavioral Couples Therapy for Alcoholism and Drug Abuse (BCT):
- Based on the assumptions that (1) intimate partners can reward each other's abstinence and (2) reducing relationship distress decreases the risk for relapse.
- The therapist works with both the person who is abusing substances and their partner to create a relationship that sustains abstinence.vii
Community Reinforcement Approach/Community Reinforcement and Family Training (CRA/CRAFT):
- Helps family members who want to help a person (e.g., child) who is addicted, by assisting them in developing strategies for their exchanges with that person; for example, helping them to communicate or to set up rewards for positive behavior.
- This approach can also prove beneficial for couples.
- Intensive outpatient treatment that integrates several approaches based off of principles of CBT, Motivational Enhancement, couples therapy, group therapy, and 12 steps.
- Approaches include individual and conjoint therapy, relapse prevention, opportunities to learn about the ways that the brain responds to substances and withdrawals, development of coping skills, and participation in community-based mutual help groups.viii
Brief Strategic Family Therapy (BSFT):
- Addresses adolescent drug use accompanied by other behavioral problems.ix
Individual Therapy Options
Sometimes individual therapy is the best option. It might be especially helpful if there is a dual-diagnosis (two co-occurring disorders, like depression and substance use). Clients may decide to work on mental health alone or with their partner. Different types of individual therapy include:
Cognitive Behavioral Therapy (CBT):
- The therapist helps the client to identify thought and behavioral patterns that undermine healthy relationships and decision-making.
- Helps the client identify past experiences, unconscious feelings and beliefs, and interpersonal interaction styles that shape behaviors.
- A non-confrontational approach that highlights the costs and benefits of using, and allows the client to come to a natural decision of if, and how, they would like to change their behavior.
Mindfulness-Based Relapse Prevention (MBRP):
- Teaches clients to relate to their cravings differently through the use of mindful awareness. By mindfully observing one's cravings, one begins to better tolerate their discomfort, recognize that they are only temporary, and make a conscious decision to choose a different behavior.
How Therapy Might Improve the Relationship
A couple's mutual commitment to treatment helps to initiate the healing process needed when dealing with an alcohol use or substance abuse disorder. Therapy facilitates each person's ability to better understand and cope with the difficulties they face. Additionally, appropriate treatment equips the couple to make and effectively navigate changes. Couples in treatment enjoy the opportunity to establish appropriate roles and mutual support within the relationship as well as improved psychological and physical well-being.
- i. Totals calculated from 2013 data on substance dependence/abuse and treatment. Data available at: http://www.drugabuse.gov/publications/drugfacts/nationwide-trends.
- ii. SAMHSA. 2012. Data spotlight: Over 7 million children live with a parent with alcohol problems. Available at: http://media.samhsa.gov/data/spotlight/Spot061ChildrenOfAlcoholics2012.pdf
- iii. http://onlinelibrary.wiley.com/doi/10.1111/j.0022-2445.2004.00018.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=
- iv. Center for Substance Abuse Treatment. Substance Abuse Treatment and Domestic Violence. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1997. Treatment Improvement Protocol (TIP) Series, No. 25. Chapter 1--Effects of Domestic Violence on Substance Abuse Treatment. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64441/
- v. Fals-Stewart, William et al. 2001. A national survey of the use of couples therapy in substance abuse treatment. Journal of Substance Abuse Treatment, Volume 20, Issue 4, 277 - 283. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11672643
- vi. SAMSHA. 2009. SAMSHA's National Registry of Evidence-based Programs and Practices. Alcohol Behavioral Couple Therapy. Available at: http://legacy.nreppadmin.net/ViewIntervention.aspx?id=3
- vii. SAMSHA. 2006. SAMSHA's National Registry of Evidence-based Programs and Practices. Behavioral Couples Therapy for Alcoholism and Drug Abuse. Available at: http://legacy.nreppadmin.net/ViewIntervention.aspx?id=134
- viii. Substance Abuse and Mental Health Services Administration (US). Center for Substance Abuse Treatment. Rockville (MD). 2006. Treatment Improvement Protocol (TIP) Series, No. 47.Available at: http://www.ncbi.nlm.nih.gov/books/NBK64102/
- ix. Jessor and Jessor 1977; Newcomb and Bentler 1989; Perrino et al. 2000. Cited in Brief Strategic Family Therapy: An Overview. National Institute on Drug Abuse. Available at: https://archives.drugabuse.gov/TXManuals/BSFT/BSFT2.html