There are drug treatment centers that can treat married couples on both an inpatient and outpatient basis.
Generally, each person will be involved in their own individualized treatment program, and they’ll come together for couples or family therapy sessions as well.
What Is Family Therapy?
Family therapy is a form of psychotherapy where the clients are family members. One subset of family therapy is couples therapy where the clients in therapy are romantic partners. They can be married, living together, or just romantically involved.
Couples therapy (marriage counseling) and other forms of family therapy have research support for their use in the treatment of substance abuse issues, but most of the research is based on outpatient treatment studies.
There is less research on the effectiveness of residential treatment for couples or inpatient couples treatment for substance abuse issues.
Even so, some indications can guide couples as to what type of treatment they should seek.
Couples Therapy for Substance Abuse
When married partners both have substance abuse issues, or even when one partner has a substance abuse problem and the other does not, couples therapy can address the issues associated with substance abuse. Very often, married partners suffer for quite some time with issues regarding substance abuse in one or both members before actually making a commitment to get help.
Couples therapy should never be considered a last resort. It should be considered a potential way to resolve long-standing issues. When couples attend treatment as a last resort to save their relationship, the relationship is already in serious jeopardy.
Like any type of intervention, the sooner the intervention can be implemented to address the particular problem, the more effective the intervention will be.
What Are the Assumptions of Couples Therapy?
In general, the treatment of couples for substance abuse issues or any other issue will typically adhere to several different assumptions.
- Each person is a separate individual with an independent existence as well as an integral part of the relationship.
- Individual experiences can be used to benefit the relationship, and joint experiences can be used the benefit the individual.
- Events that occur to one member of the couple affect them as a person and also influence their partner.
- Events that are experienced by the couple affect each member individually.
Many different issues can negatively affect the couple, including:
- Problems with trusting one another
- Keeping secrets from one another
- Developing alliances outside the relationship
- Attempting to control the partner
- Inattention, affection, or isolation
- Infidelity
The Overall Goals of Treating Married Couples for Substance Abuse Issues
When couples are in treatment together, there are several overall aims for the treatment.
- Establish clear goals for the treatment based on the presenting problem (in this case, substance abuse) in one or both partners.
- Treatment should not try to address every minor issue. The focus should be on the specific issues that brought the couple into treatment.
- Treating couples should focus on the relationship as opposed to solely focusing on one person separately, even in situations where one partner is dealing with the substance abuse issue.
- Treatment should involve a solution-based approach, meaning that the goal should be to solve the issues associated with the substance abuse problem and how they are affecting the relationship.
What this typically means is that when one of the partners has a substance abuse issue, the issues that relate specifically to the couple are treated in couples therapy, whereas the partner will address their own individual issues with substance abuse in a different form, such as substance abuse therapy. When both members are dealing with substance abuse issues, they can attend couples therapy to address their relationship issues as well as become involved in individual interventions to address specific issues related to substance abuse.
Inpatient or Residential Treatment for Couples
When both members of the relationship are struggling with substance abuse issues, being involved in a joint inpatient or residential program is possible.
Different treatment centers will have different arrangements, but typically, most treatment programs begin with the partners attending medically assisted detox (withdrawal management) separately before they attend treatment together.
While some programs may allow married couples to share the same room during their joint treatment, many suggest that the couple sleeps in separate quarters.
Residential or inpatient treatment can vary in length, lasting from 30 days to six months or longer; however, most couples who enter residential treatment programs together typically opt for shorter residential stays. Nonetheless, sources like the National Institute on Drug Abuse (NIDA) suggest that a minimum of a 30-day stay in a residential program should be the goal.
Large research studies, particularly meta-analyses, have established the effectiveness of couples therapy for many different types of issues, including substance abuse. There is much less research investigating the effectiveness of treating couples together in residential therapy, although many of the same principles apply.
Couples would be addressed as a unit, and each partner would also be addressed individually in the treatment process.
Issues That Might Rule Out Couples Therapy
Many people are under the mistaken impression that simply going to therapy sessions will resolve their issues. This is not the truth. Therapy requires work and commitment.
Several different conditions can often be used to rule out couples therapy for individuals with substance abuse problems. Residential couples therapy may not be a good option if:
- The treatment provider does not believe the specific issues with the couple can be effectively addressed in couples treatment. This decision is usually made after a thorough assessment of the presenting problems.
- One or both of the members of the couple are not committed to attempting to save the relationship.
- Only one member is interested in addressing their issues with substance use and abuse.
- One or both members of the couple have ongoing issues with infidelity and continue this practice during treatment.
- One or both members are not willing to disclose and discuss their issues when the other person is present.
- There is significant aggression or violence in the relationship. These issues are often better addressed on an outpatient basis where the partners can be separated, but this will depend on the particular facility.
Codependence
The term codependence is not an actual clinical term. It is used to describe a particular type of relationship where one of the partners enables or fosters a particular type of behavior, such as substance abuse, in the other, and the relationship is focused on this interaction. Couples therapy may be one of the best interventions for addressing issues with codependency.
The decision to put married partners who are suspected of having codependency issues together in a residential program depends on the facility.
The Approach
The majority of interventions aimed at treating couples are based on cognitive-behavioral principles, although any particular therapeutic paradigm can be used.
Many benefits to treating couples together can include:
- The development of a deeper understanding of their partner
- Understanding how individual and relationship issues affect one’s use of drugs or alcohol
- Learning how to address issues without using drugs or alcohol
- Learning how to resolve conflict in a manner that is positive and healthy for both the individual and the relationship
- Understanding how to express needs without being controlling or offensive
- Learning how to express needs, concerns, and other issues without engaging in resentment
- Developing more positive and effective communication skills
- Strengthening the notion of working together as a team, including addressing issues with substance abuse
- Increasing trust and honesty in the relationship
Finding Treatment Aimed at Couples
There are therapists and treatment centers that specialize in treating couples. Often, it is more productive for couples interested in attending treatment for substance abuse together to approach these options first.
The potential treatment providers will perform a thorough assessment of the couple and each person individually. Then, they will discuss how couples therapy can help, discuss potential drawbacks based on the assessment, and let the couple decide whether or not to enter treatment together.
When married couples enter treatment jointly, even in a residential unit, they also become involved in individual treatment.
Different Therapists for Different Situations
Typically, the therapist who treats the couple does not treat the members individually. Different therapists should be able to communicate with one another freely, and each partner should consent to allow the different therapists to freely discuss their experiences in treatment with one another.
