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Couples Therapy

Couples therapy can help people in a relationship where one or both partners have a substance use disorder. Rebuilding trust and working on communication are often major focuses during therapy with a licensed marriage or family therapist.

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Couples Therapy for a Substance Use Disorder

Addiction doesn’t just impact the individual; it effects their family, friends, co-workers, and perhaps more than anyone, their spouses. Whether couples are married, cohabiting, or just in a relationship, if one or both persons in the relationship have a substance use disorder it can be destructive to both parties and make it impossible to have a healthy, supportive partnership. Even if the addicted partner has sought treatment and is maintaining their sobriety, it does not take away the pain inflicted on the other partner throughout the relationship. Trust must be rebuilt and both people in the relationship need to realize their shortcomings and work to overcome them together. This can be difficult without guidance. Attending couples therapy can help both partners see eye to eye and work towards rebuilding a loving relationship.

What is Couples Therapy?

Couples therapy is a type of psychotherapy that aims to recognize and resolve conflicts in an intimate relationship. It is often also referred to as marriage counseling, but the partners do not need to be married to receive this therapy. Licensed marriage and family therapists help the couple to understand each other, work on open communication, and solve the problems in the relationship. Some couples seek therapy before marriage or to simply iron out small issues, and the timeline of therapy is meant to be short-term. For more serious issues in the relationship, like substance abuse or infidelity, it may take longer depending on the couple. Sometimes, one partner will choose to seek additional counseling privately.

One benefit of working with a licensed therapist is creating a space to express your emotions and frustrations with your partner. If conversations typically turn into loud arguments, the therapist can act as a referee so that both parties can have their thoughts and feelings heard. Couples therapy may provide a couple with homework, such as communication exercises, and tools to help them in the long-term. It’s important to remember that to make a relationship work, both partners must put in effort. In some cases, couples therapy may help 2 people realize that ending the relationship is the wisest option, and they can work on doing that in the best way possible especially if finances are linked and children are involved.

Navigating a relationship where addiction is present can tear otherwise strong couples apart. Fortunately, couples therapy has been shown to have positive results for people struggling with a drug or alcohol problem. Multiple studies published by the National Institutes of Health found that people who engaged in behavioral couples therapy (BCT) had greater reductions in substance use than those who only received individual counseling. They also had improvements in intimate partner violence and children’s psychosocial adjustment.

Couples receiving BCT also have reported higher levels of relationship satisfaction and more improvements in other areas of relationship and family functioning.

There are a few situations in which couples’ therapy is not appropriate. If there is a court-ordered restraining order for spouses to not contact each other, they should not see each other in therapy until the order is lifted. Also, couples are excluded if there has been severe domestic violence in the past 2 years or if one or both persons are afraid that therapy will result in violence. Severe domestic violence is defined as an injury requiring medical attention or hospitalization. Anyone in a domestic violence situation should not put themselves at risk and contact The National Domestic Violence Hotline.

Overall, research on behavioral couples therapy has demonstrated that this practice produces greater abstinence from drugs or alcohol, and better relationship functioning. When beginning treatment, it may be necessary to meet with multiple licensed therapists to find someone that is the right fit for the couple. It is important to note that couples therapy may not be effective if one person is still abusing drugs or alcohol. Some programs will not start therapy until addicted partners have completed 90 days of sobriety. However, it is still possible to begin therapy in other programs while still struggling with a substance use disorder. The intention to quit using is vital for successful therapy sessions.

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How Does Addiction Impact Intimate Relationships?

If one or both partners are abusing drugs or alcohol in a relationship, it can cause a long list of serious issues. Couples may experience financial problems if one person is spending money on their addiction or is unable to hold a job, causing stress on the other partner. They often experience poor communication, a lack of trust, and patterns of codependency. There is also an increased risk for verbal abuse and physical violence. Substance abuse co-occurs in 40% to 60% of intimate partner violence, and a parent with a drug or alcohol problem is 3 times more likely to abuse their child. Addiction can also impact sexual functioning, resulting in one or both partners feeling unsatisfied or unloved.

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Addiction and Sex Life

Drug and alcohol abuse negatively affect physical health and are likely to have a negative effect on sexual functioning. Men who are dependent on alcohol have a 60% to 70% chance of suffering from sexual problems, such as loss of sexual desire, erectile dysfunction, and premature ejaculation. Even short-term heavy alcohol use can cause temporary erectile dysfunction. Researchers have found that heavy alcohol use can have permanent effects on a man’s sexual health, even after long abstinence periods. While some cocaine users feel an increased sexual desire during drug use, cocaine use has been found to decrease sexual pleasure in the long term. A study from the University of Granada in Spain found that the sexual functioning of men who abused cocaine, heroin, alcohol, and marijuana was impaired by all drugs. The 2 areas that were most significantly impaired were pleasure and orgasm.

Not only is sexual functioning impacted by substance abuse, so is the emotional bond between partners that leads to feelings of closeness and desire. Feelings of resentment may interfere with the attraction that one partner previously felt for the other. Couples therapy may help resolve these negative feelings and help couples regain the intimacy that their relationship once had.

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Addiction and Infidelity

While abusing drugs or alcohol does not necessarily mean that a person will be in unfaithful to their partner, it increases the risk of them being in a vulnerable position and not making rational decisions. Alcohol impairs judgment and lowers inhibitions, potentially causing someone to step outside of their marriage or relationship when they would not do so sober. However, infidelity often stems from a deeper-rooted issue and someone with a drug or alcohol problem may use their addiction as an excuse to justify the cheating. Infidelity can greatly damage or destroy relationships and it takes time and work to restore the trust. Couples therapy may be able to help couples begin the journey to rebuild a fulfilling and honest relationship.

Infidelity generally comes from the same inner emptiness as alcohol and drug abuse.

- Margaret Paul, PhD

What Do I Do If My Partner Has an Addiction?

It can be difficult to find the line between being supportive to your partner while they struggle with a drug or alcohol problem, without being an enabler. Protecting someone from the consequences of their substance abuse is considered enabling, such as taking over their responsibilities, making excuses for them, and saving them from legal consequences. It may be difficult, but it is important to let them deal with the consequences of their decisions. You can offer support by setting boundaries and helping them seek out treatment options. Al-Anon, Nar-Anon, and Recovering Couples Anonymous are options for the non-addicted partner to find support and others that have dealt with similar issues. After d and treatment, couples therapy can help people get back to a place of love, support, and trust.