Historically, substance abuse treatment providers and the general public have seen alcoholism and other substance use disorders (SUDs) as problems for the individual. Therefore, they are treated most effectively on an individual basis. But during the last thirty years, professionals and the public have begun to recognize family members’ important roles in the beginnings and maintenance of an addiction.

The Role of Couples Counseling for Addiction

Behavioral couples therapy (BCT) is a treatment approach for married or drug users who live together. The goal is to directly reduce substance abuse and restructure the defective interactions between the couple that help keep it going. Several studies have shown that patients who take part in BCT have regularly reported bigger reductions in substance use than patients who only receive individual counseling.

Couples who receive BCT also report higher levels of relationship satisfaction and more improvements in other parts of the relationship and family functioning including:

  • Intimate partner violence
  • Children’s behavior and social adjustment

History of Marriage and Addiction Counseling

Early in the 1970s, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) described couples and family therapy as “one of the most outstanding current advances in the area of psychotherapy of alcoholism.” They then called for controlled studies to test how effective family-based treatments were.

Many studies were done and their results concluded that both alcoholism and drug abuse treatments that involve family result in higher levels of abstinence. This is in comparison to treatment that focuses only on the substance-abusing patient.

3 Strategies for Couples Counseling

Three treatment strategies have come to prevail in family-based ideas of substance abuse. These have provided the foundation for the techniques most often used with people with substance use disorder.

  1. The Family Disease Approach: This is the best-known approach. It views alcoholism and other drug abuse as family illnesses that are suffered by the family, not just the substance user. The treatment consists of encouraging the patient and family members to focus on their process through the disease individually. Formal family treatment is not emphasized.
  2. The Family Systems Approach: The second most used model. It focuses particular attention on the ways that family interactions become organized around drug and alcohol use. Family therapy based on this approach tries to understand the role of substance use in the way the family system functions. The goal is to change the family tendencies and interactions to end the family’s need for the member to drink or use drugs.
  3. Behavioral Approaches: There is a third set of behavioral approaches that believe that family interactions reinforce alcohol-and-drug using behavior. Therapy in this approach attempts to break this harmful reinforcement and encourages behavior favorable for abstinence.

Who Should Have Behavioral Couples Therapy (BCT)?

Since BCT depends on the power of the couple’s system to encourage abstinence, it is only suitable for couples who are committed to the relationship. Additionally, both partners must have the ability to receive and process new information, complete assignments, and practice new skills. To do this, both partners must have no obvious cognitive weakness or psychosis that would prevent accomplishing their tasks.

Counseling a Dual Addiction Couple

The BCT model expects that the main goal of both partners is abstinence from drugs or alcohol. Therefore, it is most effective when only one partner has SUD. Relationships where both partners abuse substances usually don’t support abstinence. Interestingly, compared to couples where only one partner has a SUD, “dually addicted” couples often report more satisfaction in their relationship, especially when the partners use drugs together.

Trying to confront the substance abuse of only one partner in a dually addicted couple (a most common occurrence) since both don’t usually seek help at the same time, often creates conflicts. Typically, the conflicts are only resolved by ending the relationship or continued drug use by the partner in treatment.

5 Ways Relationship Counseling Helps with Recovery

It has become clear that when one of the partners in a relationship is addicted, both people are affected. Research shows that couples counseling can help with addiction. Occasionally, one or both partners are confused or offended by the suggestion that they should have counseling for relationship issues. They believe that they have stuck together this far, and the addiction should be the focus of therapy. However, there are 5 ways that relationship counseling can lead to the way to recovery from a SUD:

  1. Recognizing that Partners Need Support

    • Problems in a relationship often take a back seat when the couple focuses specifically on addiction. Support groups can help, but counseling for relationship problems helps partners discover new sources of support and coach couples in how to become more supportive of each other.
  2. Enabling is a Relationship Problem

    • Addiction is often a relationship problem. The partner who isn’t addicted may accidentally enable the addiction. As already mentioned, if both partners are addicted, it may be more difficult for either partner to quit.
    • The things the partner does that allow the addiction to go one, sometimes without even meaning to, are considered enabling behaviors. Things such as covering up, cleaning up messes, lending money, and handling the addict’s responsibilities to mention a few. Relationship counseling can help both partners become aware of the enabling behaviors and break the patterns.
  3. Working Through Emotional Issues

    • Many events in life are emotionally troubling which can be exaggerated by addiction. Some issues such as the death of a parent and other loved ones may be more stressful if the person who died was abusive or had an addiction.
    • Pregnancy, loss of a pregnancy, or becoming parents require a lot of adjustments emotionally. When there are relationship problems between a couple, the addict might focus on ways to cope which could reinforce the addiction. Then the other partner may focus on the addict being the problem, rather than recognizing the problems in the relationship.
    • Counseling can help people work out the emotional issues that come from their relationship problems in healthy ways. In comparison to the addicted partner attempting to use their addictive behavior to cope, leaving the other partner isolated and without support.
  4. Recognizing and Solving Problems that Come from the Addiction

    • Relationship counseling can also help identify and solve problems related to addiction. Problems that stem from the addiction include:
      • Legal problems
      • Financial problems
      • Health problems
    • Although they may deny having relationship problems, relationship counseling can help fix the problems that they will admit to.
  5. Fixing and Resolving Relationship Problems

    • The most important help that couples counseling for relationship issues can give a couple affected by addiction is linked to repairing and resolving damage to the relationship. Even though they have a hard time admitting to relationship problems, the greatest healing can come from a couple working through their relationship problems together. This comes from facing patterns of:
      • lies and secrecy
      • admitting to past or current affairs
      • seeking or granting forgiveness
      • ending patterns of abuse.

When Addiction is Harming the Relationship

There are some signs that drug or alcohol use by a partner is harming the relationship to the extent that professional help may be needed. Common danger signs that when a partner has a SUD include:

  • Arguments about drinking or drug use
  • Fighting about money problems, staying out late, not taking care of responsibilities at home, etc.
  • Having to “cover” for a partner who has been drinking or using drugs. Making excuses for them.
  • Partner saying that he or she abuses substances to reduce tension or stress related to the arguments about alcohol or drugs.

Dual Addiction

  • Drinking and drug use is one of the few things the partners like to do together, perhaps the only thing.
  • Periods of domestic violence by either partner when the other has been drinking or using drugs.
  • Discovering that one or both partners need to be drunk or high to show affection or talk about relationship problems.
  • Isolation of the relationship or the whole family from friends and relatives to hide the addiction problem.

Most couples don’t show all of these dangerous signs but if even one is present in your marriage or relationship, it means you should reevaluate your situation. It’s likely time to think about making it better. Drinking and drug use will need to stop and the problems will need to be identified and discussed.

When Your Partner is Actively Addicted

If your partner is actively addicted and won’t get help, the reality is that couples therapy won’t help until his or her addiction is addressed. Addiction affects a person’s thinking and processing abilities and creates negative behaviors that can cause extreme damage to a marriage and family life.

In most cases, when personal or relationship issues need professional attention and there is an active addiction, the addictive behavior needs to be handled first. Then, other issues can be worked on. Until your partner’s mind clears up enough to think reasonably, couples therapy would probably distract from their recovery.

How Addiction Hurts the Family

People who suffer from addiction don’t typically see the damage and hurt that they are causing others. The whole family is affected.


Drug and alcohol use costs money. The people that sell it aren’t in business to make you happy. They are in it for the money. How does it hurt financially?

  • You may steal money, credit cards, or valuable items
  • You may lose your job and have to sell items to support the family
  • You may have to use college and retirement accounts to purchase substances
  • You may have to mortgage your house to raise money for treatment

Family Relationships Suffer

When you are addicted it affects the family because:

  • Family members can’t count on you to fulfill your commitments to them
  • You may have mood swings, paranoia, and unreasonable anger
  • You may physically or verbally assault family members
  • You don’t spend time with family and do things you used to do together
  • The stability of the household is upset
  • Family members often feel lonely, frustrated, ashamed, or guilty

How Addiction Affects Children

Addiction creates an unstable family environment because:

  • Parents may not be able to parent the way they should or
  • Parents may not be able to provide necessities like proper food and clothing
  • Children may not be taught basic life skills
  • Children may feel insecure and unloved
  • Some children feel that substance abuse is their fault
  • Children may begin to take on adult responsibilities that aren’t appropriate for their age
  • Children are more likely to skip school
  • Children are more likely to have anti-social behaviors or other unhealthy behaviors
  • Children of addiction are more likely to experience domestic violence and other trauma

Where to Get Couples Counseling for Substance Abuse

At Unity Behavioral Health, we believe the family is a major part of a person’s life. That’s why we encourage family therapy in all of our treatment options. If you or your family member has an addiction to a substance or an alcohol use disorder, Unity can address your needs and those of your family or partner.

How Unity Can Help

The member of the relationship with the addiction may need a medically supervised detox before counseling. This will prepare his or her mind to undertake the real work of counseling. Contact us now. We have treatment programs including online counseling options to help you put your relationship and family back on the right track. Let us help you before it’s too late.







Get Help Now

Speak to one of our experienced and caring representatives at Unity Behavioral Health to learn about how our rehab programs can help your loved one defeat addiction.


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