If you work with couples, you’ve likely heard stories of problematic substance use affecting the relationship. Historically, mental health professionals have dealt with this by separating the treatment for each member of the couple. Typically, the partner struggling with use will go to a program or individual counseling, while the other partner is encouraged to attend a support group or work on some version of codependency through individual counseling of their own.
While these treatment options have merit, they fail to address the couple ecosystem in its entirety. Instead of a sole focus on individual treatment, I would like to share the value of adding a couples treatment plan for a more comprehensive approach to recovery.
Support relationships are a critical part of recovery work. When we don’t treat the couple as a couple, and instead move forward with individual treatment for each partner, we may inadvertently overlook children, schedules, and partner communication styles and dynamics—which negatively impacts their ability to support each other. While we can recognize that the severity of substance use will impact the efficacy of couples work, it’s also true that if the couple is willing, we have the opportunity to help them structure healthy support for each other.
Creating Connection in Difficulty
I’ve treated several couples where the individual struggling with substance use does residential or intensive treatment—only to transition home without agreed-upon tools to use in their primary relationship. Think about all the groups they may have attended where members learned how to communicate, set boundaries, develop relapse plans, and support one another. Perhaps the individual did well in treatment only to return home to a system that has not similarly agreed to these rules of engagement. In these types of transitions, we can help couples move toward each other and equip them to navigate issues with more confidence.
The power of a couples treatment plan was best demonstrated for me in a training I attended several years ago led by Dr. Robert Navarra. One of the most influential interventions I witnessed was differentiating the substance use from the person. I love this non-shaming approach to communication: Each partner sits in individual chairs with a third empty chair labeled “substance use,” forming a triangle.
This exercise allies the couple in an objective way against substance use. The couple learns to humanize and empathize in their communication, instead of remaining entrenched in disconnecting and shaming language.
Key Components of Forming a Couples Relapse Plan
In my practice, I work with couples in every stage, from those who notice alcohol has become a sporadic concern to more severe cases, where clients need residential treatment and struggle with physical dependency. While each circumstance varies, setting up a relapse plan for couples can provide structure in the midst of a painful season. When I form a relapse plan with my clients, I have found it helpful to address education, collateral damage, and boundaries.
Both partners need education to effectively communicate. I’ve found it’s even better if it can be done together, with both partners in the same room. Education can be a key component for empathy and connection while a couple navigates conflict and communication.
In these conversations, I talk openly about how relapse can be a part of recovery. Potential relapse is a difficult hurdle for some to discuss, but I believe it’s necessary. I normalize that relapse can occur, and help prepare couples so they can consider how to support each other if and when it does. I address feelings such as shock and anger, and name the likelihood of unhealthy communication and relationship dynamics.
Education ensures both partners are aware of common concerns, including but not limited to the impact of using or abusing substances on the body, and changes that may occur with substance use dependency. It’s also important to discuss safety in substance withdrawal, and problem-solving tendencies during substance use and abuse.
When both partners have the same information and understanding of the concern at hand, they can move forward in better support of each other.
2. Collateral Damage
In my experience, a couple is quickly able to identify traumatizing events or feelings that have occurred as a result of use—otherwise known as collateral damage. I’ve found it helpful to review some of these events together so we can advocate for healthier boundaries and motivate participation.
Sometimes in relapse plans, couples need a healthy way to take a break from substance episodes. Many need this space to learn how to manage and take care of themselves. I believe couple-oriented relapse plans can address these breaks with respect for each partner and with an appreciation of limitations.
When you’re setting up relapse plans with your clients, you can ask these questions to help each partner feel supported and cared for:
- Is there a safe amount of substance use tolerated in the relationship? What is it?
- Has the couple had a conversation about what they do when substance use is occurring?
- Is the couple aware of the severity of substance use, considering the brain and body?
- Does each partner know how to set and communicate a boundary calmly?
- Is collateral damage occurring during use episodes? Where/when is harm occurring?
- Would temporary separation help relieve some of the stress and collateral damage incurred during an episode of use?
- Are there support people outside of the primary relationship for help if needed during a temporary separation?
Once they have the education and awareness of collateral damage, couples are able to identify areas that are in need of boundaries. In any relapse plan, we assess and make alternative plans for safety concerns. Once safety concerns are addressed, we build a plan collaboratively with the couple and prepare for actions we intend to take if boundaries are crossed.
Some couples are at the point where they just assume they will permanently separate or divorce due to substance-use conflict and the ensuing dynamics. They’re exhausted, discouraged, and often past their breaking point. My focus becomes helping them bring down this anxious ecosystem by highlighting options and ways to reduce harm through healthier boundaries.
Many couples get caught up in arguments when substance use is underway. Understandably, it may be easier to feel angry and communicate aggressively when a partner is under the influence than it is to feel sadness and communicate vulnerably when sober. As clinicians, we want to highlight for couples that it’s unlikely they’ll get their needs met or their emotions and requests heard when their partner is under the influence. We can do this by emphasizing the education about brain functioning, as mentioned before.
Creating physical space can also help couples have a different experience during use. While temporary separation isn’t necessarily a long term solution, it can function to help the couple observe boundaries and any resistance there may be to setting them. I’ve had several couples where separate bedrooms for the evening is enough space to reduce tension and take time for perspective. For others, there’s a need for more space to mitigate unhealthy habits.
If temporary space is part of a couple’s plan, it’s imperative that this is discussed fully before action is taken. Without properly addressing the goal for temporary separation, feelings of abandonment can occur. With this in mind, I prioritize practicing communication several times with the couple before they take action.
I reinforce that boundaries are a protective measure from collateral damage and a way we might preserve relationships. We practice “‘I’ statements,” an agreed upon safe place for both partners, and a plan for reuniting. Many times I’ve found it helpful for couples to have a plan in place for safe and confidential support individuals to fill in when a temporary separation is in place.
We want couples to understand that without a plan, collateral damage continues to build, exhausting the couple and leaving them less and less willing to reconcile or see each other in humane ways. Even if the couple is not ready to take action on boundaries, the process of talking through relapse plans can be incredibly beneficial in validating pain the couple has experienced and helping them gain insight on cyclical patterns.
While I don’t dismiss the value of individual treatment with substance issues, I believe a couples treatment plan advocates for a more comprehensive approach. We have the opportunity to advocate for couples and help them support each other when substance use is invading. By incorporating these plans, we can set foundations of healthy communication, imagine reprieves from exhaustion, and chart more hopeful strategies forward.