Recovery from addiction can change the shape of a relationship. Routines shift, social plans look different, spending can change, and some of the patterns that held the household together may no longer apply.
Both partners are adjusting at the same time, often without a shared plan. For example, one may start checking in more about the other’s plans or schedule. The other may pull back. These patterns are common in early recovery, and clients may respond to structured support. Couples therapy gives partners a place to work through that adjustment together.
Why the Relationship Changes When the Substance Use Stops
When a person stops using a substance, they’ll often avoid many of the familiar structures tied to their use. The Substance Abuse and Mental Health Services Administration (SAMHSA) describes how recovery involves replacing the activities, beliefs, people, and things tied to substance use with new associations. It also notes that the more of a person’s needs were met in that old setting, the harder it is to leave behind.
For a couple, some of those routines and relationships were shared. Letting go of ones that did not serve the relationship is part of recovery, but it can change how the household runs day to day.
Researchers who study couples in substance use treatment have found that relationship stress and substance use can each make the other worse. Stress in the relationship can lead to increased use, and increased use can add stress to the relationship. Couples therapy can help by addressing both sides of that pattern at the same time.
The Difference Between Supporting and Enabling
Support and enabling involve many of the same actions and can be difficult to tell apart. Support tends to help with long-term recovery. Enabling tends to reduce tension in the moment while the substance use continues.
The American Psychological Association (APA) defines enabling as a process in which someone “contributes to continued maladaptive or pathological behavior… in another person.” It also notes that the enabler is typically an intimate partner who “passively permits or unwittingly encourages” the harmful behavior, often while “aware of the destructiveness of the person’s behavior but feels powerless to prevent it.”
Another term important in relationships when one or more partners are in recovery is “codependency.” The APA defines codependency as “a dysfunctional relationship pattern in which an individual is psychologically dependent on (or controlled by) a person who has a substance use or non-substance-related disorder (e.g., alcohol use disorder, gambling disorder).”
Taken together, enabling and codependency can describe a pattern in which both partners can be stuck, not just the one with the substance use disorder.
While not universal, these patterns are common. They are not character judgments, and they may be easier to sort out with a trained counselor in the room. An experienced counselor can help a couple identify which behaviors are supporting recovery and which may be working against it.
What Couples Therapy for Recovery Involves
In couples therapy, one therapist treats both partners at the same time, addressing what each person brings individually as well as what is happening between them. Individual sessions may happen separately early on, though most of the course is spent with both partners in the room.
An effective therapeutic approach in this context is known as behavioral couples therapy (BCT). Much of the research on BCT looks at couples in which one partner has a substance use problem, and the researchers describe the approach as most effective there.
Depending on the type of therapy, early sessions with a counselor may focus on creating what clinicians call a recovery contract. With the therapist guiding it, the couple builds a short daily exchange in which the partner in recovery states they have not used in the past 24 hours and intends to stay abstinent for the next 24, and the other partner acknowledges it.
Under the same contract, neither partner raises past use, or fears about future use, at home between appointments. Those conversations are kept for sessions, where a therapist can help guide them.
The therapist also raises relapse openly as a common, though not inevitable, part of recovery, and one that is treated as something to learn from rather than a failure.
If you or your partner is in crisis, please don’t wait for an appointment. The 988 Suicide & Crisis Lifeline covers alcohol and drug use concerns and takes calls, texts, and chats at any hour. SAMHSA’s National Helpline at 1-800-662-HELP (4357) gives free, confidential referrals around the clock.
What the Research Shows
As described by Fals-Stewart, O’Farrell, and Birchler, BCT isn’t recommended when evidence is present that the relationship is “significantly destructive or harmful to one or both partners.”
For example, if one partner expresses being physically afraid of the other, or if they report an episode of violence causing one of them to need medical attention in the past year. In those cases, partners are instead referred to treatment for domestic violence or individual therapy for substance use disorder.
For couples where BCT is appropriate, the research is encouraging. A meta-analysis in Clinical Psychology Review pooled 12 randomized controlled trials covering 754 participants and found that adding BCT to treatment outperformed individual-based treatment alone. BCT also outperformed individual cognitive behavioral therapy delivered without the couples component.
A more recent review of 12 studies covering 19 randomized controlled trials found the same pattern after treatment and at 12-month follow-up. The strongest improvement was in relationship satisfaction.
Culture, Family, and Recovery
Recovery can be difficult to keep private because plans and behaviors tend to change in ways that people notice. While potentially awkward, this doesn’t have to be seen as a complete negative. SAMHSA, for example, lists community as one of four dimensions that support a life in recovery, which it defines as relationships and social networks that provide support, friendship, love, and hope.
In many families, alcohol has a place in hospitality and celebration, and in some, it has a role in religious observance. Abstinence becomes visible at every gathering, and a couple may find themselves explaining it more often than expected.
In some families, taking a problem outside the household is seen as exposing the family or airing dirty laundry, not as getting help. That view can make it hard for a partner to reach out to a therapist or counselor, even when the support might help.
No community holds a single view on addiction disorders, and early sessions are often spent with the counselor getting to know the client’s background and cultural views. It is fair to ask a prospective therapist openly about how they work with families whose views of help-seeking differ from their own.
Talk With Someone Who Will Work With Both of You
Recovery can bring changes that affect both partners, and those changes may be more easily understood in therapy. An experienced counselor can help both of you figure out what support looks like at your stage of recovery.
At Village Counseling, we work with couples at all stages of recovery. Schedule a session when you are ready, and bring your questions with you.