Once considered taboo, rehab programs for couples are now being offered at some drug treatment facilities. Proponents say the approach can provide that extra nudge some people need to seek treatment and that going through therapy together improves long-term sobriety — but the technique can also backfire.
While it’s quite common for a couple to share an addiction to drugs or alcohol, treatment for substance use disorders has traditionally been offered on an individual basis. But that’s starting to change.
Amid a growing drug epidemic that’s affected 23.5 million Americans, some treatment centers have begun offering recovery programs for couples.
Couples-based programs can seem like an enticing option when two people in a committed relationship decide to seek treatment. For many, the decision to enter rehab can feel scary and overwhelming, and it can be comforting to go through the process with their partner. If someone is struggling with the idea of being separated from their spouse or significant other during treatment, couples rehab may also provide that extra nudge they need to enter rehab.
Most rehab programs for couples are modeled after a treatment approach known as behavioral couples therapy or a variation called integrated behavioral couples therapy. Since, according to a study published in the journal Addiction Science & Clinical Practice, substance abuse and marital problems can “generate a destructive cycle in which each induces the other,” BCT and IBCT focus on “restructuring the dysfunctional couple interactions” to support sobriety. This includes learning what each other’s triggers are and working to avoid them.
It also means learning how to spend high-quality time together that doesn’t revolve around drinking or drugs and planning recreational and leisure activities that the couple might have abandoned because of strained relationships or embarrassing moments brought about by their substance abuse.
Living arrangements and the other mechanics of couples rehab can differ from one treatment center to the next, but most programs begin with each partner going through detox alone before moving into counseling together. While some inpatient facilities allow a couple to share a room during treatment, others require separate sleeping quarters. Couples rehab can also occur through an outpatient setting or with one partner as an inpatient and the other participating as an outpatient.
Treatment can last from 30 days to nine months, depending on the individuals and the program, but couples can expect to attend between 12 and 20 outpatient sessions over a three-to-six month period during BCT.
Couples rehab usually involves a mix of individual and joint counseling as well as group therapy. An important component of BCT involves the establishment of “recovery contracts.” These are promises each partner makes to the other not to drink alcohol or use drugs and to support each other’s sobriety, in the same “one-day-at-a-time” tradition that most 12-step programs employ.
While research has shown that couples-based therapy results in greater abstinence, happier relationships and fewer separations than individual treatment, most of those studies have focused on relationships where only one partner has a drug or alcohol addiction Fewer studies have addressed the effectiveness of BCT in couples where both partners are suffering from a drug or alcohol addiction.
More research into this area is needed.
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For all its promise, BCT is not advised in certain situations. Behavioral couples therapy should not be tried in relationships with a recent history of severe physical aggression. In those situations, a better course of action is referring the physically abusive partner to treatment for domestic violence while the other partner enters treatment for addiction.
Other types of unhealthy relationship dynamics can hinder recovery when couples go through rehab together. Codependent couples, for instance, may find it difficult to seek treatment together. Fearing the reaction of their mate, a more passive partner in a codependent relationship may find difficult to speak freely to their providers. Or they may be become too focused on their partner’s recovery and not their own.
Behavioral couples therapy should not be tried in relationships with a recent history of severe physical aggression.
Another major concern is whether a relapse by one partner might trigger the other partner to slip. Because the risk of relapse is highest during the stabilization period, it’s vitally important for the patient to be in a drug-free environment. So if one partner is not as fully committed to sobriety, it may harm them both.
Also because recovery is a highly individualized process, even if two individuals begin their journey to sobriety in unison, they may end up out of sync through the various stages of recovery. A partner moving more slowly than their mate may end up feeling a sense of failure. Likewise, one member of a couple who is progressing faster may end up feeling bogged down or resentful toward a spouse or partner who is struggling.
For these and other reasons, many rehab experts still recommend separate courses of treatment for couples beginning their recovery journey.