Background
Throughout history, alcoholism and drug abuse have been treated on an individual basis. With time, family has become involved with treatment and played an overall crucial role in recovery. Along with this comes the fact that family members may also be influencing the addictive behavior.
Three theoretical approaches have developed since the 1970’s. These approaches include:
1. Family Disease Approach: This approach states that the addiction and illness does not only involve the substance abuser, but also their family members. This is where codependency comes in to play. Both the substance abuser and their families are involved in this treatment process.
2. Family Systems Approach: This approach focuses on the ways that the family is able to balance substance abuse and regular family functioning. Therefore, the clinician is then able to identify who is focused on substance abuse and who is focused on family dynamics. This treatment process focuses on changing the interactions between the family members to therefore remove the need to use substances.
3. Behavioral Approaches: This approach believes that family interactions are reinforcing the substance abuse. During treatment with this approach, the goal is therefore to reduce the reinforcing behaviors and create behaviors that promote abstinence from drugs and alcohol. The most utilized behavioral approach for substance abuse treatment with couples is Behavioral Couple Therapy (BCT). This model was developed in the 1960’s and is continues to be utilized today. This form of therapy focused on antecedents and consequences with couple’s behaviors. Examples of this included relationship rewarding and non-rewarding behaviors.
Defining Alcohol and Drug Use Disorders
Utilizing the DSM-IV, there is two different categories related to the definition of substance use disorders: substance dependence and substance abuse.
1. Substance Dependence: This definition means that the individual continues to use substances despite significant substance related problems. In order to get a diagnosis of substance dependence, the individual must meet at least three of the following criteria:
2. Substance Abuse: This definition means that there is problem use, which could lead to the following:
Theoretical Rationale for Use of Couple Therapy to Treat Substance Use Disorders
There is a very strong connection between substance abuse and dysfunction with couples. Substance use with one partner in a relationship has led to the following problems:
It is also important to recognize that troubled or dysfunctional relationships often lead to other difficulties such as substance use relapse. Substance use and relationship dysfunction however is not a one-way street. This means that the substance use does not necessarily lead to the dysfunction. Therefore, it is viewed more as a “vicious circle,” which means that they play off one another.
The following are precursors to substance use or excessive use:
Overall, substance use tends to bring out emotions and feelings within a family or couple, which are not always positive. This is where it becomes difficult for the individual to remain in recovery, and often leads to relapse.
Factors That May Influence Substance Abuse Recovery, Couple Functioning, and Relationship Longevity
There are numerous factors within a relationship that tend to influence recovery and relationship satisfaction. Below are factors that may reduce possibly success:
It is very important for the therapist to address these risk factors with the client, to ensure that recovery occurs. It is necessary to recommend sober situations for the individuals to participate in, so that they are not triggered or pressured into using substances again. Often times, other referrals are needed to help the function of the relationship, such as to a psychiatrist if there are underlying psychiatric factors.
Client gender can also play a role in treatment for substance abuse within couples. An example of this might be that the woman will delay treatment because of fear of disrupting the family or children. Some women have stated that they use substances to be more alert and assertive, which therefore makes them better wives and mothers. In these situations, it is important to address possible gender roles with the couples as well.
Throughout history, alcoholism and drug abuse have been treated on an individual basis. With time, family has become involved with treatment and played an overall crucial role in recovery. Along with this comes the fact that family members may also be influencing the addictive behavior.
Three theoretical approaches have developed since the 1970’s. These approaches include:
1. Family Disease Approach: This approach states that the addiction and illness does not only involve the substance abuser, but also their family members. This is where codependency comes in to play. Both the substance abuser and their families are involved in this treatment process.
2. Family Systems Approach: This approach focuses on the ways that the family is able to balance substance abuse and regular family functioning. Therefore, the clinician is then able to identify who is focused on substance abuse and who is focused on family dynamics. This treatment process focuses on changing the interactions between the family members to therefore remove the need to use substances.
3. Behavioral Approaches: This approach believes that family interactions are reinforcing the substance abuse. During treatment with this approach, the goal is therefore to reduce the reinforcing behaviors and create behaviors that promote abstinence from drugs and alcohol. The most utilized behavioral approach for substance abuse treatment with couples is Behavioral Couple Therapy (BCT). This model was developed in the 1960’s and is continues to be utilized today. This form of therapy focused on antecedents and consequences with couple’s behaviors. Examples of this included relationship rewarding and non-rewarding behaviors.
Defining Alcohol and Drug Use Disorders
Utilizing the DSM-IV, there is two different categories related to the definition of substance use disorders: substance dependence and substance abuse.
1. Substance Dependence: This definition means that the individual continues to use substances despite significant substance related problems. In order to get a diagnosis of substance dependence, the individual must meet at least three of the following criteria:
- Physical tolerance.
- Withdrawal.
- Unsuccessful attempts to stop or control use.
- Use of larger amounts of substance than intended.
- Loss or reduction in important activities.
- Continued use of the substance despite knowledge of physical or psychological problems.
- Excessive time spent using the substance or recovering from effects.
2. Substance Abuse: This definition means that there is problem use, which could lead to the following:
- Failure to fulfill social obligations.
- Recurrent substance use in situations that creates the potential to harm.
- Recurrent substance-related legal problems.
- Continued substance use despite having social or interpersonal problems.
Theoretical Rationale for Use of Couple Therapy to Treat Substance Use Disorders
There is a very strong connection between substance abuse and dysfunction with couples. Substance use with one partner in a relationship has led to the following problems:
- Relationship dissatisfaction.
- Instability.
- Verbal and physical aggression.
- Sexual problems.
- Psychological distress.
It is also important to recognize that troubled or dysfunctional relationships often lead to other difficulties such as substance use relapse. Substance use and relationship dysfunction however is not a one-way street. This means that the substance use does not necessarily lead to the dysfunction. Therefore, it is viewed more as a “vicious circle,” which means that they play off one another.
The following are precursors to substance use or excessive use:
- Marital and family problems.
- Poor communication.
- Poor problem solving.
- Arguing.
- Financial stressors.
Overall, substance use tends to bring out emotions and feelings within a family or couple, which are not always positive. This is where it becomes difficult for the individual to remain in recovery, and often leads to relapse.
Factors That May Influence Substance Abuse Recovery, Couple Functioning, and Relationship Longevity
There are numerous factors within a relationship that tend to influence recovery and relationship satisfaction. Below are factors that may reduce possibly success:
- The substance abuse is very severe.
- Both partners abuse substances.
- Partner violence
- Psychiatric comorbidity.
- High-risk occupations (prostitution) and/or social interactions.
It is very important for the therapist to address these risk factors with the client, to ensure that recovery occurs. It is necessary to recommend sober situations for the individuals to participate in, so that they are not triggered or pressured into using substances again. Often times, other referrals are needed to help the function of the relationship, such as to a psychiatrist if there are underlying psychiatric factors.
Client gender can also play a role in treatment for substance abuse within couples. An example of this might be that the woman will delay treatment because of fear of disrupting the family or children. Some women have stated that they use substances to be more alert and assertive, which therefore makes them better wives and mothers. In these situations, it is important to address possible gender roles with the couples as well.