We’re in This Together: Aiming for Success in Recovery and Relationship

Maintaining recovery goals is challenging enough. For those in partnerships with others, the problems often multiply, as relationship issues intensify the issues related to the addiction. A partner’s worries, expectations, desires and frustrations regarding the behavior of the person in recovery (Are they being truthful? Can they be trusted?) can cause so much friction and stress in a relationship that these factors become significant obstacles to the maintenance of sobriety.

A few therapeutic models have emerged that attempt to address this dilemma. Behavioral Couples Therapy (BCT) is a substance abuse treatment approach whereby couples seek treatment together to address not only goals of sobriety and abstinence for the recovering partner, but also how the non-addicted partner can support the recovery efforts.

Components of BCT include a Recovery or Sobriety Contract and psycho-education designed to improve communication between partners. Other important aspects are the use of activities, assignments and homework designed to strengthen positive feelings and cohesiveness between the partners.

… “emotional acceptance” not only reduces the resistance of partners to work on the goals of the person in recovery, it assists both partners in learning to accept behaviors that were previously deemed unacceptable to them.-Rita Milios
Similar to BCT is Integrated Behavioral Couples Therapy (IBCT). Like BCT, IBCT engages couples together and focuses on shared goals and improved communication. But, according to a 2000 study by IBCT innovators, Neil Jacobson, Ph.D., and Andrew Christensen, Ph.D., reported in the Journal of Consulting and Clinical Psychology (Vo. 68; #2), IBCT picks up on an important missing component that BCT does not address. The two researchers stated that “emotional acceptance” not only reduces the resistance of partners to work on the goals of the person in recovery, it assists both partners in learning to accept behaviors that were previously deemed unacceptable to them. Rather than either partner acquiescing and complying with suggested changes because of complaints or pressure from the other, they each become comfortable with the idea that there are things in their relationship (as in any relationship) that may never be reconciled. But they do not allow these irreconcilable differences to prevent them from moving forward with other positive changes.

A meta-analysis of BCT, reported in Clinical Psychology Review (July, 2008), showed that BCT outperformed traditional behavioral therapies used to treat only the recovering partner. Frequency of substance use was reported as showing a “medium effect” (somewhat better); overall improvement over traditional therapies showed a “slightly better than medium effect”; and relative satisfaction of couples studied showed an improvement across the board. About half of the couples achieved the status of “happy” relationships.

Strategies that Work for Couples

So what exactly do BCT and IBCT couples do to make their relationships better, while addressing the needs of the recovering partner? Here are five essential steps for finding success together.

• • Recovery/Abstinence Contract: Couples create a Recovery/Abstinence Contract, starting with a “trust discussion” conducted during a therapy session. They then set guidelines for behaviors of each partner. The recovering partner states his or her intent to refrain from substance use and the other partner expresses his/her support for this effort. Both agree to refrain from discussing concerns regarding past or future slip-ups while at home, and to save such discussions for the next therapy session. The contract spells out exactly what steps the person in recovery will take, and when, to maintain abstinence (ex: coping techniques such as meditation, exercise, self-help group attendance, etc.). Both partners contract to stay focused on the present, not the past. The contract is signed, reviewed and updated at appropriate intervals.

• • Express Feelings Directly: Instead of blaming or avoiding responsibility, couples are encouraged to objectively, but empathetically, express their needs and concerns to one another. Role-playing during therapy sessions (ex: acting out a common dilemma and how each partner would respond) and homework assignments (avoid speaking about past issues; use “I” vs. “you” messages etc.) assist couples in learning these skills.

• • Negotiation Strategies: Couples are taught how to negotiate, rather than demand, change. Vague, unclear communication is replaced with specific negotiating strategies (If you agree to… I will agree to…).

• • Maintenance/Continued Recovery Plan: Once initial goals are met, couples review their contract, and update or change items as needed to address goals for long-term recovery. This contract also addresses specifically how any possible relapses will be dealt with. Then, should a relapse occur, the focus can be on working the contract and returning to compliance, rather than discussions of disappointment and unmet expectations, which are counterproductive to the end goal.

• Implications: Both BCT and IBCT have excellent real-world strategies that help increase the likelihood of successful recovery. Ironically, these approaches are less often used in substance abuse programs than might be expected (most programs focus on individual treatment). Researchers speculate that this may be because the therapies are fairly new and not well publicized. With increased exposure, it could be possible that they will be implemented more often as part of substance abuse programs.

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