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Couples Therapy for Opiate Dependence

Approaching opiate dependence as a couple
Approaching opiate dependence as a couple

There are many people who walk down the road toward opiate dependence accompanied by a surprising companion: their significant other. Actually, it should come as no surprise that many people share addiction issues with a partner, because it’s human nature to associate with people who have social habits similar to ours. So if you like to use drugs or alcohol, it’s likely you have a partner who enjoys partying as well. But what about when you both find yourselves addicted?

If both people who make up a couple have addiction issues, they should without doubt both seek out the help they need to achieve recovery. Opiate dependence—or any addiction—has historically been regarded and treated as an individual problem. However, over the last decade, there is greater recognition of the increasing role of family members as they affect addictive behaviors. Unrelated research on relationship stability indicates that people in stable relationships have a greater likelihood of achieving long-term recovery. Nevertheless, you are two separate people, and your addiction issues quite likely are different.

Most couples share their struggles and their successes. It’s not like that for couples who are addicted. The partners will avoid discussing issues related to the addiction. They may be ambivalent about one another’s success in various areas, including recovery. The how and when of getting their next fix takes priority over the decisions that couples normally make—such as where and when to go places or how to spend money. Both halves of the couple will experience feelings of betrayal, anger, and mistrust. Communication suffers. Within the relationship, each person feels lonely and isolated.

The trick is to realize that working on opiate dependence will not automatically improve a relationship. Most people fail to realize that the primary relationship for a person who is addicted is not their romantic partner but their drug of choice. You may be shaking your head in denial, but consider that you haven’t been able to stop using no matter what the consequences have been.

When Addiction Evolves From the Relationship

Despite the mention above of people who gravitate toward one another because they both use drugs, there are many cases in which one partner leads the other toward addiction. Maybe you’re like the young man who becomes addicted to heroin and talks his girlfriend into prostitution in order to pay for his habit, and then he makes matters worse by introducing her to the drug. Maybe you’re the woman who fears she is losing her man, and she joins in his use of opiates because she believes it will cement their relationship. Before long, she is just as addicted as he is.

Regardless of how you became a couple, there are certain unavoidable facts that researchers have proven. Couples who develop a drug addiction, including opiate dependence, separate or get divorced four times more often than non-using couples. If one partner gets treatment and the other one does not, the chance of relapse is much greater for the person seeking help.

Going Into Opiate Dependence Treatment Together

Don’t despair about your chances of success as a couple, and don’t assume that you can only succeed if you go into treatment together. If you seek treatment for opiate dependence, you will most likely be assigned to different counselors even though you’re both attending the same opiate treatment program. Your counselors will work with you individually to help you build your recovery support network and sustain recovery, and they will also help you work on strengthening your relationship with your partner. If you go to a clinic where the same counselor sees both of you, you will each be assigned to different group sessions and you will be asked to attend different 12-step groups. At yet other places, you may see individual therapists for opiate dependence several times a week and then go to couple’s counseling once every week or two with a shared couple’s therapist.

Individual vs. Couple’s Counseling

The primary reason why each of you should have individual counseling without the other is for the discussion of issues that led to your opiate dependence in the first place. When you first met and became a couple, you each brought into the relationship your individual past histories and experiences. Working on those issues plus addressing other issues that your addiction has caused can best be accomplished when each of you meets privately with the therapist so that you speak openly and honestly, knowing that your privacy will be respected.

Even if your relationship dynamics brought one of you to drug use, it’s important to recognize those dynamics. If one of you is codependent upon the other, that also should be addressed. You will both come to recognize that poor communication and problem-solving skills that develop with opiate dependence affect how you interact as a couple.

Many counselors who conduct behavioral couple’s therapy involving alcohol, drug, or opiate dependence ask the partners in the relationship to create a contract to not use drugs and to visit that contract on a daily basis. Each day, you should tell one another—you should verbally express to one another—that you will not use drugs that day. The counselor may even develop a written contract to use as a checklist. Besides reaffirming your sobriety, you can pledge to go to a 12-step group. You can promise not to accuse one another of relapse or even thinking of relapse. You can promise that you won’t bring up past use and throw it in each other’s face. If you are both taking methadone or buprenorphine for opiate dependence, it’s important to pledge that you will not share medication with one another. You can agree to take weekly drug urine screens and share the results with one another.

It’s okay, however, if you confess to urges in your weekly or biweekly sessions. While neither of you can take responsibility for the other person’s recovery, you can still be a part of one another’s support network. If you are aware that your partner may relapse, for example, you might be more understanding of moodiness or other emotional indicators.

When Couple’s Counseling Is a Bad Idea

Not every couple should go into behavioral couple’s therapy for a substance use disorder including opiate dependence. Most counselors will not engage you as a couple if there is domestic violence between you or if one of you fears the other. If one of you suffers from a severe co-occurring mental or emotional disorder, you should be treated separately. You both must accept that you cannot cure your addiction by working on your relationship, and vice versa.

If you want to go into opiate dependence treatment with your partner, be honest when you go to your neighborhood methadone or buprenorphine program. You may not be able to call the shots on getting the same counselor or even who gets which counselor, but you will not be turned away. The ultimate goal will be to take a journey down a path that will improve your relationship, and at the same time take a lifelong journey along the road to recovery.

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