Treating Functional Alcohol and Drug Abusers in Marriage Counseling

Not all substance use solicits aggressive responses and some couples bring concerns into therapy pertaining to how their partners consumption of alcohol or drugs makes them distant.  People use drugs to feel what they desire, and that could be the craving for more energy, to calm down, or to have a hallucinating experience.  I tell people that if drugs did not work, no one would use them, and they create problems when the user begins to get used by the drug.  The attachment a user develops with a drug begins to mirror a domestically violent relationship.  The user starts to get beat up physically, mentally, and emotionally by the drug but still cannot find the strength to stop using.  Just like the intimate partner who keeps going back or refuses to leave the abusive relationship, drug users find themselves trapped by fear, self-doubt, or low self-worth which keeps them using the substance.

Outside of the use of legally prescribed medications that are properly managed under the care of a physician, who requires routine follow up visits, drug use should be prohibited because our minds, bodies, and lives are constantly changing.  The major disadvantage of self-medicating with illicit drugs is the absence of a trained professional present to regulate and manage the changes in dosages and side effects.  This can lead to overdoses, addiction, and withdraws which in some cases can be lethal depending on the substance of choice.  Alcohol and drugs by themselves are not a problem, the issues come when user begin to display signs and symptoms of substance use, withdraw, or intoxication defined by the Diagnostic and Statistical Manual of Mental Disorders. Known as the DSM, it  is the international manual all mental health providers use to diagnosis both substance abuse and mental health disorders.  The DSM list eleven signs and symptoms that are associated with diagnosing clients with mid, moderate, and severe substance use disorders. Clinicians look for these signs and symptoms when administering comprehensive assessments, which include rendering screenings, questionnaires, and bio-social clinical interviews.  Other factors such as family and health histories, occupation, legal issues, and personality traits also should be considered when determining if one should decide to engage in substances use or remain sober.


How Couples Therapy Helps

Alcohol consumers and drug users are known to be very defensive when approached in any manner that challenges or threatens their continued substance use.  When working with couples who self-report substance use, the first step is to establish a rapport to assist with lowering their defenses. This approach is phase one of a therapeutic method called Motivational Interviewing.  Motivational Interviewing is essentially a conversation that assists with evoking change.  In couples’ therapy, this exchange is usually directed toward one partner who has displayed multiple signs and symptoms of having a substance use disorder.  This therapeutic process is helpful in getting the substance using partner to make changes by identifying how their alcohol or drug use has negatively impacted themselves, their intimate partner, and their family.  It takes time to implement this process and the end goal is to get the identified substance using partner or the couple ready to seek substance abuse treatment.  The time length for getting clients ready to enter treatment varies.

The four intimate relationship losses caused by alcohol and drug use

  1. Loss of Control: The substance using partner’s good decision-making power which allows them to regulate their alcohol and drug use is negated.
  1. Loss of Trust: The substance using partner begins to lie about or underreport their alcohol or substance use to avoid arguments or request from their intimate partner they stop using.
  1. Loss of Existence: The substance using partner feels a need or desire to engage in the use of alcohol or drugs all the time just to feel present or to escape life.
  1. Loss of Safety: The substance using partner becomes physically or verbally aggressive, irritable, or undesirable to be around when under the influence or withdrawing from alcohol and drugs.


Written by Chris A. Matthews