Can couples recover together?
TL;DR: Yes!!! I absolutely believe and know this to be true from both my personal and professional observations. However, it can be very hard and difficult for most couples to navigate if one partner prefers to utilize more or less of anything- alcohol, behavioral & substance misuse more than the other partner. The Gottman Method Couples Therapy incorporates Dr. Robert Navarra’s research and model of Couples and Addiction Recovery. I have personally and professionally loved his Roadmap for the Journey workshop for couples and the Couples and Addiction Recovery training for professionals- both have been so helpful for my own personal experience with addiction and helping clients heal better together.
After working inpatient hospital with children, adolescents, and their families in the beginning of my career, I noticed that 80% of my individual and couple clients had an issue or concern about alcohol or substances, and I wanted to help more. That’s when I decided to take on an additional CAADAC certification training on Saturdays at MHS, INC. to learn more about addiction- both substance, alcohol, and behavioral, and engaged in a 2 year clinical practicum to explore individual, couples, and groups providing support for those in the throws of addiction. The surprise for me was that once I learned that addictions are treatable, that was the start of a new journey in the addictions treatment field that I initially had no interest in but came to develop a passion for. I co-lead groups and engaged in regular psychotherapy services to build motivational interviewing and precontemplation stages for individuals considering letting go of opioids.
Couple Recovery, is something that is often confused in our own profession, is contradictory to some theorists. Couples and Addiction Recovery is to “help couples develop a Couple Recovery through increasing communication and understanding, establishing appropriate boundaries, and healing from the impact of addiction and recovery.” Most treatment programs separate couples from each other, remove them from their environment even, and groups a partner with their gender when they enter treatment, typically discouraging couples from addressing relationship concerns or issues together. The thought is to help individuals focus on themselves and their recovery program and to strengthen appropriate boundaries by postponing attention to the couple or family relationships until individual recoveries are well established. This is how I was trained initially, so when I started working with couples and saw how many were impacted by a partner’s excessive misuse, that was when I decided to explore Dr. Navarro’s Couples and Addiction Recovery model with couples.
However, it turns out that there isn’t any empirical support for this widely held belief- which is why insurance companies do not appropriately compensate for couples and family therapy as much as individual therapy. In fact, research supports exactly the opposite and to include the partner early in the treatment process. Couple recovery begins with emphasizing the importance of establishing individual recovery, or self-care, but we don’t assume that individual care and relationship care are mutually exclusive. By addressing relationship care in the context of individual self-care, we are building recovery into the relationship. Simply said, couple recovery addresses three recoveries concurrently: each partner’s recovery and relationship recovery. Family recovery is another component to consider as many couples are parents and caregivers. Beginning recovery is often traumatic for individuals and, as the couple relationship enters a new and unknown territory, we are abandoning couples at a time when they need support the most, at the start of recovery.
Can Couple therapy improve the Couple’s ability to Recover?
It is often stated that addiction is a “family disease.” If we play out what that really means, then it makes perfect sense to include the partner and the family in treatment, anyone who is in the family. Sometimes people assume that recovery means not using the substance anymore or stopping the compulsive behavior. Couple recovery takes into account much more than abstinence from the addictive behavior and includes addressing issues left unsaid during the active addiction, talking about the impact of recovery, and developing a roadmap for going forward with couple and family recovery integrated into family life. We also know that a satisfying couple relationship is the single biggest predictor of successful long-term recovery. Families can create a legacy of recovery; a study that found that a family member with an alcohol use disorder is three times more likely to get into treatment when a first-degree relative is already in alcohol recovery.
Dr. Robert Navarro’s Systemic Addiction Treatment in Couple and Family Therapy, discovered that studies on the couple relationship in alcoholism treatment dates back to the 1930s, three decades prior to the evolution of the systemic family therapy models that emerged in the 1960s first highlighting addressing couple and family issues in addictions treatment. Per his research, there IS a direct reciprocal relationship between the family’s impact on the member with an addictive disorder and vice versa. Systemic approaches are designed to help couples and families move and transition from an “addicted system,” to a “recovering couple system” which accounts for both parties. Core goals in a systems approach include addressing communication patterns, roles, rules, boundaries, problem-solving, and managing the impact of addiction and of recovery. Blending Gottman Method Couples Therapy with Dr. Navarro’s Couple Recovery Development Approach, we have what we believe to be a research-based, state of the art approach in a relational approach to addiction recovery, which is why I love to use it! It works and helps clients actually heal together, while maintaining their recovery.
Every couple I work with goes through the same assessment that Gottman Method Couples Therapy uses, but beyond that, I include 15 assessment tools to screen for alcohol or other substance use problems, sexual addiction, gambling addiction, and a model for screening for addictions of all kinds. A particularly effective alcohol screen that we cover is called the AUDIT, which evaluates and differentiates problematic alcohol use from alcohol use disorder. Another adaptation of a Gottman intervention is in the Recovery and Compromise Ovals Intervention. Like the Gottman compromise intervention, this intervention includes a decision-making process that helps partners to figure out areas of inflexibility, areas of flexibility, and adds a third circle, core recovery needs as another layer of decision making. Addiction IS rooted in isolation, therefore rituals of connection are very important for couples in recovery.Your partner is your friend, they are telling you their perspective in hopes to be closer to you.
How do Rituals of Connection help to prevent relapse for someone who is recovering from an addiction? And how do those rituals help the couple recovery overall? It is crucial for all couples to develop rituals that provide predictability, consistency, and meaning in their relationship. Families and couple relationships without a sense of connection through rituals will feel like a ship adrift at sea, nobody knows what is going on or when they will be rescued. This is especially relevant for recovering couples given that rituals they had previously were lost in the progression of an addictive disorder, where they were emotionally numb or avoidant.
Couples often need to develop new rituals to integrate into family life. I had one couple who had a ritual of connection by having an extended happy hour every night. When they both got into recovery they started an alcohol-free happy hour, which wasn’t working, so they started taking yoga, which evolved into a bike ride. That became one of their new rituals of connection that worked very well for them in their recovery. Couples that build families that develop rituals are less likely to pass on the legacy of alcoholism.
In an active addiction, formal rituals like holiday celebrations or birthdays may begin well and quickly escalate into something else. With the unpredictability of behavior that comes with addiction, the partner can anticipate with dread whether, once again, the addiction ruins things. When couples begin recovery, this is an important part of the work. I also address helping couples manage trauma from addiction, develop rituals and routines in the relationship with a recovery focus, knowing the difference between codependency and interdependency, and managing conflict. One effective intervention based on the Gottman tool Aftermath of a Regrettable Incident, and it is called Celebrating a Positive Event, which provides a structure for couples to talk about and process what worked well instead of what didn’t work, furthering the shame and isolation cycle.
My final recommendations…
The challenge of getting people to seek help with a substance use disorder is overcoming the stigma & shame associated with addiction. Many people could lose their job if their substance or behavioral use was known. It’s been reported that only about 10% of Americans who need treatment for an addictive disorder are in treatment, which I can believe after working with families for so long. If you or a loved one are struggling with a possible addiction, remember that addictions are classified as a disorder in the DSM in order for you to get help, it is not a moral failure, and it is 100% treatable. First, find a therapist who is trained in treating substance abuse disorders and other compulsive behaviors and if you need any help, reach out to me! There are also numerous mutual aid groups like SMART Recovery or Life Ring, and there are effective medications to help treat substance, nicotine, opiate, and alcohol abuse disorders as well. I strongly encourage anyone to reach out to these resources for evaluation, exploring alternatives, and getting the support you need.
