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Often in recovery, it takes two

January 16, 2018
by Gary A. Enos, Editor
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In cases where a couple in a committed relationship is affected by addiction in one or both partners, conventional wisdom has advised that healing the relationship should take a back seat to establishing a track record of stable recovery first. As the notion of addiction as a family disease has taken greater hold across the field, however, professionals and programs are breaking from that tradition and directly addressing relationship dynamics earlier in treatment.

What is resulting from this evolving mindset includes the establishment of defined treatment programs or tracks for couples in early recovery, including in residential facilities where in some cases couples will live together during their stay.

“My overall philosophy is they're going to live together anyway, so let's treat them the best way we can,” says Fredi-Ruth Levitt, a director at Behavioral Health of the Palm Beaches in South Florida. “These couples don't know how to have a positive relationship—it has been more of an enabling relationship.”

Robert Navarra, PsyD, LMFT, a family therapist and consultant based in San Carlos, Calif., says the addiction treatment field's tendency to postpone addressing relationship dynamics until recovery is more fully established actually flies in the face of research evidence. Studies have demonstrated that satisfying family relationships constitute one of the greatest predictors of long-term recovery, Navarra says.

“There are the individual partner recoveries, and then there is relationship recovery,” says Navarra. “We work to create a language for the couple to talk about recovery in the relationship.”

Newly developed programs

Over the past year, the Addiction Reach luxury treatment program in Palm Beach County, Fla., has developed a track available to couples who want to share the experience of early recovery. “Our clients have researched couples programs countrywide and have not found any other integrated programs that let them support each other on their own terms,” says Addiction Reach CEO Sue Merklin.

Nicholas S. Aradi, PhD, oversees clinical care in Addiction Reach's couples program. Although a daily recovery contract that seeks to establish a few-week period of abstinence serves as a cornerstone of the center's work, relationship-focused intervention begins fairly early in treatment, Aradi says.

“When you do the relationship piece, there is a higher likelihood of success,” says Aradi. He saw the drawbacks of narrowly defined individual treatment during his time as a school psychologist, where he would observe that children would regress after consistently being returned to a dysfunctional family system.

The level of trust has declined to basically nothing in a relationship where one partner has a substance use disorder, says Aradi. He points out that the dynamic differs when both partners have a substance use problem. “The partners will con each other in that arrangement,” he says.

Developing better communication skills becomes critical during the course of treatment. Aradi finds several therapeutic techniques to be useful here; one involves educating partners by employing videotapes of other couples talking. Another involves teaching couples to adopt a “7-to-1 ratio” pledge: agreeing to make seven positive comments or reactions to their significant other for every negative one. Because of the damage that negative acts or thoughts can inflict on the relationship, “You've got to have seven positives in order to neutralize one negative,” says Aradi.

Merklin says Aradi will see the couple up to five times a week while the partners are in the treatment setting. The goal becomes one of helping each partner express oneself in a respectful way, while being able to see things from the perspective of the other person. Problem solving strategies and negotiation of behavioral change agreements also are important components of the process.

It is also necessary to emphasize within couples treatment that the relationship did not cause the addiction, Aradi says.

More recently, Morningside Recovery in Orange County, Calif., formally announced in December that it has launched an inpatient center designed to treat couples in recovery. Hand in Hand Recovery combines individualized therapy and couples counseling, with an early goal of establishing autonomy for each partner, says Jennifer Friend, a primary therapist in Morningside's residential detox program.

Couples admitted for treatment have to be willing to work on their own issues separately as well, says Friend. The partners will be together during meals and recreational time at Morningside, but they are housed in separate sleeping quarters, she says.

The latter is more in keeping with tradition in addiction treatment, with this approach used partly because of concerns that couples living together could contribute to triggering other patients in the treatment setting. But that is not a universally held view. Levitt says that at Behavioral Health of the Palm Beaches, couples in treatment are housed together but advised not to remain so close as to compromise the therapeutic environment. “We try to separate them in process group so that they each have different experiences,” Levitt says.

Friend says it is also important that the couple be committed to sobriety and to each other. “This is not a program for someone to do with someone they just met in [treatment],” she says.

Both partners experience trauma

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Comments

I'm pleased to work for an organization that is willing to try something new. There's always been a belief that couples do not go through treatment together. I doubt that many people can think of where that belief comes from?
I do know that there are couples who will go to treatment together or not at all. "Not at all" is not a reasonable option.
As a field we can't continue to say stupid stuff like "oh well, I guess they weren't ready."
Some couples remain abstinent, some don't. It's the same for individuals.
We can give a couple a dose of treatment. They can learn what a positive experience it can be. If the needs occurs at a later time they may be likely to go as individuals.
Let's figure out how to go from "no" to "yes."

Great to hear we are getting somewhere, trying out new methods is always good. Couple treatment should be more effective (at least on paper) but it also has its own issues we have to work on and minimize them. I'm sure it will prove to be good in some cases, but it's still not a universal method of treatment.

Best,
Ethan

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