Couples and Substance Use: a Different Treatment Approach – Part 1

I’m passionate about working with couples impacted by substance use problems.  In my opinion, the therapy and treatment community has largely failed these relationships by oversimplifying issues and scapegoating people. For example, the substance user who has not achieved abstinence is “in denial,” and the partner who remains in that relationship is “codependent.”  Clearly, this can be an unhelpful way to frame the issues, at least for many couples.

I believe in a treatment method rooted in Harm Reduction and a Systems Approach.  These views have the benefit of honoring the complexity and humanity of couples’ relationships.  Working from this perspective can help a couple create lasting change.

Harm Reduction theory supports any step that reduces the harm of the substance use, even if the individual continues to use the substance.  Harm reduction also holds that minimizing harm (versus complete abstinence) may be a reasonable end-goal for a particular individual.  This is in contrast to the 12-Step, abstinence-only orientation that is much more rigid, stressing abstinence as a universal goal for all problematic substance users.

A Systems Approach looks at all relationships (whether two people or a large community) as something that is co-created by every member of the system.  Individuals impact the system, and the system impacts every individual.  It is therefore something deserving of the same level of attention and concern that the client uses in working on himself/herself.  The couples system can thus become a resource, a comfort, a goal-setting team, etc.

 In the next few blog posts, I will outline in more detail how I believe that Harm Reduction theory and a Systems Approach can be powerful tools in the treatment of substance use, particularly for couples affected by it.

 Thank you for reading! I am excited to be sharing these ideas with you.