Couple Therapy for Substance Abuse

As is widely acknowledged in the scientific and popular press, alcoholism and drug abuse are among the most deleterious and corrosive problems facing society; by virtually any standard, the personal, familial, community, social, and economic costs are staggering. Approaches to address alcoholism and drug addiction have ranged from broad societal interventions (e.g., Prohibition, the War on Drugs) to narrowly focused biomedical treatments (e.g., use of Antabuse, which causes individuals to become ill when they consume alcohol); yet the backbone of this effort has been and remains psychosocial treatment. This entry describes the use of a particular type of psychosocial treatment, couple therapy, as an intervention for substance use disorders and includes a discussion of its theoretical underpinning, empirical support, limitations, and future directions.

Until recently, a widely touted and largely unchallenged axiom of agencies and providers who treat individuals with substance use disorders is that alcoholism and drug abuse are individual problems most appropriately treated on an individual basis. In the last quarter century, such thinking has gradually given way to a more systemic understanding of how addictive behavior evolves, is maintained, and may best be treated. This comparatively newer conceptualization has focused on how family interaction and dynamics influence substance abuse etiology, maintenance, relapse, and recovery. In turn, treatment providers have placed increased emphasis on treating the family as an approach to address a given member's or members' substance abuse.

Family-involved therapies for substance abuse can take many forms. They can focus on family issues with only one family member (e.g., the patient), they can include most or all members of the immediate family in treatment, or they may include family members from the patient's family of origin. Yet of the various family-based intervention approaches that have been developed and used by providers to treat substance abuse by adults, couple therapy has received the most attention from both the treatment and research communities. Indeed, among the various psychosocial interventions presently available to treat alcoholism and substance abuse, it could be reasonably argued that partner-involved treatments are the most broadly efficacious. More specifically, there is substantial empirical support for the use of couple-based treatments not only in terms of improvements in primary targeted outcomes, such as substance use and relationship adjustment, but also in other areas that are of clear public health significance, including intimate partner violence, children's adjustment, and cost-benefit and cost-effectiveness.