A Couples Approach to Substance Abuse


Relationship difficulties can be compounded when your partner struggles with a substance abuse problem. But, there’s good news, Behavioral Couples Therapy (BCT) can help. In her guest post, Lindsay Melka, LPC shares exactly what BCT is and how it can help your relationship.

Lindsay is the founder of Empathic Counseling and Therapy in Denver, Colorado.

Struggling with a partner who has a substance abuse problem? Behavioral Couples Therapy may be the answer.

Do you have a partner who you love but continue to struggle with because of their drug or alcohol addiction? Do you want to support them without enabling them? Get back to where your relationship was before the addiction took over? It’s possible! There is something called Behavioral Couples Therapy that has shown to be extremely effective in helping couples heal and grow through the often trying times of early sobriety.


What is BCT?

Behavioral Couples Therapy (BCT) for alcoholism and drug abuse is currently considered the most effective family therapy method for treating couples with one spouse in early recovery from addiction. For more than 25 years, multiple studies have shown that participation in BCT by married or co-habitating partners results in significant reductions in substance abuse and marital distress, and also improves relationship satisfaction.

As a therapist working in the field of substance abuse for almost a decade, I can say I’ve witnessed couples feel immediate relief and hope in just the first few sessions of BCT. I believe this is because it is designed to be a supportive method of treatment wherein both partners feel heard, loved and accepted. There is no shaming or babysitting, no blaming or bringing up the past. Couples learn to be present together, building each other up, and helping each other recover.


How does BCT work?

In the simplest of terms, BCT works directly to increase relationship factors conducive to sobriety. Because this is a behavioral therapy approach, it is believed that family members can reward abstinence, and that substance abusing individuals in happier, more supportive relationships with better communication have a lower risk of relapse. BCT therapy is based on the premise that the partner who is abusing substances has a much better chance of long-term recovery if the treatment 1) effectively addresses and reduces problems that are occurring in the couples relationship, and 2) actively includes the spouse who consistently supports and rewards abstinence.


Goals of BCT:

  1. Promoting abstinence by expanding parts of the relationship that naturally reward it
  2. Strengthening and deepening the relationship between partners
  3. Addressing problems in the couples relationship that directly and indirectly relate to substance abuse
  4. Ridding of problematic behaviors by encouraging and reinforcing positive behaviors
  5. Reducing risk relapse by strengthening couples relationship and their communication patterns.

What to expect in BCT

Compared to some types of behavioral therapy, BCT is relatively short in duration. Components typically include:

  1. A recovery and sobriety contract. This contract is between the therapist and the partners
  2. Activities and homework that help strengthen and awaken the couples relationship
  3. A focus on relapse prevention

Having a contract between the therapist and the couples helps provide accountability in holding both partners to their weekly goals. I’ve heard several couples tell me that they didn’t want to come into their therapy session and not have done the work. They often look forward to meetings as they progress and succeed through the treatment protocol.


Contracts are an essential tool of BCT success

Contracts in BCT typically include:

  1. An agreement to stay clean from alcohol or drugs that day (one day at a time)
  2. An agreement by the spouse to be supportive of their partner’s abstinence
  3. An agreement that neither partner will bring up issues related substance abuse from the past or future. This can be very triggering for those in early recovery and often serves no purpose and sets couples back.
  4. An agreement to take any medication related to the substance abuse problem on a daily basis (or recommended by physician).

And one that is not always included, but I like to think as extremely important: an agreement that the spouse agrees to attend her own support groups (aka Alanon)

One of the goals of the recovery contract is to increase the loved one’s trust. Essentially, the contract is a positive intervention that helps the couple rebuild overall trust in their relationship.

There is power in actually creating and adhering to a written contract. There becomes less of a need to ask your spouse questions as everything one needs to know about the partner’s recovery is found in the contract. This takes the burden off of the substance abuser and relieves their partner of any fear of appearing to be too involved, a “nagger” per say.


Communication Skill Building

This kind of work typically begins with teaching the couple how to practice effective communication skills. Teaching basic skills of listening and speaking and how to used planned sessions are essential for obtaining desired behavior changes. Typically, most therapists will begin with non-problem areas that are neutral or positive and move to problem areas only after communication skills have been practiced on easier topics. Main topics covered in effective communication using BCT include, listening skills, expressing feelings directly, scheduled communication sessions and negotiating requests.


What if there is a Relapse?

Relapse is often a part of the recovery process and is typically recommended that the partner contact their therapist as soon as possible. The relapse should be addressed immediately as the sooner the relapse is addressed the better the outcome. It can be used as an experience to learn and grow, to do things differently. At this time the contract may be adjusted to better help the couple move through the relapse and get back on track. It is very important not to view this as a failure, but rather as a part of the process.


The Fun Parts of BCT

Improving the relationship throughout the BCT process entails some homework. This is where I see the sparks start to fly again! Basically, you get to tell your partner how much good stuff they’ve been doing and how appreciative you are of them. Who doesn’t like that?! One of the assignments often given in therapy is the “catch your partner doing something nice” assignment.     It’s funny, because I swear every time I introduce this in session, both partners relax a little bit and start to smile. I often hear comments about how much they like this idea before they even hear the instructions! It’s simple, every day you make a note of something you witnessed your partner doing that was nice, like washing the dishes or taking the dog out for a walk. This kind of homework can be so important, because often times when we’re in chaotic relationships, we neglect the little things that let our partners know how much we care and appreciate them.

There are other fun and restorative homework assignments that include spending meaningful time together and giving your partner their own “caring day”. The list goes on with what you can do as you heal through this process of recovery, but sometimes the very basic things appear to be the most helpful.


Why BCT is preferred among various treatment modalities

A series of studies have shown that BCT, when compared with other forms of therapy, has a much higher success rate when measuring not only abstinence, but relationship satisfaction, happiness and lower risks of couple separation.

In BCT, both partners are actively involved in healing and restoring their relationship. This is why I believe it has proven to be so helpful time and time again. The struggling addict/alcoholic does not feel ashamed and pushed/prodded but rather encouraged and supported. The partner of the substance abuser feels some relief that they can trust in the process and do some of their own work. This is not just a treatment method for helping one stay sober, but a therapeutic family intervention that fosters growth and re-connection. If you or your partner is struggling with a substance use problem, I would highly recommend finding a therapist who specializes in BCT. It’s effective, supportive and sustainable.

Lindsay Melka, MS, LPC * Empathic Counseling and Therapy

If you connected with this post and would like to hear more, you can contact me at 720-295-5490 or at www.empathiccounselingandtherapy.com.

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