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Navigating Substance Use in Our Romantic Relationships

Current image: holding hands

When we are struggling with substance use, our relationships can also become more complicated. Similarly, dating and being in a relationship can bring challenges that are not always easy to navigate. Interestingly, being in a romantic relationship while dealing with substance use can have both positive and negative effects for our own mental health, depending on factors like partners’ substance use patterns, the quality of the relationship, and more. Still, couples where both partners struggle with substance use (such as drugs and alcohol) are more common than we might first think, which invites us to consider the role of relationships in helping vs maintaining substance use patterns.

How do relationships affect our own substance use challenges?

The short answer is, it depends. Research shows that a significant portion of adults who struggle with substance use are in dual substance use relationships, where both partners experience challenges with substance use. In fact, the risk of developing a substance use disorder can be eight times higher for individuals with a partner who has a substance use disorder (SUD) compared to those without (Molla et al., 2018). Conversely, relationships can also be protective and restorative factors for individuals who struggle with substance use, increasing wellbeing and helping to maintain treatment and sobriety. This invites us to think about the conditions under which relational factors play a role in substance use and recovery. While many approaches to treating addiction focus on individual factors such as how we individually cope with stressors, there is also growing recognition of the importance of considering couple dynamics, especially for partners who are both affected.

When our relationships maintain our substance use challenges:

Our relationships often become a container for what we experience individually. When we experience stress in our personal lives, such as job or school stress, feeling lost in our direction, or having problems with family members, these also get reflected in our relationships either directly or indirectly. When this happens, we may go through more arguments, start pulling away from each other, experience changes in communication, or lean on each other more for reassurance and support than usual, even though nothing has changed about how we feel about each other or our relationship.

Similarly, when our partner or we are dealing with substance use, such as drug or alcohol use, it can also become a part of the relationship. This can, in turn, influence our own personal substance use and even our treatment trajectory. Substance use and relationships can affect each other in many different ways. For example:

  • “Assortive-mating”: We may tend to date partners who already use similar substances to us, because this can create a sense of comfort, familiarity, and shared meaning at the beginning of the relationship, even though we may not be compatible in other ways (Fleming et al, 2010).
  • “Contagion effect”: as partners, we may tend to mirror each other’s behaviors, which can increase our substance use together (Fleming et al, 2010). This way, it can become easier for us to use substances as we observe our partner’s use eventhough we have not planned to use them personally. In fact, sometimes this can get complicated, and we may have a hard time differentiating our partner’s behavior from who they are and what we feel for them, for example, where we can start feeling like saying no to substance use would mean saying no to our partner, denying our love for them, or making them feel bad.
  • Substance use replacing genuine closeness and intimacy: when we share activities with our partners, it can become a source of bonding and closeness for each other. Watching a TV series with our partner, for instance, makes us feel closer through the experience. In those moments, our partner’s presence makes us feel comforted and held, which makes us want to keep doing them in the future. Most often, it is not even the “content” of the activity we are doing but rather the physical closeness, a shared sense of comfort, reduced tension, and feelings of joy that feel rewarding. This can also be true for substance use when it becomes a shared activity. It can create the sense that it is strengthening our bond and that we are getting closer, when in fact it is the time we spend together, our partner’s presence, and the sense of physical and social closeness that is driving the actual bonding. However, this can become problematic over time and can increase our substance use, even though we do not individually plan to use anything.
  • Substance use replacing regulation tools: because substance use is often used to alleviate some level of discomfort and replace it with a level of pleasure or comfort, when there is shared substance use in partners, it can also be used as a way to regulate emotions, manage conflicts and disagreements, and as a response to mistrust and communication issues, among other things.

Thus, shared substance use can generate the following overarching effects in our relationships:

  • These contributing patterns in relationships (outlined above) can worsen our own existing substance use problems.
  • Because substance use can take up financial resources, time, and energy, it may become the main routine in the relationship, leaving fewer ways to connect differently.
  • This can create a sense of dependency on substance use as the default way of showing and receiving love from each other, resolving conflicts and soothing after arguments, and even the way to maintain or “save” the relationship.
  • Reducing use or entering treatment may start to feel like rejecting our partner or the relationship, or betraying them. We may fear that if we stop substance use-related habits, we will automatically lose the relationship, eventhough it is not necessarily true.
  • For better treatment outcomes, it is important to consider both individual substance use and how it interacts with relationship dynamics.

How can therapy help?

Navigating substance use can feel overwhelming, both individually and in relationships. Connecting with professional help can support us in this process. 

Individual treatment options can include:

  • Individual psychotherapy: support in identifying triggers and patterns, building coping skills aligned with personal values, and managing symptoms.
  • Medication: support in symptom management, such as cravings or withdrawal effects.
  • Intensive Outpatient Programs (IOP): structured care with relapse prevention, coping skills, and group therapy.
  • Partial Hospitalization Programs (PHP): short-term, structured support for more severe symptoms.
  • Residential programs: live-in treatment with intensive support.
  • Peer-based groups: peer-led support such as AA or Smart Recovery.

Couple’s therapy, where both partners attend therapy together, can also help us:

  • Understand relational patterns in maintaining substance use
  • Identify communication issues and conflicts, and build regulation and communication skills that can support you.
  • Establish clear boundaries and agreements around substance use.
  • Cultivate coping skills and positive experiences in the relationship that can rebuild trust and intimacy and support abstinence.

Sometimes, therapy can also bring up uncomfortable topics, such as areas of mismatch, unmet needs in a relationship, or even incompatibility and a desire to break up, but it does so in a safe environment where we can navigate these challenges in a less isolated way. 

Our relationships are unique, just like we are, and so are our therapeutic journeys. While the process can be uncomfortable and challenging, connecting with the support we need can be deeply transformative and rewarding.

Takeaways

  • Relationships can either support recovery or contribute to substance use challenges. While dual substance use by partners can introduce additional struggles that can maintain use, supportive partnerships can enhance wellbeing, treatment engagement, and sobriety.
  • Relationship dynamics can unintentionally maintain substance use through shared behaviors and emotional patterns, including “assortive mating” (choosing partners with similar substance use habits), the “contagion effect” (mirroring and reinforcing one another’s use), using substances as a source of closeness and bonding, and relying on substances together to manage stress, conflict, or emotional discomfort.
  • As shared substance use becomes the central way partners connect, reducing use or seeking treatment can become associated with losing a relationship, creating fear and barriers.
  • Effective support often requires addressing both individual substance use and associated relationship dynamics through options like individual therapy, medication, structured treatment programs, peer support, and couples therapy to rebuild communication, trust, boundaries, and healthier coping patterns.

References