Spouse's Attitude Can Affect Alcoholic's Relapse

Partner's Criticism or Encouragement Makes a Difference

Couple Holding Hands
Spouse's Support Is Essential. © Getty Images

Research into couple therapy confirms that Al-Anon's purpose of offering "understanding and encouragement" to those with drinking problems is a very helpful approach family members can take in dealing with the situation.

One study, conducted by William Fals-Stewart of the Research Institute on Addictions at State University of New York at Buffalo, found that men recovering from substance abuse are less successful if they believe their spouse or partner is critical of them, rather than supportive.

Criticism Linked to Relapse

The study found that of 106 married men studied, those who reported greater criticism from their partners were more likely to have relapsed, regardless of the severity of their drug problem, age or race.

Al-Anon is a support group for those who are affected by someone else's drinking. In the "preamble" which is read at most Al-Anon meetings, it says:

"Al-Anon has but one purpose to help families of alcoholics. We do this by practicing the Twelve Steps, by welcoming and giving comfort to families of alcoholics, and by giving understanding and encouragement to the alcoholic."

"Compared to treatments for substance abuse that do not involve spouses, individuals who get couples treatment have much better outcomes -- less drug use, fewer arrests, greater likelihood to remain abstinent from drugs," Fals-Stewart said.

Half of Men Had Relapsed

Other findings of the study include:

  • Of the 106 men in the study, half had relapsed a year after treatment.
  • Most of the men perceived their partner to be moderately critical of them, with only 2 percent saying they were not critical at all, and 29 percent saying they were "very critical."
  • Older men were more likely to perceive criticism, as were those involved in more distressed relationships.

    The study measured the men's perceived criticism, not how much and how often their partners actually criticized them.

    Fals-Stewart said relapses themselves may increase criticism from a spouse, who may be especially disappointed by the failure of treatment.

    Individual Recovery May Not Be Enough

    The well-known "family disease approach" to alcoholism suggests that all members of the family have been affected by the disease and each member must address their issues individually in Alcoholics Anonymous, Al-Anon or Alateen.

    Although individual recovery efforts can be helpful, there is a great deal of research that shows that therapy that includes the family may produce better outcomes.

    Behavioral Couples Therapy

    The early research of Fals-Stewart and other investigators has lead to the development of a therapy approach called Behavioral Couples Therapy (BCT). It is a treatment approach "for married or cohabiting drug abusers and their partners which attempts to reduce substance abuse directly by restructuring the dysfunctional couple interactions that frequently help sustain it."

    Behavioral couples therapy has been found to be effective in multiple studies with a variety of diverse populations in reducing substance abuse and strengthening the family.

    Greater Relationship Satisfaction

    Compared to individual based therapy, couples therapy has been found to:

    • Produce greater reductions in substance use
    • Create higher levels of relationship satisfaction
    • Reduce intimate partner violence
    • Increase children’s psychosocial adjustment

    The BCT approach has also been found effective for patients who abuse drugs, instead of alcohol. Studies have found that the couples approach to therapy is equally as effective when the substance abuser in the family is female.

    BCT has also been shown to be effective, over individual therapy, for patients receiving naltrexone therapy. Those patients were more likely to take their medication if there were also in couple therapy.

    When Both Partners Are Addicted

    Behavioral couples therapy works best when only one of the partners is addicted. When both partners abuse drugs, BCT has not been found to reduce substance abuse or lower the number of abstinent days. It does, however, increase relationship satisfaction.

    "They apparently have less conflict related to substance abuse, and attempting to reduce their substance abuse may reduce their relationship satisfaction by depriving them of a primary shared rewarding activity," Fals-Stewart wrote. "Attempting to address the substance abuse of only one partner in a dually addicted couple—the most common circumstance, since both partners rarely seek help at the same time—often creates conflict that may be resolved only through either dissolution of the relationship or continued drug use by the partner being treated."

    Not for Violent Couples

    Behavioral couples therapy is not for all couples, however. BCT is not recommended for couples who have reported violence within the past year that require medical attention or if one partner reports being physically afraid of the other.

    In those cases, the couple is usually referred to domestic violence treatment and the substance-abusing partner receives individual treatment for alcohol or drug abuse.

    One thing is clear, the chances of an alcoholic or addict becoming abstinent and staying clean and sober increases significantly if family members become involved in the process and help provide a positive environment.


    Fals-Stewart, W et al. "Behavioral Couples Therapy for Substance Abuse: Rationale, Methods, and Findings." Addiction Science & Clinical Practice August 2004

    Fals-Stewart, W. et al. "Behavioral couples therapy with alcoholic men and their intimate partners: The comparative effectiveness of bachelor's- and master's-level counselors." Behavior Therapy Accessed February 2016

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