Rehab for Couples

Addiction does not just impact the life of the individual using substances—it can profoundly affect the lives of their loved ones as well. This is especially true for couples. Many people whose partners use substances have worried about “covering” for their partner’s addiction, or they may feel worried or ashamed about seeking help.¹ However, if you are both using substances, you may be concerned that addiction has made some of the problems in your relationship unsolvable.¹

In both scenarios, couples rehab can be a powerful intervention to gain an understanding of how addiction has impacted your lives both separately and together. Understanding what couples rehab entails, how it can help you and your partner, and how to find nearby couples rehab programs can help you and your partner begin your journeys to recovery.

Addiction In A Relationship

Substance use is a major stressor in romantic relationships. It can impact the physical and mental health of both partners significantly.

In couples where one partner misuses drugs or alcohol there are usually significant relationship problems, high levels of relationship dissatisfaction and instability, and there may also be verbal and physical aggression. Relationship dysfunction and substance use has a reciprocal relationship. That is, substance use both causes dysfunction and is also worsened by it.¹⁰

Conversely, research indicates that couples who use substances are more committed and willing to care for each other, reinforcing substance use.² Reducing substance use may reduce relationship satisfaction, and conflict and dissatisfaction in the relationship may increase when only one partner seeks treatment.¹⁰

There are many ways that addiction can affect the relationship, such as the following:

• Codependent behaviors: In relationships where just one partner is abusing substances, the sober partner may find themselves compensating for their partner’s addiction. Whether this behavior is voluntary or not, the sober partner will often prioritize their partner’s needs over their own.³ They may also engage in enabling behaviors by shielding the substance using partner from the negative consequences of their substance use.¹¹
• Domestic violence:If one partner is under the influence, they may be more likely to physically harm the other.¹ Likewise, partners who have experienced domestic violence are more likely to use substances to cope.⁴
• Abusing substances together:In couples where both people misuse substances, partners may find that using drugs or drinking alcohol together becomes their only shared activity, or the only way they are able to relax or show affection to each other.¹
• Neglecting responsibilities:The stress of managing responsibilities without support from an addicted partner, or the inability to manage household tasks together when both partners are using, can create a feeling of hypervigilance and stress in couples.⁵
• Neglect or abuse of children: If a couple has a family together, their substance abuse may compromise their ability to care for children, resulting in neglect, abuse, and potentially having their children removed from their home.³

Can Couples Go To Rehab Together?

Many rehab programs will allow partners to attend treatment together or will include partners in couples- or family-focused programs and therapy sessions. To participate in rehab for couples, both partners do not need to be using substances—there is still a significant benefit for the sober partner to participate in treatment. A common approach known as Behavioral Couples Therapy takes a step-by-step approach to address addiction in relationships, asking each partner to make a daily commitment to sobriety and to each other.⁶ This helps couples to rebuild trust as they unpack how addiction has affected their life together.

What to Expect in Rehab for Couples

Not all rehab programs are the same, but whether only one partner is entering treatment and the other participating or both partners enter treatment together,  rehab typically follows the same steps for a couple as it does an individual and includes the following:

• Intake assessment:Just as in individual rehab, each couple will have an individualized treatment plan to address their unique needs.²
• Detox: Depending on the drug(s) of choice that you and/or your partner use, your treatment plan may include a period of medically supervised withdrawal management, known as detoxification.³
• Rehab: The treatment stage of rehab can include individual, group, couples, and family counseling. When both partners participate in therapy, you’ll be focusing on listening, communication, and rebuilding trust.⁶
• Aftercare: Most rehab programs stress the importance of maintaining new habits and preventing relapse after leaving treatment, sometimes called aftercare or continuing care.⁶ In this stage, partners may attend mutual support groups such as Alcoholics Anonymous and/or Al-Anon or continue with individual or mutual therapy sessions at a lesser frequency to discuss prevention of relapse and other issues impacting the functioning of the relationship. If one or both of you relapse, this can be addressed as well.⁶

What Therapies Are Used in Couples Rehab Programs?

There are several different approaches that are used in couples rehab programs. Behavioral therapies are some of the most commonly used modalities for addiction treatment, targeting the behaviors that contribute to substance abuse and introducing new behaviors that can promote abstinence.⁷ When couples gain a shared understanding of these behaviors through therapy sessions, they can then learn new ways of communicating more openly about their thoughts and emotions.

Some modalities used in couples rehab programs include the following:

• Behavioral couples therapy (BCT): A structured approach lasting between 3 to 6 weeks with multiple therapy sessions weekly, in which both partners learn to communicate more openly about substance abuse and maintain abstinence from drugs.⁶
• Medications for Addiction Treatment (MAT): If one or both partners are in treatment for alcohol use disorder or opioid use disorder, medications may be used to help reduce cravings and urges to use substances, which can help prevent a return to substance use.⁷ In BCT, a client taking medication may be encouraged to do so in front of their partner for accountability and to foster trust.⁶
• Group therapy: Many addiction treatment programs use group therapy to encourage clients to share their experiences with others and create positive relationships during treatment.⁷
• Family therapy: In addition to including intimate partners, therapy may also include other family members in therapy sessions to address the impact of addiction on their home and family lives, especially if they have children.⁷
• Individual therapy: Meeting one-on-one with a therapist can be helpful for anyone in rehab, and for couples this is a good time to be able to process individual thoughts and emotions without the influence of their partner.⁶

What Types of Treatment Programs Are Best for Couples?

What type of rehab program will be best for you and your partner is a highly personal choice. Based on your needs as individuals and as a couple, there are a number of factors that can influence your decision. Some rehab programs have specialized treatment tracks designed to serve specific subpopulations. For example, a gay, lesbian, or transgender couple might prefer to attend a treatment program that is culturally competent and equipped to address the unique needs of the LGBTQ+ community. Survey data indicate higher rates of substance use among adults in the LGBTQ+ community, and there are rehab programs that offer treatment tailored to the LGBTQ experience.⁸ The same is true for military veterans, too.

At the start of rehab, you will have the opportunity to meet with an intake counselor and create an individualized treatment plan together.² At this time, it is worth considering additional factors, such as the cost of treatment, what is covered by your insurance, the length of treatment, and whether inpatient rehab or outpatient rehab is appropriate.

Couples Inpatient and Outpatient Rehab

Inpatient rehab for couples typically lasts between 30 and 90 days, and clients stay overnight at the treatment center during this time.⁷ While in rehab, partners will participate in individual, couples, and group therapy daily or weekly to learn communication strategies, develop healthy coping skills, and process past experiences.⁶ Inpatient rehab is considered a more intensive option for addiction treatment because treatment typically occurs more frequently than it does in most outpatient programs and clients reside at the treatment center for the duration or treatment.

In contrast, outpatient rehab may occur several times per week, but clients go home between sessions.⁷ Specialized modalities may have a more rigid or manualized treatment schedule. Those participating in Behavioral Couples Therapy, for example, generally receive 12 to 20 sessions over the course of 3 to 6 weeks.⁶ While outpatient rehab is considered less intensive than inpatient, it can be a highly effective option for couples who need to stay at home due to cost, family, or work obligations.

No matter the treatment setting, it is very important that individuals  stay in  treatment for the entire duration.⁷

How Much Does It Cost To Go To Rehab As A Couple?

The cost of couples rehab treatment depends on several factors, such as the following:

• Type and frequency of care: What modality or approach is used and how often is treatment received?
• Treatment setting: Is treatment on an inpatient or outpatient basis? If you are staying at a residential treatment center, you may incur a cost for food and lodging.
• Length of stay: How long does will treatment last? Longer treatment programs may be associated with a higher cost.
• Amenities: What other programs or accommodations does the treatment center offer?
• Insurance: What proportion of the overall cost will your insurance plan cover?

Does Insurance Cover Rehab for Couples?

Under the Affordable Care Act (ACA), all insurance companies are required to cover at least some portion of medically necessary mental health and substance use disorder treatment.^{9, para 2} If you have any insurance coverage, whether it is through your employer, a marketplace plan, or state-funded insurance like Medicaid or Medicare, your plan will likely cover part of the cost of rehab. It is a good idea to contact your insurance company to determine what your out-of-pocket cost will be before starting treatment.

Finding Couples Rehab Centers Near Me

Whether you are using substances with your partner, or love someone who is in the midst of addiction, couples rehab can be a powerful step to improving your relationship and your life. If you think that you or your partner could benefit from attending rehab together, start by consulting a medical professional about your concerns. To find a treatment center near you, visit the SAMHSA treatment locator or contact American Addiction Centers (AAC) 24/7 helpline at or through text.

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