Most modern day hospitals and institutions approach patients in treatment with both an individual and family approach. Individual therapy, group therapy, family group meetings and 12-step meetings are standard protocol for treatment. It is also common standard of care for these institutions to offer a directory to Al-Anon meetings for aftercare treatment for family members. Unfortunately, as of now, there is no after program designed to specifically treat the couple dynamic; particularly with the type of hands-on intensity and care that is needed for a robust and sustainable future.

Inpatient treatment centers have their hands full in their client-centered attention on sobering the alcoholic. After the sober client leaves the safety of inpatient treatment and goes home, the couple is then vulnerable to having to fend for themselves in the process of adjusting to sober living. As of now, there is a lack of widespread understanding of the unique systemic dynamic of the newly sober couple relationship and the implementation of treatment for that unique dynamic.

What Happens
When a couple is dependent on substances for aid in mood regulation, the overall dynamic between the husband and wife becomes fixed and predictable in levels of engagement and disengagement. Over time, these fixed and predictable patterns systematically become more corrosive to the well being of the couple, ultimately creating a dysfunctional marriage.

The dissociated states that occur from substance abuse render the couple vulnerable to being engaged in a false sense of engagement from the most superficial of behaviors to the most intimate. Common lifestyle behaviors that normally create a sense of closeness in the couple mimic "parallel play" of children in a sand box.

What this means is that children in this stage of development may mimic what a child next to them is doing, even comment out loud, but are not at a stage where any active cooperation or engagement is occurring. So even though they may be sitting side-by-side, there is no true connection occurring. Like these children in a sand box, the substance abusing couple is operating with a false sense of connection that engenders habitual pseudo mutual interactions from the start of the day until their head hits the pillow.

When one partner decides to get on a path to recovery by going into treatment, the couple’s lifestyle pattern is severely disrupted. Old patterns don’t work to keep the couple glued together, and new patterns have not been created yet.

Inpatient treatment erupts the known pattern that the sober spouse has grown accustom. A 30-day break within a rehabilitating environment can create new patterns for the sobering partner to begin regulating himself or herself as a non-substance abusing individual. The newly sober spouse is being offered a chance through rehab for their brain to acquire new sober experiences to store in the memory banks, while the partner at home is left to continue to operate in a non-emotionally sober manner.

The spouse at home is anticipating their sober partner to complete rehab and come home with the ability to provide more satisfying, connected and loving skills to bring to their marriage. The couple begins the newly sober lifestyle filled with fantasy and hope about what future patterns may possibly emerge with sobriety now in the mix.

Coming Home
Without the benefit of forewarning, focus and education toward marriage while in treatment, or specifically folded in as part of an aftercare program, the sober partner’s new learned patterns will be highly disjointing to the marriage when re-entering the home environment. More times than not, the fantasy of connection, mutuality and intimacy are dashed within a short time after the sober partner comes home to resume a life with their spouse. With optimistic hope, the newly sober person is anxious to create a new lifestyle that allows them to stay sober, as well as be close to their loved one. Unfortunately, their days become fraught with unanticipated tensions and emotional mis-attunement instead. Anxieties and frustrations are soon replacing the sought after fantasies of closeness that one or both spouses have been carrying. Why? There are many reasons for this.

Unbeknownst to most couples, the unresolved issues of trauma, injury, betrayal, fear of intimacy and lack of social skills that have been masked by substance abuse steadily become unmasked by sobriety. More importantly, couples universally underestimate their lack of skill for regulating their own anxieties when attempting connection, making it close to impossible for the couple to be able to facilitate connection. The lack of true self-understanding and education are not being addressed on the couple’s behalf in rehab, leaving the couple to try and wend their way out of these dysfunctional habit patterns on their own. Just as the newly sober alcoholic is in need of a road map to living a sober life, the newly sober couple needs a road map for their marriage dynamic as well.

The stark reality of where the couple’s development actually lies stands between them as a huge roadblock toward attaining the hoped-for-renewed lifestyle. Sadly, this is why a newly sober couple can become chronically engaged in volatile or conflicted interactions, or end up separating or divorcing prematurely. The couple’s true desire to engage and unite is deterred by the mere fact that one of the members is now sober.

The need for programs for married couples to be supported in making the transition from a non-sober lifestyle to a sober one cannot be underestimated. All across the country scores of effective rehabilitation programs help to get the individual sober, only to send them home to spouses who have no skills to involve themselves intimately with their sober mate. Newly sober people coming home with the best of intentions to stay sober suddenly find themselves drunk again or divorced. The couple does not know how much time they should be devoting to the needs of the relationship or how much time to devote to individual needs.

What's a Couple to Do?
The skills of effective communication, mindful awareness, compassion and various anxiety regulating techniques from meditation or prayer, as well as relief from past resentments through the art of forgiveness, are necessary for recovering couples to exist in the joy of what the partnership has to offer. When a newly sober couple takes advantage of the combination of 12-step programs and a therapeutic couple’s group, or Recovering Couples Anonymous, a new intimacy can genuinely be hoped for and the couple will then have a running chance of not just surviving, but thriving.

Beverly Berg, MFT, PhD has been working in the chemical dependency field since 1982. Beverly has worked as a psychotherapist for the Providence Saint Joseph Medical Center’s Chemical Dependency program and for The Betty Ford Center Medical Director Garrett O’ Connor’s Repair program in Los Angeles in 1989. She has served as a consultant/trainer in the areas of alcoholism treatment, hypnosis and meditation. For more information, Beverly can be reached at Beverlyberg@mac.com or 310-288-3417