For more information on addressing substance concerns in relationship:
There’s a Problem: No There Isn’t
Morgan and Chris, once again, began arguing about Morgan’s alcohol and marijuana use. The argument was falling into a very familiar pattern. Morgan felt distant from Chris every time they had this discussion that inevitably ended up as an argument. Morgan felt that Chris was overreacting and fended off his concerns with defensive explanations about why this wasn’t really a problem.
Where to Start
Conversations about substance use can start with both partners expressing perspectives on whether either or both have a concern about the substance use. The couple starts with the question “Is this a problem for the individual using?” “Is this use causing problems in the relationship?”
Both partners may have concerns in one or both areas. If this is the case and the couple is willing to talk about it, then both can share specific concerns. This could lead to ideas for next steps.
If one partner feels there is a problem in one or both areas and the other partner does not, then it is important for both partners to share about their thoughts and feelings. As therapists are apt to say, “If one partner feels there is a problem, then it’s an issue that needs to be talked about.”
Some guidelines and questions for couples to grapple with can be found at the end of an article titled Marijuana and Couples: A Needed Conversation.
Substance Use Disorders
Sometimes the substance-related problems are more complex and need greater attention and more is needed to manage the issue. It helps to understand that substance use falls on a continuum.
At the more serious end of the continuum there is substance use disorder. This is diagnosed by mental health professionals typically using criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
It takes a minimum of two symptoms to meet the criteria for a substance use disorder, mild. Meeting six or more symptoms would be considered substance use disorder, severe. At this level the person most likely has an addiction. Addiction science can explain uncontrolled use that continues despite negative consequences because of actual changes in the brain.
It’s possible, even likely, that conflicts around substance use are because of heavy use, not addictive use. But as concerns escalate, defensiveness may escalate. Where the substance use falls on a continuum is the core question.
When Conversations Spiral Quickly
Continuum of Use
- Non-problematic use
- Problematic use
- Substance use disorder – Mild-Moderate
- Substance use disorder, severe: meeting criteria for the disease of addiction.
At mild or moderate levels, there may not be changes in the brain associated with addiction. The CDC determines that about 70% of people who meet alcohol use disorder today, will not meet that criteria in four years. Assessment by a professional can help clarify risks and suggest ways to prevent the disorder from progressing.
While partners can’t diagnose each other, sometimes it becomes clearly evident that there is a severe problem with substance use. This is terrifying for both partners to acknowledge. Denial buffers the addicted person from acknowledging the reality of addiction and how it is affecting those around them.
It is hard for partners to understand why their loved one doesn’t see the damage or do something about it. It seems so clear, yet, there often is tremendous resistance and anger directed at the non-addicted partner.
Dynamics of Addiction
It is important for partners to understand that the drug of choice (or addictive behavior) is the primary relationship for the person with the addictive disorder. This is the very nature of addiction.
Someone with an active severe substance use disorder most likely has experienced structural and functional changes in the brain impacting Judgement, reason, and the ability to stop. The projection of blame and minimization all serve to keep the person from accepting the reality of addiction.
Being Behind the 8-Ball
In one version of the game of pool the 8-ball is the last ball a player must sink (either stripes or solids) in order to win the game. One is said to be ‘behind the 8-ball’ when stuck in a position where any move will have a negative result — to be trapped with no way forward.
You may feel this way if your partner is denying that there is anything to be worried about with substance use. I call this the “8-Ball Dynamic” because in active addiction the person with an addictive disorder may be very skilled at putting their partners behind the 8-ball. Efforts to get help, or address concerns are met with anger, blocks, challenges, and obstacles of all sorts. No matter what move you try, you seem to lose.
When Will My Partner “Get It?”
Discuss the possibility of meeting with an addiction trained professional to try to sort things through with an initial assessment. I worked as a Clinical Director in a drug and alcohol treatment program years ago and learned that the staff could never really tell initially who was going to be successful or drop out of the program. Those patients that at first looked motivated could still relapse. Those most resistant to treatment sometimes proved to be the poster child for addiction recovery.
We never know what will happen, people can suddenly “get it”. In the meantime, focus on self-care is essential. Get help and support, go to Al-Anon and/or other support groups. Remember you can’t control your partner, no matter how loving or how angry you get.
Recognize the “8-ball dynamic” for what it is, a symptom of active addiction. Don’t buy into blame or accusations, from yourself or others. Instead try to focus on help for yourself, especially if your partner refuses to address the issue. It’s a hard thing to do, but you don’t have to stay behind that 8-ball.