Treating drug users whose partners misuse

The substance-fuelled exploits of singer Amy Winehouse and her husband Blake Fielder-Civil have often been splashed across the tabloids. Her parents have long laid part of the blame for their daughter’s continuing drug problems on her husband. Until recently, Winehouse denied this, but she has recently said, according to the Daily Telegraph: “Our whole marriage was based on drugs.“

More often than not, substance misusers are surrounded by a network of other users but when that includes a partner problems are multiplied. Anyone who has tried to diet or give up smoking only to be faced with their partner eating junk food or lighting up will know the willpower needed to resist temptation.

Surely the craving for the next heroin hit is even harder to resist if your partner uses in front of you, and it is an everyday part of your relationship.

Working with someone who wants to end their addiction, but whose partner is also an addict, is challenging for drug workers and social care practitioners. Zoe Davis, assistant director of operations, north east, for drugs charity Addaction, says: “A lot of workers think it’s almost impossible to deal with a client like this because it’s a very difficult issue if their partner is also using and the person has to break a strongly entrenched behaviour. But they can be worked with successfully.”

Wanting to change

Addaction helped 26,746 people into treatment across the UK to the year ending July 2008. Key to achieving positive outcomes is for the client to really want to change – even if their partner hasn’t yet reached the same point. Davis says those who voluntarily contact the charity for support are more likely to have success in tackling their addiction than those who are there through a drug rehabilitation requirement in a community order.

But partners may try to derail any steps towards recovery. “Partners who are still using drugs and alcohol can be quite manipulative because they are fearful of losing that person,” she says. “My staff have come across partners self-harming and making themselves homeless in order to sabotage their partner who has stopped.”

Heidi Alexander is a social worker in Edinburgh Council’s drug referral team. She has a caseload of between 10 and 12 – of whom half admit their partner also uses – and works with clients for 16 weeks to find them appropriate community-based support.

Dynamics change

She has found when an addicted person is in a relationship with another user their habit sometimes goes unchallenged because each person is dependent on the other continuing to use. The dynamics of the situation then change if one partner wants to stop using and not all relationships survive such a huge change.

“Drugs or alcohol in a relationship is like a mistress, it is a third party,” says Alexander. “When one member of the party is moving away from using and has a distinct commitment to recovery, in order for the relationship to survive it means specialist help is needed.”

So is it ever right for a practitioner to advise a client to leave their substance misusing partner in order to help themselves? Alexander doesn’t think so, but says professionals have a responsibility to work with the individual to look at what may help or hinder their recovery – and this may include their relationship.

Social work values

This is something social workers can be particularly skilled at, she adds, because of the ethos of social work. “Social work values dictate that people should work with the best intentions at all times,” Alexander says. “I intervene with a client to help them reclaim responsibility for their own lives and not be directed by drugs.”

Jonathan Cooke firmly agrees. He has first-hand experience of overcoming an addiction: he was dependent on alcohol and drugs for more than 15 years before he stopped using them in 1991. Now, as addictions team leader for residential rehabilitation provider the Priory Group, he says: “It is none of our business to tell them to leave their marriage. We don’t bring the partner into the equation. The person at the Priory is here as an in-patient and the partner may not want to talk to us. Our advice to the client is ‘don’t make any dramatic changes unless the environment is a risk to you’.”

Discussing home life

This does not mean that practitioners should avoid raising difficult issues with a client about their home life and interpersonal relationships, but when they do, they must do so with care and respect, he says.

Encouraging the client’s partner into treatment is one way of trying to resolve the problem. John Dunn, clinical team leader at the National Treatment Agency and consultant psychiatrist in substance misuse for Camden and Islington Foundation NHS Trust, is in favour of this: “Professionals should encourage the partner into treatment, either separately or offer a three-way intervention where the patient brings the partner in, or the partner has separate treatment,” he says.

Engaging in treatment together can be difficult for addicted couples because of the highly personal nature of the therapy they have to undergo.

Dunn favours sequential treatment because some clients may feel restricted about what they reveal in therapy sessions if their partner is there. “A lot of residential rehab facilities won’t take partners in because they are worried about the influence it may have on other patients,” he says.

Best practice

So how can practitioners best work with clients who want to end their addiction when they are in a relationship with another misuser? Alexander says the key is not to be judgemental and to create an environment where people can reveal their concerns about stopping their use, and signpost them to appropriate support agencies. “Be honest, transparent and respectful at all times and acknowledge their right to a relationship but be clear about your concerns that continuing their relationship can be a risk to them.”

Looking at what may trigger any continued drug use is also important, says Davis. “Practitioners need to work with clients on what the danger points are in the day for example, can they avoid being around at the time of day their partner is using?”

Dunn says it is also important for a person to identify what internal triggers, such as unhappiness and isolation, may prompt substance misuse and not just focus on the fact that their partner continues to use.

In denial

When two addicted people are in a relationship there is “an elephant in the room” – they are often in denial about the serious impact on their health and well-being, just as Winehouse appears to have been until recently. It takes courage and strength to overcome an addiction, especially if your loved one continues to use.

Successful recovery is very much an individual achievement, with no right or wrong approach. For Cooke, addicts can sometimes inspire each other: “If a person gets well and goes back to their partner who is still using, then showing the partner their wellness is the best thing they can do for them.”

• For more, see our expert guide on substance misuse