Expert: Peter L. - 4/26/2011

Question
Hi, I am a new addictions counselor, and while I am fine with most aspects of addiction, and counseling for same, I am currently employed in a prison, where one half of a relationship is clean and looking for help due to being in prison... My question is this, how do I help these guys manage recovery, and build treatment/recovery plans with them if their biggest trigger to use is a spouse who is still using, and they are not willing to give her up?  There are two treatment centers here that do couples treatment, but both are aboriginal so that excludes anyone of any other origin from attending.  Plus I have zero contact with the spouse.  I am in no way ever able to talk to that spouse or offer any kind of counseling.  For the guys who are willing to leave still using spouses this is at least doable, ie I can help them formulate a recovery plan that makes sense to them, but I am totally stuck on what to offer these poor guys who are not ready or able to leave a still using spouse, yet desperately want to remain clean themselves.  Any treatment model or useful resource would be very much appreciated.  Thank you

Answer
Hi Cris,

Thanks for a very unusual question, and I'll do my best to answer it.  You are also in a very interesting part of the world that I have always wished to visit!

First, congratulations on deciding to pursue an addictions counseling career.  It has very many rewards, and the challenges you describe are, to me, what makes it such a compellingly interesting field.

I can understand the issue you are describing, and have had many clients with the same dilemma.  If they don't have a still-using spouse, they have still-using other family members or acquaintances who can always pose risks to their recoveries.

The key point here can be made here, or the question that can be asked is: "How much is one willing to sacrifice in the pursuit of a sober life?"  A number of my clients who may not be doing well at an intensive outpatient level of care resist inpatient options, even though they recognize they are failing at the outpatient level. They don't want to leave their homes, families, pets, etc.  But, they can't stay sober in their current domestic environment.  As long as they try to run their treatment in that way, they fail.

Your incarcerated clients have some important decisions to make.  One decision to be made has to consider the futility of living with a still-using spouse.  Now in recovery, your guys have become different individuals.  They are learning how to scan their environment for relapse triggers, ascertaining dangerous situations, and making necessary changes to support recovery.  You are helping them develop these plans.  It's important for them to understand that there cannot be two realities in recovery: one being involvement in a committed relationship characterized by substance use behaviors that remain in either party, and the other the attainment of a secure recovery environment.  There can never be a secure recovery environment where there is a still-using individual present.  So, these two realities cannot co-exist, even though one would wish that somehow they can.

So we come back to the essential point: How far will you (i.e., the recovering individual) go in creating a secure recovery environment?  That choice ultimately lies with your clients.  They can either listen to the thousands of individuals who have preceded them in recovery and engaged in every recovery behavior scenario- successful or unsuccessful - or choose to reject common wisdom and go their own way.  It's their failed recovery to have, if they wish.  Live and learn.

Another strategy might be for there be some insistence that the spouse enter treatment as well.  Why would the still-using spouse ever think there can be co-existence with a recovering person?  Only one who is so blindingly caught up in their addictive lifestyle could believe that.  Yet some will.  If that person is not willing to pursue recovery themselves, they will never truly support the recovering spouse.  Can you imagine that scenario?  "Great to see you going to those meetings, and connecting with that sponsor, and keeping up your aftercare appointments" while smoking a joint, crack, or swallowing a few oxys.  And if they did manage to express some apparent genuineness, it would be hollow, as there can be no (credible) hypocrisy here.  Hypocrisy is hypocrisy.

I hope this is helpful to you.  I don't know of any treatment materials or models that specifically address this circumstance, but you might find something with some searching.

Peter