Chapter 18

Substance Abuse in Marriage

Impact of Substance Abuse

Case number 18 focuses on substance abuse in marriage. The man is passive-active, and the woman is an active personality. They had been married 15 years, and the woman was not using any substances. However, the man had a long history of abusing alcohol, tobacco and drugs. At one time, he had been using large quantities of heavy drugs like LSD, amphetamines, as an example. He had long hair down close to his waist, and a big, full beard. He was a leftover from the hippie era where he had been into the drug scene and culture, and had continued the drug usage off and on over a number of years, which was the major issue in their marriage causing many arguments. Looking at the Symptoms of the Dysfunction text you will find: poor work performance or loss of or a series of jobs. This man was a machine operator in a factory, and had been disciplined for arguments with the management and given several days off, had been fired, had come to work while using substances, and had been through a treatment program. He had poor health and ongoing physical deterioration. The man was tall and skinny, because he didn't eat really well, and would drink his dinner at times. He'd had a number of DUIs. He had typical legal difficulties with creditors, or arrests for burglary, drunken driving, and drug sales. He had a pattern of late payments on bills, trouble with a mortgage company, on top of marital difficulties of all types. You will also see in the symptoms list, violence, multiple marriages, adultery, child abuse. In this case, he had been violent more than once, and had separated from his wife. There had been adultery or potential adultery. The addiction levels may range from casual use to total addiction with the inability to function within societal norms. In general and throughout the decades, research shows 11-13% of American adults abuse either alcohol, drugs or both at any given time.  A lot of people are weekend drinkers. Some of them are 4-6 beers at night. Some of them are bingers. Some of them go on patterns of drinking which can lead to violence towards other people or each other, loud, angry discussions, shouting, threatening gestures, and extreme emotion. There was a lot of that, a lot of “I'm so sorry. I'll never do it again. And then, who do you think you are?” 

In this case, the three children learned when he was drinking, and they even confronted him, sometimes properly, sometimes arrogantly. The mother was pretty strong in her discipline of the children, so that didn't get out of hand. But she still wrestled with the effects of her husband’s addiction  on her relatives. Her parents had been very concerned for a number of years, and she went to live with them during the separation. Inappropriate control or sexual dysfunction results from addiction. The two of them had not experienced any closeness or sexual frequency for a very long time, because of the unending problems and no relationship to God. In this case, while the man was struggling with substance abuse, he had been saved and had been involved with street evangelism through a church. He became disillusioned with the church, because he felt that they weren't doing their part. He saw them as being dishonest and hypocritical. All those sorts of issues came into the forefront when I started to work with him

The Treatment text says to “identify the type of substance and quantity that the client is using, in order to find the proper medical facilities to maintain the physical health and safety of the client.” The client may be in or have gone through a 12-step program, including 12-step meetings. When possible,  retrieve his records from these treatment programs for a further understanding of the client's background. Make no mistake here, if you get somebody who is into an extreme amount of drug usage, withdrawal from various substances can literally cause them to die.  Like a lady who worked at the local grocery store, who came for counseling at her daughter’s request.  She stated in the initial session, she stopped drinking that morning and her daughter was going to monitor her.  Even though it was strongly recommended for her to go to a local detox facility, covered by her health insurance, she refused.  The next morning her daughter found her dead in her bed apparently from her withdrawal symptoms.

You may not know all of the mixtures of drugs they have ingested. Do not try to treat this person alone. Get them into a detoxification center, at least, document that you tried. Educate both spouses about a substance abuse evaluation at a treatment center, which will determine the level of treatment needed. Tell them point blank, you must get an evaluation before I can help you. Assist them in the office to contact a facility by phone or online, that will give an initial recommendation. Do not encourage them to detox on their own, or take the risk that they would die. If they stop their daily alcohol or drug abuse immediately, this person will go into shock and could die very quickly. So, gauge the severity of their addiction. Ask them specific questions. What do you consume? How much, how often, how long? What are they medicating, like guilt/shame, past traumas, depression, anxiety, voices in their head, etc.?  What mixtures do you take? What sort of symptoms do you have? Look for DTS, (delirium, tremors, shakes), profuse sweating. Look for dilation of the pupils. Smell their clothes or breath if you can, as close you can get to them to see if you smell alcohol. If they need to go to treatment and they won't work with you, then tell them you can't counsel them. They're not ready to get help, so you need to back off from taking on that kind of case. 

If they follow your recommendations, go through detox, then you need to gather all of their medical and treatment records through a release of information. You will learn from the records important information for your counseling. Most all addicts will minimize their use of alcohol and other substances, while the treatment facility can medically monitor their detox that generally shows their level of use and tolerance capabilities.  Find out how long this has been going on. Is there a psychiatric diagnosis? Is there a DSM diagnosis? How many treatment centers have they been through? What have they tried? Have they been in a 12- step program? Let them know about public and faith based 12 Step Programs, potentially referring them to someone in recovery who will walk beside them.  Be aware that a local AA/NA, 12-step program can help them, but only to a point they, yet they can develop support from attending the meetings, less learning dependance on the Holy Spirit. There are a growing number of faith-based meetings in larger cities that do base their ministry on spiritual transformation and discipleship.

See what they believe about their “higher power”. Once you set these medical concerns aside, and both spouses demonstrate a willingness to attend counseling sessions, begin your evaluation with the ISI, IDI and the AQAL. Learn what their personality types, their concept of God and Agape love.  Inquire about their marital/family dynamics involved in the addiction issues.  Who enables the addiction?  How do they talk about problems?  Has there been violence or abuse in the home? Have the police been involved in the last year? How are the children impacted by his and/or her substance abuse?  What are the family members’ roles? Does the family need to go to AL anon?