In my 18 years of practice, I have encountered many clients who either personally have addiction problems or are married to someone who does. My heart goes out to these clients, and I want to be a source of help to them. So, I asked Dr. Robert Martin, a psychiatrist, if he would provide some understanding of addiction and how he can offer help to those who need it.
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Addiction is any family's nightmare. The affliction torments, interferes, and aggravates any relationship. In a marriage or almost any committed arrangement, it insidiously destroys any semblance of trust or loyalty. Addicts promise the sky and give the grave.
All committed relationships are based on trust, understanding, and the expectation that betrayal is out of the question. When these building blocks of conviviality and comfort are knocked out of place, the love between two people, no matter how strong it once was, begins to rot away.
Despite this, it is important to appreciate that the addict may be just as dismayed by the turn of events in a relationship as is the victim on whom the addiction plays out the relationship's disintegration. Addiction is an affliction. Let no one tell you anything different. The idea that a person brings it on themselves is an over simplification. It is an illness of enormous complexity which common thinking reduces to a failure of will. Installing the will into people to make them "beat the addiction" is not an easy task. The reason for this is that will is not by itself enough, and behind this is the increasingly obvious fact that the body fights the will.
It is safe to say that no one wants to be an addict. Why would any person wish to be forever attached to difficult to obtain drugs which make them feel a moment of comfort and hours of misery? Would anyone want to die with a heroin needle in their arm, losing their last breath as the drug robs them of the ability to breathe? Is there an athlete in the world at large who wants to be performing when a stimulant such as cocaine suddenly stops their heart? Does anyone enjoy the vague fuzziness of thinking which interferes with their relationships and sense of responsibility that pain killers such as codeine cause? Why would anyone want to slobber over themselves, waddle down a dark street at night, completely confused only to later find themselves waking up in a jail cell or emergency room from severe alcohol intoxication. I assure you, no one wants these effects of addiction.
George and his wife loved each other until after work bar blasts in the city led to the use of cocaine. He began coming home at ten or eleven at night, making excuses about work keeping him away. Alice knew at once his explanations didn't make sense, but he became enraged whenever she challenged him. He was fidgety at night, tossing and turning in bed, and complaining of insomnia. Insomnia was new for him; in his thirty years of life, and five years of marriage, he never had problems with sleeping. All of this confused and troubled Alice until she found powder in his sock drawer. She put all of it together and came up with cocaine. Now his anger made sense, as well as his persistent irritability, his growing irresponsibility in not paying bills or forgetting other obligations. When he lost his job she knew the final straw had come.
Addicts don't come home and announce their addiction. They feel ashamed and fearful that they will have to give up their solution to an otherwise bored, troubled, or unhappy life. Their misery has to be discovered. The first thing someone like Alice asks is what can she do. The answer is both easy to know and hard to implement.
Addiction has two sources: one is emotional difficulties that the addict can't face; the other is the addiction itself. Each addiction has to be approached in different ways. The cocaine addict has to stop. The alcoholic has to stop but there are drugs that can help. The opioid addict can use methodone or gradually wean from use. The Xanax and Valium (benzodiazepines) addict also has to gradually be weaned from use. All of these types, must face their underlying psychological troubles which feed the addiction. This combination of medical care with the drugs and psychological assistance with the emotions is the mainstay of addiction treatment. Putting George in an institution for a time will get him off the drugs, but will not approach the issues that left him empty and unhappy.
If a couple does not address the addiction as soon as possible, the marriage will suffer. The distrust that's created eats into the security of the relationship like a worm in an apple. Alice needs emotional support, George needs to understand his demons. Marital counseling will help, but the bottom line is that, in order for the marriage to survive, George has to give up his addiction. The distrust, the lies, the subterfuge that addiction behavior creates is against the survival of any relationship. It is most important that Alice sees it as George's immediate problem, and both of their long term problem. However, Alice should not allow George to victimize her and must not take his behavior as a statement of her personal failure.
It is impossible to cover all the issues regarding addiction here. The essential understanding includes an appreciation of the power of chemicals to capture certain people's brains, an appreciation that there is always an assortment of psychological issues leading to the addiction in the first place, and, finally, that the non-addicted spouse should not allow himself or herself to be destroyed or victimized. The problem should be confronted with all the energy available and if the addiction cannot be eliminated, the only solution likely is the dissolution of the marriage. Sadly, this way, one person can be saved.
However, if the addict is courageous enough to confront his or her addiction and comes for treatment, the care will be respectful and tailor made to the individual. A regime for dealing with the drugs involved will be established. The addict will be encouraged to face the problems which preceded the drug abuse. Marital counseling designed to protect the innocent spouse and to encourage a re-establishing of the trust essential to any relationship may be implemented. Addiction is an individual affair and a family affair. You cannot treat the addict without the family involvement.
Alice brought George to see a psychiatrist. He came because he loved Alice, realized he had a serious problem, and decided he wanted help. He was weary of the strife his addiction caused. His cocaine use was related to a long standing depression that was never treated. The causes for the depression were addressed and George was placed on an anti-depressant. Alice was coached on how to handle George's problems and was given support that this problem was not of her doing. George was seen for individual sessions as well. He did over his resume, and was able to get another job in the finance industry. Marital counseling helped them see some of their earlier problems in a different light; in this way adjustments between them were made. They developed a better understanding. The addiction became a side light to the more significant life problems that needed to be addressed. George began to live better. Both were greatly relieved.
They both had to come to terms with the reality of the situation. George had to confront his problems, most of which related to his relationship with his parents and issues during his developmental years. Alice had to understand that George's addiction was separate and apart from their marriage. Often spouses believe their loved one's behavior is connected to them in some way when it is not. By Alice realizing George had a problem and helping him confront this problem without feeling she was part of it, she could more accurately help him. The causes of addiction usually predate the relationship in the marriage. Confusing marital issues with addiction issues is not helpful. As George and Alice saw the addiction issue as separate from their marital differences, their approach to each changed. This led to constructive changes on both their parts.
Sadly, this outcome is not always achieved. If the addicted person is in a stage of denial in which he or she avoids the impact of their behavior on the marriage, little can be accomplished. Therapy can only work with a cooperative person. If the addict is immersed in covering their feelings with drugs, he or she is not going to participate in controlling and understanding themselves. In this case, the non-addicted spouse may have no choice but to break off the marital relationship, a healthy option to save him/herself from a life of misery.
Robert D. Martin, MD, FAPM has been in academic and private practice for over 40 years. He has practiced marital, group, and individual therapy, with particular emphasis on addiction issues. He also is board certified in two areas, both general psychiatry and psychosomatics. He is able to help people with medication requirements as well as personal therapy, and, when required, is comfortable doing both at the same time. He is certified to use Buprenorphine in the treatment of opioid addiction. His titles include Associate Clinical Professor of Psychiatry at Hofstra Medical School, Senior Attending Psychiatrist at the North Shore Long Island Health Systems, Teacher at Nassau County University Hospital, and fellow of the Academy of Psychosomatic Medicine.
