By Dr. Narine Arutyounian, M.D., Medical Director
Clinical contribution by Ritsa Fistes, LMFT, Clinical Director
Healthy Living Residential Program, Santa Clarita, CA
If you and your partner are both struggling with substance use, or if addiction has shaped your relationship over months or years, you have probably already faced one of the most painful questions in recovery: Do we go through this together, or do we go through this apart?
It is a question we hear from couples nearly every week, and the honest answer is more nuanced than the standard industry response. Most residential treatment programs in the Los Angeles area do not accept couples. The default clinical assumption has been that partners need to be separated for recovery to take hold that being together during treatment will compromise the individual work, dilute the focus, or blur the boundaries required to get well.
There is real clinical reasoning behind that assumption, and we take it seriously. But decades of research on couples-based addiction treatment and our own clinical experience at Healthy Living tell a more complete story. For the right couples, going through residential treatment side by side, with a clinical team that treats each partner as an individual while honoring the relationship between them, can be one of the most effective paths to long-term recovery available [1] [2].
In this article, I will walk through how couples treatment actually works clinically, why so few programs offer it, which couples are appropriate candidates, what the research says about outcomes, and how our 30-day residential program at Healthy Living is structured to make shared recovery possible.
Why So Few Programs Accept Couples
When two people who use together enter treatment together without proper clinical infrastructure, three things tend to interfere with recovery:
- Codependency. One partner’s identity becomes wrapped up in managing, rescuing, or being needed by the other [3].
- Enabling behaviors. Loving each other has quietly become a way of accommodating the addiction covering for missed work, smoothing over consequences, financing use, or minimizing severity [4].
- Shared triggers and cues. Two people who used together carry environmental, emotional, and relational cues that the brain has paired with substance use. When those cues are present in treatment, relapse risk for one partner can pull the other down.
The fear that one partner will relapse and trigger the other is not theoretical. It happens. And the risk that couples will use shared treatment to avoid the deeper individual work each partner needs to do is also real. Any program offering couples treatment without addressing these dynamics directly is setting both partners up to fail.
That is exactly why our couples program at Healthy Living is built the way it is around individualized clinical care, structured daily programming, medical oversight, and a clinical team experienced with the unique dynamics of shared recovery.
What the Research Says About Couples-Based Addiction Treatment
The evidence base for treating couples together in addiction recovery is stronger than most people realize. Behavioral Couples Therapy (BCT), the most studied couples-based model, has been examined in more than 20 randomized controlled trials over four decades.
The findings have been consistent:
- BCT produces greater reductions in substance use than individual-based therapy alone [1] [5].
- BCT produces higher relationship satisfaction and improved dyadic functioning [2].
- BCT is associated with reduced intimate partner violence and improved psychosocial outcomes for children in the household [6].
- A meta-analysis of 12 randomized controlled BCT trials (n = 754) found that BCT outperformed control conditions across substance use frequency, substance-related consequences, and relationship satisfaction at post-treatment and at 12-month follow-up [7].
BCT is now considered a “gold standard” couples-based intervention for substance use disorders [2]. At Healthy Living, BCT principles are integrated into our broader clinical programming alongside individual evidence-based care.
Which Couples Are Appropriate for Shared Residential Treatment?
Not every couple is a good candidate for going through residential treatment together. In our clinical assessment, the couples who succeed in shared treatment generally share three characteristics:
| Indicator | What It Looks Like Clinically |
|---|---|
| Mutual commitment to recovery | Both partners are entering treatment voluntarily and are genuinely motivated, not coerced by the other |
| Willingness to do individual work | Both partners understand and accept that their personal clinical work is the foundation, not the relationship itself |
| Absence of active intimate partner violence | No current pattern of physical violence, intimidation, or controlling behavior that would make shared treatment unsafe |
When those conditions are present, treating couples together can produce outcomes that single-partner treatment cannot not just sobriety, but a measurable rebuilding of the relationship itself.
When those conditions are not present, separating partners for treatment is the safer clinical choice, and we will say so directly during the admissions assessment.
The Patterns Addiction Creates in Relationships
Addiction does not stay in one person’s lane. When substance use is part of a relationship, it almost always brings with it patterns that have to be examined and unlearned for either partner to fully recover. The most common patterns we see clinically:
Codependency
A codependent partner’s sense of identity and self-worth becomes tied to managing or rescuing the other [3]. This can look like love, and it often starts as love. But over time, the codependent partner may unconsciously fear that recovery will make them no longer needed and that fear can drive subtle behaviors that interfere with treatment, even after treatment has begun [8].
Enabling
Enabling is the slow, often invisible accommodation of an addiction by the people closest to it. Covering shifts at work. Making excuses to family. Paying off debts. Calling in sick. The enabling partner is usually doing what feels loving in the moment, but the cumulative effect is that the addicted partner is shielded from the natural consequences that often drive someone toward treatment [4].
Shared Trauma and Trauma Bonding
Many couples in active addiction share trauma histories whether from family of origin, from earlier life, or from the relationship itself. Substance use becomes one of the ways the couple manages, avoids, or numbs that trauma together. Untangling the trauma from the substance use is essential clinical work for both partners.
Communication Breakdown and Erosion of Trust
By the time a couple reaches residential treatment, honesty has often been replaced by avoidance, secrecy, or chronic conflict. Lies told to protect use, money spent that wasn’t accounted for, promises broken these accumulate. Rebuilding trust is slow, deliberate work that cannot be skipped.
Our clinical team is experienced in working with these dynamics not by lecturing couples, but by giving each partner the individual tools to recognize their own patterns, take responsibility for them, and begin the slow work of building something healthier.
How Couples Treatment Works at Healthy Living
Each Partner Receives Their Own Personalized Treatment Plan
This is the core clinical principle of our couples program. When you and your partner enter Healthy Living together, you do not enter as a unit you enter as two individuals. Each of you receives:
- A separate clinical evaluation
- A personalized treatment plan based on your unique medical and psychological needs
- Your own primary clinical relationships with our therapists and physicians
- Your own path through the 30-day program
This is not optional, and it is not a formality. It is what makes shared recovery actually work. Without each partner doing their own deep individual work, treatment becomes a shared experience without shared transformation.
Medical Detox, Supervised 24/7 by Board-Certified Physicians
For couples whose substance use has progressed to physical dependency whether on alcohol, opioids, benzodiazepines, methamphetamine, cocaine, or other substances, medically supervised detox is the safe and necessary first step. Withdrawal from alcohol and benzodiazepines in particular can be life-threatening without medical supervision.
At Healthy Living, both partners receive medically supervised detox managed around the clock by our physician-led team. Our Licensed Vocational Nurse administers Medication-Assisted Treatment (MAT) as part of a carefully structured protocol, and our doctors are on call 24 hours a day, seven days a week.
Structured Daily Programming Built Around Individual and Shared Growth
Our daily schedule is structured and intentional from morning to evening. Both you and your partner attend the same clinical programming, but you participate as individuals building your own insights alongside the small community of clients in our 12-bed facility.
Daily programming includes:
- Morning Reflections
- Medication Administration with our LVN
- Process Groups
- Recovery Maintenance
- Health in Recovery
- Anger Management
- Step Study
- Psychodrama
- Breathwork
- Rock to Recovery
- Faith in Recovery
- Mindfulness
- Yoga
- Art Therapy
- Rotating Groups
All groups are facilitated by our licensed therapists, LMFTs, certified counselors, and credentialed recreational therapists. Evenings include dinner, AA/NA meetings, and a structured wrap-up session to close each day.
What If Only One Partner Is Struggling?
Many of the couples who come to Healthy Living are in a situation where only one partner is dealing with active substance use disorder. The other partner is often exhausted, hurt, or simply ready to be part of the healing process.
We welcome these couples too. Our program prioritizes the clinical recovery of the partner with substance use disorder, while creating space for the other partner to:
- Address their own emotional needs
- Examine and unlearn codependent or enabling patterns
- Build healthier ways of supporting a loved one in recovery without losing themselves
- Begin their own work in family-of-origin and relational therapy
Both partners benefit. Both partners heal. And the relationship benefits because of it.
Pets Welcome
For many couples, a beloved pet is part of the family they are coming to treatment to protect. At Healthy Living, pets are welcome at our facility one less logistical barrier between you and the help you both need.
Aftercare: Building What Comes Next, Together
The 30-day residential program at Healthy Living is the foundation, not the finish line. Before you complete the program, our clinical team will work with both of you to develop personalized aftercare plans that support continued recovery as individuals and as a couple. This may include:
- Outpatient services (IOP or PHP)
- Sober living arrangements
- Ongoing individual and couples therapy
- AA/NA community resources
- Recovery support programs throughout Santa Clarita and the greater Los Angeles area
Couples in active recovery should expect that the relational work continues for months and years after residential treatment ends. That is normal, and it is not a sign of failure it is the actual work of building a life together that addiction does not define.
When Shared Treatment Is Not the Right Clinical Choice
To be clear about something we tell every couple during admissions: shared residential treatment is not always the right call.
If one partner is not genuinely committed to recovery, if there is an active pattern of intimate partner violence, if one partner’s clinical needs require a level of separation we cannot provide on-site, or if either partner would clearly benefit more from gender-specific or specialized care elsewhere we will say so during the admissions assessment. We would rather refer you to a more appropriate level of care than admit a couple whose situation our program cannot safely serve.
Our admissions team conducts a thorough clinical screening with each partner individually before approving any couple for our program.
Why Choose Healthy Living Residential Program
Healthy Living Residential Program is a 12-bed co-ed residential detox and treatment facility in Santa Clarita, California. We are DHCS licensed and JCAHO accredited, owned and operated by board-certified physicians and staffed by licensed therapists, LMFTs, certified counselors, and credentialed recreational therapists.
We welcome couples in our 30-day program. We accept most PPO insurance plans, and our admissions team is available 24 hours a day, seven days a week to verify benefits for both partners, answer your questions honestly, and help you understand what enrolling together would actually look like.
We serve couples from across Los Angeles County, the San Fernando Valley, Burbank, Glendale, Valencia, Newhall, and communities throughout Southern California.
You should not have to choose between your relationship and your recovery. At Healthy Living, you don’t.
Call us today at (661) 536-5562. Together that is how you got here, and that is how you can begin again.
Learn more about our Couples Program →
Sources
[1] Fals-Stewart W, O’Farrell TJ, Birchler GR. (2008). Behavioral Couples Therapy for Substance Abuse: Rationale, Methods, and Findings. Science & Practice Perspectives. https://pmc.ncbi.nlm.nih.gov/articles/PMC2851021/
[2] Schumm JA, et al. (2022). Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature. Behavioural and Cognitive Psychotherapy. https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/mechanisms-and-moderators-of-behavioural-couples-therapy-for-alcohol-and-substance-use-disorders-an-updated-review-of-the-literature/FAC067342A79B2B339B9B41F045208DF
[3] American Addiction Centers. Codependency & Addiction: Signs, Effects and Treatment. https://americanaddictioncenters.org/rehab-guide/family-members/codependent
[4] Recovery.com. Codependency and Addiction: Understand the Relationship and Get Help. https://recovery.com/resources/codependency-and-addiction/
[5] Schumm JA, O’Farrell TJ, Kahler CW, Murphy MM, Muchowski P. (2014). A Randomized Clinical Trial of Behavioral Couples Therapy versus Individually-Based Treatment for Drug Abusing Women. Journal of Consulting and Clinical Psychology. https://pmc.ncbi.nlm.nih.gov/articles/PMC5364810/
[6] Klostermann K, O’Farrell TJ. (2013). Behavioral couples therapy for the treatment of substance abuse: a substantive and methodological review. Journal of Family Psychotherapy. https://pubmed.ncbi.nlm.nih.gov/21083548/
[7] Powers MB, Vedel E, Emmelkamp PMG. (2008). Behavioral couples therapy (BCT) for alcohol and drug use disorders: A meta-analysis. Clinical Psychology Review. https://www.sciencedirect.com/science/article/abs/pii/S0272735808000275
[8] Pathways Recovery. Codependency in Recovery. https://pathwaysrecovery.com/blog/codependency-in-recovery/
About the Author
Dr. Narine Arutyounian, M.D. is the Medical Director at Healthy Living Residential Program in Santa Clarita, California. She oversees the medical care of all clients in detox and residential treatment, and leads the physician-led team that provides 24/7 medical supervision at the facility.
Clinical contribution by Ritsa Fistes, LMFT, Clinical Director at Healthy Living Residential Program. Ritsa oversees the clinical programming and therapeutic services at the facility, including the couples treatment track.
