(97) Lift Me Up or Bring Me Down: Partner Influence on Substance Use

Background & Introduction: Substance use in the context of romantic relationships is complex with research highlighting both potential negative and positive influences of partner substance use.1 In cases of alcohol use, romantic partners often influence each other’s drinking habits, acting as either a protective or risk factor depending on the relationship and context.4,5 When both partners use drugs, relationships may exhibit patterns of dysfunction in which the partnership is maintained for the purpose of securing drugs or money, rather than for emotional fulfillment, a dynamic that can foster instability and perpetuate drug use.3 On the other hand, in a recent meta-analysis, romantic relationships where only one partner uses were found to play a role in supporting the recovery process.3 The influence of partners’ behaviors and characteristics on an individual’s substance use remains an area that needs further investigation, particularly among men and women with criminal-legal involvement, a population that experiences high rates of substance use disorders (SUD). To address this gap, we analyzed interview transcripts for themes focused on relationship dynamics from two qualitative studies that were designed to understand the experiences of women and men who use substances and have criminal-legal involvement regarding their substance using behaviors before and during pregnancy.

Methods: In the first study, we conducted 33 in-person qualitative interviews with formerly incarcerated women from a community organization providing services to women transitioning from incarceration into the community. In the second study, we conducted 30 virtual qualitative interviews over Zoom (due to COVID-19) with men confined in a Midwestern U.S. community supervision prison facility participating in a reentry program. Participants had to be at least 18 years old, ever partnered with a man (first study) or woman (second study) and have a history of alcohol or drug use. Questions focused on factors that influenced substance use and sexual behaviors before and during pregnancy (first study) or partner pregnancy (second study). In-person and Zoom interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using Atlas.ti software. In this secondary analysis of interview transcripts, we used a modified grounded theory approach to create a preliminary codebook with constructs from the Health Belief Model focused on participant discussion of aspects of their romantic relationship(s) impacting their substance use, including Substances and Relationships, Barriers to cutting down/quitting and Facilitators to cutting down/quitting. Team members reached a consensus on applied codes and resolved disagreements through discussion. The codes were applied to each of the transcripts.

Results: Average age of female participants was 37 years (range 20-65), 42% self-identified as Black and 48% as White. Average age of male participants was 37 years (range 21-66) with participants 40% Black and 60% White. All women and men respondents reported a history of substance use with 73% of women having used one or more substances during a pregnancy and 48% of male respondents reported fathering a child exposed to drugs or alcohol in-utero. The majority of respondents had annual incomes less than $10,000 (88% of women and 87% of men).

Women respondents described barriers and facilitators to stopping substance use that were influenced by their male partners: (1) barriers to sobriety in a relationship where both partners used substances included using substances together as a form of bonding in the relationship, pressure to continue to use with their partner, and lack of support of a partner attempting to quit; (2) facilitators to sobriety in a relationship included a partner providing emotional support in maintaining recovery, encouraging engagement in recovery activities and having a positive relationship that improved mental health and confidence of the respondent.

In interviews with men, respondents described two distinct types of relationship contexts: the respondent used substances with his partner and only the respondent used substances. Respondents described unique facilitators and barriers to recovery within the context of these varied relationship types: (1) The aspects of partner relationships that facilitated sobriety included emotional support, increased motivation, mutual accountability, and fatherhood/partner pregnancy. (2) Barriers to sobriety were created by relationship challenges that included communication problems, discordant priorities with substance use prioritized over the relationship, financial strain, and jealousy due to infidelity and competition for substances.

Conclusion & Discussion: Romantic partners can play a crucial role in either facilitating or hindering their partner’s recovery. The conclusions drawn from these two studies emphasize the need to adopt therapeutic techniques that both leverage the positive influences romantic relationships can provide in aiding recovery and in helping to overcome the barriers that may inhibit the recovery journey of individuals with criminal legal involvement. By recognizing the influence of romantic partners within the broader social context of SUD, clinicians have an opportunity to promote healthier behaviors and reduce substance use among women and men with criminal legal involvement. Interventions aimed at improving supportive relationships through couples/family therapy and fostering group/peer support focused on navigating relationships in the context of substance use treatment have the potential to improve treatment engagement through the involvement of romantic partners.

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2) Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug use, dependence, and abuse among state prisoners and jail inmates, 2007-2009: Special report. Bureau of Justice Statistics, U.S. Department of Justice. https://www.bjs.gov/content/pub/pdf/dudaspji0709.pdf
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