The Impact of an Inpatient Treatment on the Psychodynamic and Symptomatology in Couples Concordant for Substance Use: An Exploratory Study

Abstract

Background: Much literature deals with patients who use drugs and have partners who are drug-free. However, concordant couples, in which both partners are consuming drugs, are sparsely examined in the literature. This might be due to the fact, that couples are rarely treated together in healthcare services. Despite that fact we propose that it is feasible and clinically meaningful to treat concordant couples in the same ward. Consequently, this study pursues the goal to expand the body of knowledge in the treatment of concordant couples investigating the research question: is it feasible, clinically and prognostically meaningful to treat these patients in the same ward? Method: This exploratory study included five concordant couples (ten patients), which were simultaneously treated between August 2013 and November 2014 in a specialised substance use ward at the Psychiatric Hospital Münsterlingen, Switzerland. All patients passed through a psychodynamic characterisation based on the OPD-II interview and the Structured Interview for Personality Organization. Symptom load was measured with the Brief Symptom Inventory at admission and termination of treatment. We calculated comparisons at the individual level using t-tests for paired samples. Results: We showed that it is feasible and clinically meaningful to treat couples concordant for substance use in the same ward. The psychodynamic characterization of the five concordant couples revealed recurring patterns of collusion, involving divided roles between dependence and independence, caregiving and neediness, activity and passivity, control and submission, strength and deficiency as well as superiority and inferiority. The patients didn´t change significantly on the BSI between pre- to post-treatment, although men (d = 1.64) benefited to a greater extent than women (d = 0.10). Conclusion: Treating concordant couples together in the same inpatient setting is unusual, but feasible and clinically useful, because it makes it possible to take into account the couples dynamics in the treatment.