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Drugs and the Couples Who Love Them

Updated: Aug 30, 2023

Wine, chocolate, cigarettes: psychoactive substances have long been trappings of romance. As far back as high school English, I was instructed that the definition of romanticism owes a debt to the Shelleys and their opiates. For lovers who make substance use a routine rather than a romantic ritual, the days of wine and roses turn tragic. Psychologists have other words for this dynamic: codependency, misplaced loyalty, marital dysfunction.*


Some anthropologists take issue with the way substance-using couples are depicted in mainstream public health scholarship: “While other people have lovers and spouses,” wrote Nina Glick Schiller, “drug users have only ‘sex partners.’”  People who use drugs—whether in couples or subcultural social networks—are seen as a special population at greater risk for contracting and transmitting infectious diseases such as AIDS or hepatitis. Neutral scientific terms like “sex partners” are designed, at least in part, to de-stigmatize at-risk populations by objectively describing pathways of disease transmission that might necessitate public health interventions.

But even before the AIDS crisis reinvigorated the perception of substance-using sex partners as vectors of disease, self-help and social science literature depicted the relationships as degrading. Seminal research by scholars like Howard Becker or Marsha Rosenbaum demonstrated that romantic relationships between people who misuse psychoactive substances tended to be dysfunctional and self-destructive, suggesting that true love and frequent substance use are fundamentally incompatible.

Such bad romances were inevitably linked to issues of gender. Throughout much of the twentieth century, women who used illicit drugs were depicted as either vixens or victims in the context of their romantic relationships or sexual encounters. Regardless of who initiated the relationship (or the substance use), male partners tended to take responsibility for procuring illicit substances, and thereby often took the punishment for female deviance. Taking a few talking points from radical feminists, addiction treatment reformers in the 1970s created single-gender treatment centers. Some versions of woman-centered addiction treatment, like the battered women’s shelters that emerged at this time, viewed aggressive or mutually destructive relationships as symptoms of patriarchal false consciousness, not unlike the compromised will so often associated with addiction itself.

By the 1970s, a time of rapid privatization and expansion for the addiction treatment industry, a special population of substance-using women presented a niche market opportunity. As sociologist Laura Schmidt explained elsewhere on Points, the scant scientific literature on the efficacy of treatment tailored to women suggests that the outcomes are decidedly mixed.


While addiction related epidemiology and ethnography studies often examine the social and interpersonal dynamics surrounding substance use, treatment research metrics in the United States have remained focused on individual behavior change. One early study that used the substance-using couples (or “dyads”) as a unit of analysis found that, “for couples in which both partners abused drugs, a higher percentage of days abstinent was associated with relationship instability.” Effective treatment apparently revealed that what bound these couples together was a shared love of substance use—not each other.

Recent research led by ethnographer Janie Simmons complicates this finding and commonplace assumption. In a qualitative study, Simmons and Singer found that the gendered dynamics of drug acquisition and administration among couples were fluid rather than fixed. In contrast to earlier findings, when the study participants were able to access treatment together and subsequently maintain sobriety over time, their perception of their relationship improved. Simmons calls for a reformation of the current treatment system that works “against couples” rather than “with them.” Contemporary drug treatment is based on the premise that the relationships in which substance-using couples are entangled will necessarily pose a “threat to recovery” by “pull[ing] patients out of treatment and back into the streets with a resumption of drug use.”

Cathy Thorne &

A clinical trial of an educational intervention targeting HIV-negative couples who were  were active drug users or had recently entered treatment randomized participants into three groups: individual, couples, and control. Compared to participants who took prevention education classes individually, the participants who took classes together as couples experienced a 41% reduction in unprotected acts of intercourse when the researchers followed up with them one year later. The couples also experienced a greater reduction in injection drug use behaviors (although these results were only marginally statistically significant). Still, the study suggests that in some circumstances, romantic relationship dynamics can be channeled into powerful positive health effects for people who use drugs.

Of course, in some cases, a clean break is the best decision for both members of a couple struggling with addiction. And many people newly invested in recovery happily swear off romantic entanglements in order to allow them to focus on their own spiritual and psychological development. But, for those who want to work on their relationships and recovery at the same time—a fairly common practice in the context of family therapy—the available options for treatment present constraints (see the chart above). While historians aren’t always the most reliable source for relationship advice, we do have practice in challenging current assumptions and re-assessing earlier evidence. Given a second look at records related to couples that used substances, I wonder whether we might find chronicles of healing as well as dysfunction, true love as well as tragedy.

* This post focuses on heterosexual relationships. Same-sex relationships are a different story.

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