“He would take pain killers like Oxycontin and morphine, and I was addicted to heroin,” wrote a woman named Heather on an online forum. She also said: “We have both battled addiction but we are different.”

She noted she had been clean for a month — but that her boyfriend “uses Adderall and also drinks a lot to cure his withdrawals, and I fear it will just cause another addiction. What do I do?”

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Right now some 2 million Americans use prescription painkillers or heroin. About 78 Americans die every day from an opioid overdose. Things just seem to be getting worse as people overdose in libraries, stores, parks, and in their own homes. And more couples use drugs together now — making full and lasting recovery even more tenuous.

Some 2 million Americans use prescription painkillers or heroin. About 78 Americans die every day from an opioid overdose.

The woman known as Heather described how her boyfriend is only clean when he comes to stay at her place — the rest of the time, he’s back to using and drinking all day. “I am still clean, yes,” she said, “but I am still having pains and my sleeping patterns are horrible. I don’t know what to do anymore.”

Remaining in a relationship in which the other partner continues using is a “high-risk situation,” according to Dr. Ryan Potter, director of clinical development at Ambrosia Treatment Center in Singer Island, Florida. Potter has seen numerous patients in these situations succeed, such as alcoholics who return to their jobs as bartenders without falling into addiction. It’s possible to stay sober — but it requires a lot of what Potter calls “extra credit”: attending support group meetings after work, setting up boundaries on behavior, and absolutely rejecting opioids or opioid use in the home.

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Once the sober partner has detoxed in a controlled environment, returning home to a partner who has continued using means sometimes facing compromising situations. For instance, if the sober partner discovers a stash of drugs, it could be a tremendous trigger for backsliding into abuse. In this case, “the sober partner is going to have to immediately call a sober support person, and leave the home as soon as possible,” said Dr. Howard Samuels, a recovering addict and founder of The Hills Treatment Center in Los Angeles, California. “An opiate addict cannot be around any opiates, or be around anybody under the influence of opiates, because it’s too much of a trigger. You can’t stay sober in that kind of environment.”

“When they realize their partner hasn’t stopped and doesn’t intend to stop, they have to put the oxygen mask over their own mouth first,” said an addiction specialist.

The key to remaining clean in this high-risk atmosphere is developing a network of supporters, according to Donna Hugh, program director at Sovereign Health in Culver City, California.

“When they realize their partner hasn’t stopped and maybe doesn’t intend to stop or can’t stop, they have to put the oxygen mask over their own mouth first,” she said, in reference to the emergency oxygen masks on airplanes. “You have to save yourself, or you’re no good for anyone else. As a sick person, you can’t help them if you decide to collude with them and become sick.”

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Addicts in recovery must work to “resist the urge to isolate,” Hugh told LifeZette. Medicated detox when combined with support groups has the highest recovery rates. Ultimately, a spouse’s choices can only have as much influence over an individual’s choices as that person allows.

“We as individuals are our ultimate enablers,” Potter said. “Specifically for a couple that has issues with substance abuse, I would encourage them to seek couples therapy from someone who specializes in substance abuse and couple or family therapy. The therapist may guide the couple to find healthy boundaries and let them sort out their own feelings about the future of the relationship.”

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Hugh remains optimistic about these couples and believes a continued example of sobriety will help spouses who continue using to find the motivation to change.

“It’s attraction rather than promotion,” she said, “by seeing their partner get well, enjoying life, having freedom from the bondage of a drug.” She added that she has witnessed this in her own line of work as an interventionist. “[These relationships] survive all the time. We have all kinds of success stories.”