Helping Couples Address Drug Use and Sexual Risk

Because I develop and study substance use and sexual health interventions for male couples, I sometimes get asked what couples get out of going to counseling together. Couples therapy costs money and takes time. Why would partners consider doing it?

One answer is that these interventions have the potential to reduce drug use and the occurrence of riskier sexual behaviors like condomless sex with partners outside the relationship (Starks et al., 2022; Starks et al., 2019). Alternatively, I could describe what couples themselves tell their counselors they “got out of” or are “taking away from” their time in counseling. This latter strategy is what we used in our publication in Counseling and Psychotherapy Research (Starks et al., 2024). We listened to what couples said they valued or appreciated about completing 3 sessions of motivational interviewing focused on substance use and sexual risk reduction.

Why Male Couples Counseling Is Important

For more on the specific counseling style being examined, see my previous post on motivational interviewing with couples. The development of interventions that address drug use and sexual health in male couples is a priority for several reasons. Sexual minority men are at high risk for HIV infection and many (possibly most) new HIV infections in this population are transmitted between relationship partners (Sullivan et al., 2009). Rates of drug use are also higher in this population compared to heterosexual men and drug use is consistently linked to sexual HIV transmission risk.

How This Study Was Conducted

In this study, 24 couples (48 individuals) completed 3 sessions of motivational interviewing. All the participants were aged 18 or older. Each couple included at least one person who was aged 18 to 29 and reported recent cannabis or illicit drug use.

The data are counseling sessions that were transcribed. Coders reviewed these transcripts looking for content in which participants talked about how the intervention impacted their life or their relationship outside of the therapy session.

Benefits Couples Report from Counseling Sessions

These sessions focused on substance use and sexual risk reduction. In addition, the counselor engaged the couple in a strengths-based conversation about their communication skills. Three themes were salient in the data.

• Participants found that just taking intentional time to talk about how they communicate as well as substance use and sexual health was helpful. One participant summarized this by saying, “[Counseling] gave us the space to talk about things we are not comfortable talking about.”
• The presence of the counselor influenced the they way partners spoke and listened to one another.
  • For some couples, the counselor made it easier to talk. One couple said, “Ironically it is easier to talk through you [the counselor] than to each other. It helps that we don’t know you.”
  • For other couples, the counselor’s presence decreased the likelihood of conflict during discussion. One participant said, “It is really nice to have a third person in the room. When people are being watched they are likely to act more cordially.”
• The counselor was able to say things that were hard for the partners to say. Remember, this was an intervention for substance use and sexual behavior. So most often, those were the topics being raised by the counselor. One participant said, “We don’t hear each other say these thing that are, in fact, very true about our relationship with each other with, I guess, someone like you being present. Because we don’t know how to ask the questions you’re asking.”

Why A Human Therapist Matters

In an era where we are increasingly interested in artificial intelligence and social media, the findings from this paper suggest something rather old fashioned. The presence of a human therapist mattered to these couples. It was easier to talk about drug use, sexual behavior, and the way they communicate together when a non-judgemental third party raised these issues and facilitated that conversation. No one can guarantee therapy outcomes. Whether an individual couple benefits depends on many circumstances. But if you find that you and your partner are consistently struggling to have difficult conversations, finding a counselor might be one way to help.