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. Author manuscript; available in PMC: 2025 Oct 31.
Published before final editing as: Couple Family Psychol. 2025 Aug 28:10.1037/cfp0000290. doi: 10.1037/cfp0000290

Opioid Use Among Individuals in Intimate Relationships

Amber M Jarnecke a, Jeremiah A Schumm b,c, Julianne C Flanagan a,d, Tanya C Saraiya a,e, Sudie E Back a,d
PMCID: PMC12574659  NIHMSID: NIHMS2115713  PMID: 41179557

Abstract

Relationships and social support have direct effects on opioid misuse, which is highly prevalent and associated with morbidity and mortality. However, there is a dearth of research focusing on the characteristics and quality of intimate relationships in the context of opioid misuse, which is important for informing interventions with the dual target of improving intimate relationships and reducing opioid use. The current study surveyed individuals with opioid misuse who are in intimate relationships to characterize how they perceive (1) their relationship functioning and (2) how their intimate partners impact their opioid use. Individual participants (N=93) were recruited from Amazon’s Mechanical Turk (mTurk) and answered quantitative survey questions related to their opioid and other substance use, intimate relationship quality and functioning, and intimate partners’ behaviors in relation to their opioid use. Opioid misuse severity significantly differed by sexuality and rates of polysubstance use were high in this sample. Many participants reported low relationship quality and intimate partner violence in their relationship. Some participants reported using opioids with their intimate partners (33.3%) and having an intimate partner who had overdosed on opioids (15.1%). Many participants also reported that arguments with intimate partners impacted their opioid cravings (52.7%) and that they have an interest in couples treatment for opioid use (80.7%). Findings highlight links between intimate relationships and opioid misuse and identify areas in which behavioral treatments may be adapted to address the needs of couples with OUD. Future research should replicate the current findings in larger and more diverse samples.

Keywords: opioids, intimate relationships, couples

The prevalence of opioid use disorder (OUD) continues to rise in the U.S., and rates of OUD were further exacerbated by the COVID-19 pandemic, especially for marginalized individuals (Ahmad et al., 2025; Furr-Holden et al., 2021; Larochelle et al., 2021). Strategies for reducing opioid use and opioid-related mortality have been explored and some have received mixed support (e.g., adjunctive behavioral interventions; Brown, 2018), suggesting that additional targets to address the opioid crisis need to be explored. Intimate relationship functioning is one important mechanism in the etiology, course, and treatment of addiction that could be a target for future OUD interventions. For instance, social support, particularly from intimate partners, can impact the trajectory of OUD and medication for opioid use disorder (MOUD) adherence (Bentzley et al., 2015; Kumar et al., 2021). However, more research is needed to characterize how intimate relationships impact opioid use so as to inform future interventions. Thus, the current study uses descriptive data to examine opioid use and relationship functioning among individuals with opioid misuse in intimate relationships and identify how intimate relationships may influence opioid use.

Relationships and Substance Use Disorders (SUD)

There are well-documented, bi-directional associations between relationship functioning and substance use etiology, course, and treatment. Better intimate relationship functioning (e.g., positive reinforcement between partners, effective communication) is negatively associated with substance misuse and substance-related problems, while relationship distress is associated with greater risk for substance use (McCrady & Flanagan, 2021; Whisman & Baucom, 2012; Zhou et al., 2017). Relative to other substances, fewer studies have examined opioid use, specifically, and intimate relationships. However, existing research shows that women with OUD commonly cite intimate partners as key sources of social support (Oles et al., 2022), and greater social support from intimate partners and relationship closeness is associated with commitment to reduce opioid use among individuals on MOUD (Brousseau et al., 2022). Conversely, patients with OUD and other SUD who report more negative intimate partner behaviors and more interpersonal stressors have worse substance use treatment outcomes (Polenick et al., 2021; Tracy et al., 2005). Other research suggests that perceived criticism from close others predicts more frequent opioid use, even while patients are in treatment for OUD (Schweitzer et al., 2024). As such, characteristics of intimate partners and relationship functioning may be necessary to consider when assessing and developing strategies for enhancing social support among individuals with OUD.

Role of Partners in OUD Risk

Intimate partners who use opioids may increase the risk of opioid misuse and relapse to opioids (Brousseau et al., 2022; Polenick et al., 2021; Sparks et al., 2021). Data from the National Survey on Drug Use and Health (NSDUH) found that 47% of individuals obtain illicit opioids from a friend or relative (Administration, 2021). Research also finds that, for many individuals in intimate relationships, both partners use opioids. For instance, in a study of participants in treatment for OUD (N=53 couple dyads), opioid use was highly correlated within couple dyads (Polenick et al., 2021). Another study of military service members and their spouses (N=8,217) found that 7% of couple dyads were both prescribed high-risk opioids (defined as an opioid prescription with ≥60 days’ supply during a 3-month period or an extended-release opioid formulation) (Sparks et al., 2021). Further, service members who were prescribed long-term opioid medications or high-risk opioids had spouses at greater risk for a high-risk opioid prescription (Sparks et al., 2021), suggesting that there tends to be concordance within couple dyads of being prescribed high-risk opioids, putting both partners at risk for adverse events and misuse associated with opioids. Finally, in a recent study of individuals on MOUD (N=106), authors compared participants who disclosed their opioid use to an intimate partner with whom they had used opioids versus participants who disclosed to an intimate partner who did not have a history of opioid use (Brousseau et al., 2022). Among participants who disclosed to an intimate partner with whom they had used opioids, lower perceived social support was associated with less commitment to reductions in opioid use. Collectively, these findings suggest that having an intimate partner who uses opioids may increase the risk of opioid use.

Opioid Use in Relationship Discord and Intimate Partner Violence

Opioid use can negatively impact intimate relationship quality and functioning. Qualitative research finds that some couples with OUD experience hardships in their communication, interactions, and identity as a couple (Crowley & Miller, 2020). For instance, withdrawal from opioids can be associated with irritability, leading to negative communication patterns between intimate partners (Crowley & Miller, 2020). In addition, individuals with OUD are more likely to experience intimate partner violence (IPV) perpetration and victimization in their relationships (Stone & Rothman, 2019). In a qualitative study among women with OUD, participants attributed physical IPV to their intimate partner’s substance use and endorsed that psychological IPV interfered with their recovery (Pallatino et al., 2021). Another theme was that women reported using substances to cope with IPV experiences. Other research shows that IPV can be a barrier to treatment-seeking for OUD (Phillips et al., 2021). For example, intimate partners might control money or resources that could be used for treatment-seeking, some individuals fear retaliatory violence if they seek help, and others have concerns about criminal justice or child welfare involvement if they seek treatment (Phillips et al., 2021).

Benefits of Healthy Relationships on OUD Recovery

Support, encouragement, and adaptive communication from intimate partners may assist individuals in recovery from OUD. Joint coping with an intimate partner can facilitate problem-solving related to opioid use or relapse, and feeling loved and valued by an intimate partner might protect against stigma associated with opioid use (e.g., Crowley & Miller, 2020). When a relationship with an intimate partner is more positive, women have lower treatment-related stress and less nonmedical prescription opioid use (Polenick et al., 2022; Polenick et al., 2021). Thus, intimate relationship quality is essential in supporting reduction or abstinence from opioid use. Indeed, a recent review of 41 studies found that social support, defined broadly, is associated with improved MOUD adherence and reduced opioid use (Kumar et al., 2021).

Current Study

A growing body of research demonstrates that intimate partners and relationship functioning impact an individual’s opioid use and that enhancing social support and healthy relationship behaviors may have positive impacts on the reduction of opioid use and related treatment outcomes. However, additional research is needed to understand how intimate partners and relationships are associated with opioid use. For instance, more information on the behaviors intimate partners enact to either reinforce or discourage opioid use may point to specific behaviors that need to be targeted through interventions. By pairing this information with more global assessments of relationship functioning, research could elucidate in-roads for engaging people in treatments for OUD. This descriptive study aims to expand extant knowledge by assessing how intimate partners influence opioid use and how individuals with opioid misuse perceive their relationship functioning. As an exploratory study, no specific a priori hypotheses were generated. However, we expected that participants would report a range of relationship behaviors, including those that were perceived to be associated with their opioid use.

Methods

Participants

Participants were enrolled in a larger study assessing opioid use and psychosocial functioning. Amazon’s Mechanical Turk (mTurk) was used to enroll participants nationally, resulting in a more representative and generalizable sample of participants with opioid misuse than if participants had only been recruited locally. Participants completed all study procedures through mTurk. Inclusion criteria for the study were (1) age 18–70; (2) comprehension of English (i.e., ability to read and write in English); (3) resident of the U.S.; and (4) score of 3 or greater on the Rapid Opioid Dependence Screen (RODS; Wickersham et al., 2015), which assessed opioid misuse over the past 12 months. A total of N=554 participants initiated the prescreen survey, n=301 participants completed the prescreen and enrolled, n=207 completed the study survey, and n=106 correctly answered all distractor questions embedded in the survey (used to assess attention), demonstrated valid responding via data quality checks, and did not have a duplicate record. The final sample comprised n=93 individuals who reported being in a current intimate relationship.

Materials

Opioid and Other Substance Use.

The Rapid Opioid Dependence Screen (RODS; Wickersham et al., 2015) was used as part of the prescreening questionnaire to assess study eligibility. The RODS assesses the type(s) of opioids used in the past 12 months, and 7 questions (yes/no) evaluate problems related to opioid use. Endorsing use of at least one type of opioid in the past 12 months in addition to a score of 3 or greater on the 7 questions assessing opioid-related problems is suggestive of OUD (Wickersham et al., 2015). Additionally, enrolled participants were asked to report how many days they used prescription opioids, heroin, and other substances (i.e., alcohol, nicotine/tobacco, marijuana, stimulants, sedatives, hallucinogens) in the past 30 days.

Intimate Partner Opioid Use and Relationship Behaviors.

A questionnaire was created for the study to assess participants’ perceptions of their intimate partners’ opioid use, opioid overdose, and behaviors, as well as the impact of interactions with their intimate partner regarding their own opioid craving. Seven questions (yes/no) asked about their intimate partners’ opioid use and overdose, opioid use with their intimate partner, and getting or taking opioids from their intimate partner. Six questions (yes/no) each asked about behaviors that participants’ intimate partners employed to get the participant to use opioids (e.g., “Has your partner ever insisted you use opioids?”) or stop using opioids (e.g., “Has your partner ever insisted that you stop using opioids?”). Five questions (assessed on a Likert-type scale) related to how their relationship impacts cravings (e.g., “Does thinking about your relationship with your partner make you feel cravings or an urge to use opioids?”), how often intimate partners talk with the participant about their opioid use (e.g., How often does your partner talk to you about your opioid use?”), and interest in couples therapy to address opioid or other substance use (e.g., “How interested would you be in engaging in a therapy with your partner [e.g., couples therapy] to address any problems related to your or your partner’s opioid or other substance use?”).

Relationship Functioning.

Relationship quality and functioning were assessed using the Dyadic Adjustment Scale–7 Item Version (DAS-7; Hunsley et al., 2001) and the Investment Model Scale (IMS; Rusbult et al., 1998). The DAS-7 assesses relationship satisfaction, the extent to which the participant perceives agreeing with their intimate partner on relationship matters, and how often the participant engages in adaptive relationship behaviors with their intimate partner. Higher scores reflect greater relationship adjustment (α=0.57). The IMS assesses four constructs of relationship satisfaction and investment: relationship commitment, relationship satisfaction, quality of alternatives outside of the relationship, and investment in the relationship. Higher scores reflect greater relationship commitment, satisfaction, quality of alternatives, and investment (αs=0.66 to 0.85).

Intimate Partner Violence.

The Revised Conflict Tactics Scale (CTS-2; Straus et al., 1996) was used to assess IPV. The CTS-2 assesses perpetration and victimization of psychological, physical, sexual aggression, and injury. The variety scoring method was used because of its strong internal reliability and our interest in assessing how many different types of IPV occurred in the past year (Shorey et al., 2012). Higher scores reflect a greater number of IPV acts (αs=0.87 to 0.94).

Procedure.

All procedures were approved through the affiliated Institutional Review Board and data were collected in 2021. Individuals with a 90% or greater approval rating on mTurk tasks and living in the United States could see the published study description on the mTurk website (Mellis & Bickel, 2020). Eligibility criteria were not published in the study description. Interested individuals were first presented with a prescreening questionnaire that included questions about demographic information and opioid use, assessed with the RODS (Wickersham et al., 2015). Additional demographic questions, unrelated to the study inclusion criteria, were included in the prescreening questionnaire to further mask eligibility criteria. Participants who met the eligibility criteria were directed to a research statement detailing the purpose and procedures of the study, answered questions (as attention checks) about the nature and the purpose of the research, and confirmed their interest in participating. Participants then completed the study survey. Distractor questions (e.g., “Now think about your drug use over the past year. Then select “A” to answer this question.”) were embedded in the survey to ensure attention and appropriate responding. Participants were paid $3.50 to complete the study survey, which was consistent with recommended pay rates for mTurk workers at the time of data collection (Chandler & Shapiro, 2016). Participants took an average of 24 minutes and 58 seconds (SD=11.03) to complete the study survey, including distractor questions. Inclusive of the prescreener and review of the research statement, participants took an average of 42 minutes (SD=8.26) to complete all study procedures.

Data Analysis.

Descriptive statistics were run in SPSS v. 28 (IBM, 2021) to characterize the sample with regard to demographics, substance use, intimate partner behaviors, intimate relationship functioning, and IPV.

Results

Descriptive Characteristics.

Participants were an average age of 35.13 years (SD= 10.06) and identified as cis-gender men (n=47; 50.5%) or women (n=46; 49.5%). No participants identified as transgender men or women, nonbinary/non-conforming, or questioning. Most participants were White (n=63; 67.7%), followed by Black/African American (n=24; 25.8%), Asian (n=2; 2.2%), Native American or Alaskan Native (n=1; 1.1%), or another race (n=1; 1.1%). Over thirty percent (n=30; 32.3%) of participants identified as Hispanic or Latino. Participants averaged 15.26 years of education (SD=3.24), equivalent to some college. Most participants were employed full-time (n=79; 84.9%), followed by part-time (n=10; 10.8%), unemployed (n=1; 1.1%), or a student (n=2; 2.2%). Most participants lived in urban areas (n=58; 62.4%), followed by suburban (n=21; 22.6%), and rural (n=12; 12.9%) areas. Participants lived in the following regions of the U.S.: Southwest (n=25; 26.9%), Northeast (n=23; 24.7%), Midwest (n=21; 22.6%), Southeast (n=13; 14.0%) and West (n=10; 10.8%). Most participants indicated they were in an intimate relationship with someone of a different gender (n=78; 83.9%). The remaining participants indicated they were in an intimate relationship with someone of the same gender (n=16; 17.6%). Most participants reported being married to their current intimate partner (n=82; 88.2%), and fewer were not married but living with (n=9; 9.7%) or dating (n=2; 2.2%) their current intimate partner.

As shown in Table 1, participants endorsed using a range of opioids and medications for opioid use (e.g., buprenorphine) in the past year; they had a mean RODS score of 5.33 (SD=1.42), suggesting several opioid use-related problems within the past year. There were no differences on RODS score by gender, race, or ethnicity. Individuals in same-gender intimate relationships had significantly higher scores than individuals in mixed-gender intimate relationships (Msame-gender=6.50, SD=0.94; Mmixed-gender=5.13, SD=1.40; t=4.62, p<0.001, Cohen’s d=1.02).

Table 1.

Opioid use endorsed in the past 12 months (N = 93).

Opioid Use N (%) / M (SD)
Heroin 65 (69.9%)
Morphine 53 (57.0%)
MS Contin 51 (54.8%)
Oxycontin 50 (53.8%)
Oxycodone 60 (64.5%)
Methadone 56 (60.2%)
Buprenorphine 40 (43.3%)
Other Opioid 51 (54.8%)
Total Rapid Opioid Dependence Screen (RODS) Score 5.33 (1.42)
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Note: M = mean; SD = standard deviation; ≥3 on RODS suggests opioid dependence (Wickersham et al., 2015).

Substance Use in the Past 30 Days.

Within the past 30 days, participants reported, on average, using opioid medications on 6.94 days (SD=7.18) and heroin on 5.33 days (SD=6.75). Among participants who reported using opioid medications, 62 (66.7%) indicated that they were misusing opioids (i.e., using opioids without prescription or using more than prescribed) and they used opioid medications on an average of 8.55 (SD=7.42) days over the past 30 days. Most participants (n=57; 61.3%) indicated that they used both opioid medications and heroin in the past 30 days. To further characterize the sample, we also report on participants’ other substance use over the past 30 days (see Table 2): 72 participants (77.4%) reported alcohol use, 66 participants (71.0%) reported cannabis use, 55 participants (59.1%) reported nicotine/tobacco use, 52 participants (55.9%) reported cocaine/crack use, 49 participants (52.7%) reported amphetamine use, 45 participants (48.4%) reported benzodiazepine/sedative/anxiolytic use, and 38 participants (40.8%) reported hallucinogen use.

Table 2.

Participants reporting substance use in the past 30 days (N = 93).

Substance reported N (%)
Opioid medication 75 (80.6%)
Heroin 62 (66.7%)
Alcohol 72 (77.4%)
Cannabis 66 (71.0%)
Nicotine/Tobacco 55 (59.1%)
Cocaine/Crack 52 (55.9%)
Amphetamine 49 (52.7%)
Benzodiazepine/Sedative/Anxiolytic 45 (48.4%)
Hallucinogen 38 (40.8%)
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Partners’ Opioid Use and Relationship Behaviors.

A substantial proportion of participants (n=31; 33.3% of all participants) reported that their intimate partner had used opioids in their lifetime; 7 participants out of these 31 (22.6%) reported their intimate partner used opioids in the past month. Many participants endorsed using opioids together with their intimate partner (n=34; 36.6%), getting opioids from their intimate partner (n=36; 38.7%), or taking opioids from their intimate partner without their partner’s knowledge or permission (n=37; 39.8%). Some participants (n=14; 15.1%) reported that their partner previously overdosed on opioids, and n=11 (11.8%) reported that they witnessed or found their intimate partner overdosing.

Figure 1 presents the percentage of participants who endorsed that their intimate partner engaged in a behavior that may have been an attempt to reinforce or discourage their opioid use. As this figure illustrates, many participants reported that their intimate partners insisted (n=53; 57.0%), yelled at the participant (n=47; 50.5%), or avoided the participant (n=45; 48.4%) because the participant was using opioids or to try to get the participant to stop using opioids. Participants also endorsed a range of behaviors their intimate partners engaged in that may have reinforced opioid use, such as using physical force (n=44; 47.3%), threatening the participant (n=44; 47.3%) or insisting that they use (n=39; 41.9%). Other intimate partner behaviors reported that may have been used to either try to reinforce or discourage opioid use included withholding opioids to manipulate the participant (n=38; 44.1%) or throwing things at the participant because they used (n=49; 52.7%) or because they refused to use opioids (n=40; 43%).

Figure 1.

Figure 1.

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Note. N = 93. Behaviors that partners engaged in to either reinforce or discourage their opioid use.

Nearly half of the participants indicated that thinking about their relationship with their intimate partner (n=43; 46.2%) and arguments or conflicts with their intimate partner (n=49; 52.7%) made them feel cravings or an urge to use opioids. Only 9 participants (9.7%) reported their intimate partner never talked to them about their opioid use, while 11 participants (11.8%) reported this happened a few times a year; thirty-six (38.7%) and 32 (34.4%) participants reported this happened a few times per month or week, respectively, and 3 participants (3.2%) reported this happened nearly every day. Most participants reported that if their intimate partner talked to them about their opioid use, this made them feel a craving or urge to use some of the time (n=53; 57.0%) or all of the time (n=21; 22.6%). Finally, the majority of participants indicated they were somewhat to extremely interested (n=75; 80.7%) in couples therapy for opioid or other substance use, while fewer participants reported they were somewhat to extremely disinterested (n=17; 18.3%).

Intimate Relationship Functioning and IPV.

Table 3 presents means, standard deviations, and ranges for the intimate relationship functioning and IPV scales used in this analysis. Participants in this sample had an average DAS-7 score of 20.87, which below the average for non-distressed couples (M=15.7) but above the average for distressed couples (M=26.2) reported in other papers (e.g., Hunsley et al., 2001). To our knowledge, there are no published normative data for the IMS; however, participants’ means for the IMS subscales suggest that, on average, participants were above the midpoint for the Commitment subscale and under the mid-point for the other subscales, perhaps suggesting most participants were committed and felt their needs could not be met in alternative relationships, though they were somewhat dissatisfied and under-invested in their intimate relationships. Finally, participants, on average, endorsed engaging in or experiencing several IPV acts for each subscale of the CTS-2, suggesting most participants in the sample reported experiencing a range and number of IPV acts in their intimate relationship.

Table 3.

Means, standard deviations, and ranges for relationship functioning and intimate partner violence (IPV) variables (N = 93).

Variable M SD Range of Scale
DAS-7 20.87 4.79 0–36
IMS - Commitment 36.57 8.47 0–56
IMS - Relationship Satisfaction 26.57 7.09 0–60
IMS - Quality of Alternatives 24.24 7.96 0–60
IMS - Investment Size 25.61 5.37 0–60
CTS-2 - Psychological Aggression Perpetration 5.92 2.61 0–8
CTS-2 - Psychological Aggression Victimization 5.81 2.54 0–8
CTS-2 - Physical Assault Perpetration 8.57 3.94 0–12
CTS-2 - Physical Assault Victimization 8.78 4.08 0–12
CTS-2 - Sexual Coercion Perpetration 5.18 2.35 0–7
CTS-2 - Sexual Coercion Victimization 5.15 2.39 0–7
CTS-2 - Injury Perpetration 4.30 2.13 0–6
CTS-2 - Injury Victimization 4.43 2.15 0–6
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Note. M = mean; SD = standard deviation; DAS-7 = Dyadic Adjustment Scale–7 Item Version; IMS = Investment Model Scale; CTS-2 = Revised Conflict Tactics Scale.

Discussion

Opioid use can significantly impact intimate relationship functioning; likewise, intimate partners can impact opioid use (Crowley & Miller, 2020; Polenick et al., 2022; Polenick et al., 2021; Whisman, 2007). In the current study, we examined descriptive data from a sample of individuals in an intimate relationship reporting opioid misuse. The objective was to better characterize opioid use among individuals in intimate relationships, how intimate relationships impact opioid use, and what behaviors partners may engage in that reinforce or discourage opioid use. These findings may further inform the role of intimate partners in opioid use and considerations for how to best adapt behavioral couples or conjoint therapies for OUD.

By nature of the study protocol, all participants in this sample reported opioid misuse in the past year. The current study characterized the sample, demonstrating that individuals in same-gender relationships had significantly higher RODS scores, suggesting more perceived problems related to their opioid use. Data from the current study are consistent with epidemiological data from NSDUH, finding that LGBTQIA+ individuals tend to have higher rates of opioid misuse and OUD than heterosexual individuals (Han et al., 2017; Medley et al., 2016). Disparities in opioid and other substance use for the LGBTQIA+ population may be related to experiences of stigma, discrimination, and minority stress (Avery-Desmarais et al., 2020; Lehavot & Simoni, 2011; Pellicane et al., 2023). In the current study, RODS scores did not differ by gender, race, or ethnicity; however, other research has found that men and individuals who are Black and Hispanic/Latino in the U.S. have growing rates of opioid misuse and opioid-related deaths (Drake et al., 2020; Han et al., 2017; Substance Abuse and Mental Health Services Administration, 2020). Inequities and disparities in health and healthcare are a major reason why opioid-related problems tend to be greater among historically marginalized groups (Drake et al., 2020; Hatzenbuehler & Pachankis, 2016; Mental Health Services Administration: The Opioid Crisis and the Hispanic/Latino Population: an Urgent Issue. Publication No, 2020; Slater et al., 2017). Thus, clinicians should work to address these disparities by increasing cultural humility in their practice, actively considering social determinants of health, and advocating for change to address systemic inequities (Andermann, 2016). Differences in the sampling methodologies used across the various studies as well as the small sample size of the current study limited our ability to thoroughly investigate intersectional identities and opioid use. Additional research is needed to examine how demographic factors (e.g., gender, race/ethnicity, sexuality) are associated with intimate relationship functioning.

Polysubstance use was common among participants in the current study. Over 60% of participants reported using both opioid medication and heroin in the past 30 days and most participants endorsed using other substances (e.g., alcohol, cannabis) in the past 30 days as well. In general, polysubstance tends to be common among individuals with OUD, in part attributed to trying to enhance the reward or compensate for negative effects of another substance or internal state (Ahmad et al., 2025; Compton et al., 2021). Polysubstance use increases risk of overdose and mortality and may reflect greater opioid misuse severity (Ahmad et al., 2025; Compton et al., 2021). Current findings point to substance use severity and risk in this sample and suggest the need for clinicians to carefully assess the use of all substances among this patient population.

The present findings add to a growing literature finding that individuals who use opioids might have an intimate partner who uses opioids as well (Polenick et al., 2021; Sparks et al., 2021). Approximately 33% of the sample reported that their intimate partner used opioids in their lifetime, and 23% indicated their intimate partner used opioids within the past month. In addition, nearly 40% of participants indicated that they had, respectively, used opioids with their intimate partner at some point in time, gotten opioids from their intimate partner, or taken opioids from their intimate partner. Rates of taking an intimate partner’s opioids without their knowledge or permission (39.8%) in the current study were substantially higher than what was found in the NSDUH (3.7% of those surveyed took opioids from a friend or relative without asking) (Administration, 2021). Future research should explore this further, but this may be due to differences between samples (e.g., NSDUH included anyone age 12 or older who had misused pain relievers in the past year).

A meaningful proportion of participants reported that their intimate partner had overdosed on opioids at some point (15.1%) and/or they had witnessed their partner overdose (11.8%). Recent national data show a decline in drug-related overdose deaths, with overdose related deaths at their lowest level since 2019, and this decline has been attributed in part to increased education about and availability of naloxone to individuals with opioid misuse, their families, and community members (Ahmad et al., 2025; Razaghizad et al., 2021). In the current study, we did not collect additional information to assess the context around these overdoses (e.g., if there was medical intervention/hospitalization, if naloxone was administered), but these data point to the need to further understand the presence and role of intimate partners in opioid overdoses so that more resources and tools (e.g., naloxone and naloxone education) to prevent overdose can be deployed, particularly to relationship partners. Previous research found that women who use drugs are at increased risk of witnessing overdose of a family member or friend if they had an intimate partner they relied on to get or use drugs, experienced IPV, or experienced childhood adversity (El-Bassel et al., 2019). Although the current study did not assess how getting opioids from an intimate partner or experiencing IPV was associated with risk of witnessing overdose, many of the participants in this sample endorsed the same types of risk factors assessed in the study by El-Bassel et al. (2019). Thus, targeting each of these identified risk factors may also help prevent overdose.

Participants in this study endorsed a range of intimate partner behaviors that may have been used to try to reinforce or discourage opioid use. Some of these behaviors included acts that could be characterized as aggressive or violent (e.g., hitting, holding down, using a weapon) to get the participant to continue or stop using opioids, suggesting that IPV may be used specifically related to opioid use. Likewise, participants in this sample reported experiencing IPV victimization and perpetration on the CTS-2. This suggests that many participants were in relationships with mutual IPV, consistent with the literature (Stone & Rothman, 2019). IPV is a barrier to substance-related help-seeking and recovery (Phillips et al., 2021). For example, intimate partners may hold control of money and resources to seek care and individuals may fear retaliatory violence and consequences of violence being reported to authorities (Phillips et al., 2021). As such, practitioners should thoroughly screen IPV among patients with OUD and determine which resources or interventions are indicated for these patients. Couples-based or intimate partner-integrated approaches may be appropriate and beneficial for patients without IPV or where IPV is mutual and not severe (Brigham et al., 2014; Karakurt et al., 2016; Schumm et al., 2018). For patients in which couples-based approaches are contraindicated and/or unsafe, safety planning and providing guidance and resources for the patient to leave the relationship and seek trauma-informed care and/or mutual support groups may be needed.

Lastly, many participants endorsed that arguments or conflicts with their intimate partner impacted opioid craving. Most participants reported talking with their intimate partner about their opioid use regularly (weekly or monthly). While the current study did not assess the nature of these conversations, most participants indicated that talking with their intimate partner about their opioid use was associated with cravings or urges. Further, participants in this study had somewhat low dyadic adjustment and satisfaction scores on the IMS. Polenick et al. (2022) found that women with higher intimate relationship quality had less nonmedical prescription opioid use and partners with less opioid use. Thus, intimate relationship quality and functioning may be an important intervention target for reducing opioid use. A majority of participants in this study reported interest in engaging in a couples-based intervention for their opioid or other substance use. Taken together, there is a rationale and desire for couples or conjoint treatments for OUD.

Limitations

There are several limitations to the current study. While best practices for collecting survey data via mTurk were used, concerns have been raised about the quality of data that can be collected via crowdsourcing websites such as this (Mellis & Bickel, 2020; Strickland & Victor, 2020). This study employed a single reporter method to assess self and intimate partner experiences and behaviors. Future studies can improve by incorporating partner reports. While we recruited a sample of individuals across the U.S., this sample may not be representative of all individuals with opioid use. Even though this sample was somewhat more male, Black, and Hispanic/Latino than the overall U.S. population (Bureau, 2020), most participants identified as White, male, residents of urban areas, and in marital relationships with a partner of a different gender. The sample was not necessarily treatment-seeking. Many participants reported using multiple substances, and we did not assess if non-opioid substances were prescribed. Measures were limited by a lack of assessment of fentanyl use and context surrounding intimate relationship behaviors and their impact. More research is needed to assess intimate relationships among larger and more diverse samples of individuals with opioid misuse to determine if findings generalize. This descriptive study collected quantitative data; however, future studies should integrate qualitative methods which may enrich interpretations of the current findings. Finally, the internal reliability for some of the measures was low in this study, which may have impacted findings. Despite these limitations, results highlight the role of intimate partners in opioid use and several key areas in which future OUD and couples-based or conjoint interventions could be adapted.

Implications and Applications

Several evidence-based couples or partner-integrated therapy approaches for SUD currently exist (e.g., Brigham et al., 2014; McCrady Barbara & Epstein, 2009; O’Farrell & Fals-Stewart, 2006). Findings from this study point to adaptations that could be made to existing interventions to enhance outcomes for couples with opioid misuse or OUD. First, this study found that individuals in same-gender relationships, relative to mixed-gender relationships, reported more perceived problems related to their opioid use. It is critical that disparities and the cultural needs of historically marginalized groups are considered when increasing access to and advancing treatments (e.g., see Burlew et al., 2020), and LGBTQ+ individuals may benefit from OUD treatment programs that address known disparities, utilize sexuality- and gender-affirming approaches, and employ a trauma-informed lens (Girouard, Goldhammer, & Keuroghlian, 2019). Second, given the risk of overdose related to opioid use and high rates of polysubstance use, incorporating more education about and means for preventing and responding (e.g., naloxone) to opioid overdose is needed for couples with OUD.

Additionally, many participants in this study reported that discussing their opioid use with their partner increased their cravings and urges to use. Clinicians may want to discuss with patients and their partners about how to adaptively communicate about opioid use, including facilitating trust discussions that are specific to opioid use and taking medications for opioid use disorder. Finally, participants in this study reported a range of IPV acts, including acts specifically associated with opioid use. Increased focus on IPV and safety agreements during assessment and treatment of individuals or couples where one or both partners has OUD is needed. Universal IPV victimization and perpetration screening for this patient population could enhance IPV detection and increase access to services and resources to reduce IPV (Jarnecke & Saraiya, 2024).

Public Significance Statement:

This study finds that many individuals who misuse opioids use opioids with their intimate partners and that these intimate relationships may be marked by discord and aggression. Findings have implications for ways in which intimate relationship functioning may need to be addressed to promote recovery for individuals with opioid use.

Role of funding sources:

This study was supported, in part, by grants from NIAAA (K23AA027307; PI: Jarnecke), NIDA (K23DA055209; PI: Saraiya), and NCATS (UL1TR001450; PIs: Brady & Flume).

Footnotes

Conflict of interest: The authors have no conflicts of interest to disclose.

Data Statement

De-identified data can be made available from the first author.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

De-identified data can be made available from the first author.

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