Substance use agreements: An exploratory study of dyadic coping processes related to substance use among male couples in the US.

Substance use disparities are well-documented among sexual minority men (SMM) and substance use is associated with increased sexual HIV transmission risk. SMM in relationships may engage in dyadic coping whereby partners establish explicit joint goals restricting health-limiting behaviors. This formative study examined discussion of substance use concerns and substance use limit setting in 50 male couples. Eligible couples were recruited between March 2018 and March 2020. All participants (n = 100) were cisgender adult males. Each couple included at least one partner who was aged 18-29; reported drug use and sexual HIV transmission risk; and was HIV-negative. Partners in 35 couples (70%) agreed about whether they had discussed substance use related concerns or not; in 36 couples (72%) partners concurred they had discussed the possibility of setting substance use limits; and in 9 couples (18%), both partners asserted that they had established a specific limit. In addition to abstinence, couples formed rules limiting the type, quantity, timing and motivational context of use. The 16 couples (32%) who discussed but did not set a limit provided open-ended responses that emphasized global desire for change, saw past failures as a barrier to current goal setting, or comprised partners who had different perceptions of the content discussions. Measures of substance use problems provided preliminary evidence they might covary with limit setting. Findings generally align with theories of interdependence and health. These posit that couples who have substance use concerns and can successfully negotiate shared limits may be more successful at regulating use.