Problematic substance/gambling use has major harmful effects on both members of a couple and on their relationship. It is also exacerbated by couple distress. However, for a person with an addiction (PA), the desire to maintain the relationship and the partner’s support are strong sources of motivation and reinforcement for change and recovery. Although research has shown for decades that couple therapy is an effective way to treat addiction, services are focused largely on individual treatments (Ariss and Fairbairn, Consult Clin Psychol 88:526–40, 2020). The first part of this chapter reviews the literature to provide a brief description of the interactions between problematic use and couple relationships and of effective models of couple treatment for addiction, along with their limitations. The second part of the chapter delves more deeply into Integrative Couple Treatment for Addiction, an approach developed by the authors of this chapter. It focuses on assessment and intervention strategies designed for integrating partners of persons with an addiction (PPA) into couple treatment. Specific issues of addiction treatment with couples and observations on the obstacles to disseminating and implementing couple treatments in real-life settings are briefly addressed.