Intimate partners consuming different amounts of alcohol tend to have lower relationship satisfaction, whereas those drinking at similar levels often report happier unions. It is presently unclear how dyadic alcohol use patterns impact relationship satisfaction for couples wherein one member has an alcohol use disorder. We examined this using longitudinal data from an alcoholic treatment sample (N = 181) and further explored whether conflict pursuant to differential use played a mediating role. Partners similar in their baseline frequency of alcohol intoxication reported higher initial satisfaction but experienced significant declines in satisfaction longitudinally. Highly differential alcohol use was associated with lower satisfaction for both partners at baseline, which was mediated by conflict specific to men’s alcohol use. Notably, baseline relationship variables also predicted subsequent changes in alcohol use. These findings overall support a dyadic understanding of alcoholism and highlight that drinking patterns may link to long-term relationship outcomes differently for alcoholics.