According to Leonard J. Davis, author of Obsession (a book about individuals with severe preoccupations with others), the notion of codependence comes from early members of Alcoholics Anonymous who visualized that an alcoholic’s family and friends directly or indirectly support (enable) the person’s addiction to alcohol. It was eventually broadened to indicate how individuals in relationships may become enmeshed and dependent on one another for approval and emotional support in both a functional and dysfunctional manner.

This article will discuss some of the characteristics of the so-called codependent relationship between couples where at least one individual has a substance use disorder, as well as issues with the notion of codependency.

Codependency

Two Girlfriends Or A Lesbian Couple Standing In Autumn Woods LeaAccording to the book Codependent No More: How to Stop Controlling Others in Care for Yourself, codependency is often described as a pattern of excessive reliance on compulsive-type behaviors in pursuit of approval from another person in an effort to define one’s own identity and self-worth, and to develop feelings of security. Some of the characteristics of a codependent person are:

  • A severe fear of being alone, which is often manifest by extreme efforts to avoid feeling alone or actually being alone
  • Making one’s personal needs secondary to the person with whom they are involved, such as a romantic partner, spouse, family member, etc.
  • A chronic feeling of being empty and/or bored
  • Having very intense and unstable personal relationships with others
  • The overwhelming desire to feel accepted
  • An overwhelming desire for affection
  • Looking to others for value in oneself
  • Low feelings of self-worth or self-importance
  • A tendency toward dishonesty and denial of one’s personal feelings
Codependent Relationships and Substance Abuse

In essence, a codependent relationship between spouses where one person has a substance use disorder allows the individual with a substance use disorder to justify using their substance of choice. It also allows the other individual to feed into that person’s disorder and maintain and support that person’s disordered behavior. For example, codependency is often linked to relationships where one individual has an alcohol use disorder. According to the book Beyond Codependency, a codependent relationship in this context would have these features:

 

  • The individual with alcohol use disorder will often attempt to restrict their use of alcohol to specific situations or times of the day. This presents the illusion that the person is in control of their drinking. The spouse or partner of such an individual gives that person their personal space and time with alcohol and at the same time justifies the behavior as being “normal” for that person.
  • The codependent relationship is one of dishonesty and denial. The codependent partner of an alcoholic will often be called upon to cover for the individual when their alcohol use interferes with issues of daily living, such as not going to work due to a hangover after being intoxicated (the partner will call in sick for that person), hold off paying certain bills when the individual spends too much money on alcohol, supply the individual with alcohol when they are depressed, etc. These actions help both parties deny the real problem.
  • The codependent partner may remain under the impression that their usefulness and self-worth are bolstered by supporting their partner, relieving their partner’s discomfort, solving their partner’s problems, and by pleasing their partner. These feelings and activities are enmeshed in the individual’s substance use disorder and any other psychological issues, such that the realization that substance abuse is dysfunctional is never touched upon to a significant extent.
  • The individuals in a codependent relationship will continue to support the notion that these behaviors are “normal” for them, even though they may not be normal for other people. They will make an exception for themselves and excuse away the dysfunctional aspects of the substance use disorder while at the same time supporting one another.
  • Because codependent relationships are intense and unstable, there often periods of aggressive disagreement and even verbal and/or physical abuse interspersed with periods of caring and affection.
  • People in codependent relationships often begin to feel responsible for the other person, and both parties in the relationship attempt to control each other in such a manner to maintain the illusion of a functional family unit despite issues with denial, dishonesty, and unstable relationships.

 

The codependent partner of an individual with a substance use disorder will inevitably be focused on the other person to the point of not really understanding their own feelings. They may be overly compliant at times to the point of sacrificing their own wants and needs for the other person. They may have a poorly developed sense of self, display problems with openness and intimacy, and feel safety and security in manipulating and controlling others. The codependent partner of a substance abuser constantly alternates between the role of rescuer, personal confidant, and supporter of the individual, and despising and loathing the person.

Treatment for Codependency

There several treatment options for individuals who are codependent. One option is the use of Cognitive Behavioral Therapy (CBT) to identify the individual’s irrational thinking processes, including their beliefs, self-view, attitudes toward others, and approach to maintaining their relationships. CBT can strengthen the person’s own sense of self-identity, challenge their irrational beliefs about their own self-worth, and challenge their beliefs about aspects of their relationship and substance abuse.

Family therapy or couples therapy using CBT techniques can also be applied to individuals who are in a codependent relationship in order to get them to adopt the realistic approach to the nature of their relationship, define their interactions in a mutually satisfying way, and allow both partners to develop a sense of self and a feeling of self-worth. These types of interventions are most likely relatively common in family and marriage therapy situations, and it may well be that the term codependent is not even used by the therapist to describe the situation in a good number of these cases.

A group known as Codependents Anonymous follows a 12-Step approach to codependency similar to the 12-Step approach used in Alcoholics Anonymous, Narcotics Anonymous, etc. Other treatment approaches may include medication management for individuals who have serious issues with depression, anxiety, and personality disorders.

The substance abuse aspect of the treatment for the individual in the codependent relationship with a substance use disorder would follow the traditional standard substance use disorder treatment approach. It would consist of withdrawal management if needed, counseling and therapy, social support, family support, and long-term aftercare.

Is Codependency a Disorder?

residential treatmentDespite what some sources claim, codependency is not a recognized psychological or psychiatric disorder. The actual list of the symptoms of codependency are quite varied and in many cases considered to be questionable in terms of their clinical utility. There was a movement to have codependency listed as codependency personality disorder in an earlier version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R); however, codependency did not meet the formal criteria for inclusion as a formal disorder for the diagnostic manual. They were not enough well-designed research investigations to identify codependency as any type of syndrome.

The list of symptoms above describing the aspects of codependency do coincide with other known personality disorders that are currently in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition, such as dependent personality disorder and borderline personality disorder; however, there is no formal diagnosis of codependency or a codependency personality disorder (codependency disorder) in any of the accepted diagnostic manuals used in the United States.

Instead, codependency may exist as an aspect of relationships that occur in individuals who are diagnosed with other types of psychological/psychiatric disorders, such as borderline personality disorder or dependent personality disorder. In other cases, it may represent a subclinical style of interacting in relationships that is based on a number of other variables, such as upbringing, expectations, and past experience with others in relationships. This means that individuals deemed as being codependent may display certain types of dysfunctional behaviors, but these are not considered to be consistent enough across relatively large numbers of individuals to warrant a formal diagnostic category.