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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.
According 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:
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 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.
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.
Despite 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.