Addiction Treatment and Codependency: Information & Overview
A codependent relationship is dysfunctional in that a person’s self-esteem and happiness are completely tied up in their partner’s wellbeing instead of their own. Codependency involves unhealthy helping and even enabling behaviors, a lack of inner boundaries, and a need to feel needed.1 While codependency most frequently applies to romantic relationships, such as spouses or partners, virtually any relationship can be affected by codependency.
Codependency and Addiction
Codependency often goes hand in hand with addiction, as spouses or partners of someone battling addiction may regularly enable them to continue problematic drinking or drug-using behaviors, making excuses for them and helping them to cover it up. A codependent spouse often enables the user by making excuses for them, cleaning up their messes, and taking care of them when they are intoxicated or sobering up.1
Someone who suffers from codependency needs to be needed and goes out of their way to help their partner or loved one regardless of any personal consequences. This is, of course, unhealthy and does not serve either person in the relationship as it allows the same mistakes and unhealthy behaviors to be perpetuated and ignored.
A codependent person may appear selfless and strong; however, these types of relationships are highly dysfunctional and unhealthy. Codependent relationships and maladaptive behaviors are unlikely to improve on their own. In fact, they will likely get worse over time, Psych Central warns.2 With treatment that targets these behaviors along with other mental health problems, codependency is reversible, and relationships may be salvageable.
Specifics of Codependency
Someone suffering from codependency will not be able to self-soothe and will rely on their partner in order to meet their own emotional needs.3 Codependence can cause an irrational fear of rejection and being alone. Codependence can be one-sided, or both partners may suffer from it.
In a codependent relationship, individuals put the other person’s needs before their own, often sacrificing their own integrity and sense of self in the process. Codependency can cause a person to have an overinflated belief that they alone are responsible for affecting the beliefs, thoughts, emotions, and behaviors of those around them, Psych Central publishes.4
A codependent relationship allows the parties involved to avoid their fears and problems, serving to promote bad behavior and maladaptive patterns instead of improve upon and learn from them, Psychology Today reports.5
Causes of Codependency
Although a number of predictors have been proposed for codependency, there is no consensus on the exact causes of the behavioral pattern. Research suggests that the following factors may have a role in developing codependent tendencies:6
- Codependency is often thought to be a result of living with alcoholic parents or other family members who struggle with substance abuse.
- Codependency may begin in childhood, as children often grow up modeling behaviors after a parent who may have been codependent or in a codependent relationship.7
- Codependency may also be the result of a traumatic event, whether in childhood or adulthood.
- A complex relationship between codependency and narcissism has been established, indicating that the two often go hand in hand, and even sometimes overlap.8
While childhood abuse, traumatic experiences, and exposure to narcissistic behaviors of parents and/or partners seem to play a role, it is difficult to predict codependency on the basis of any of these factors alone.
Symptoms of Codependency
Generally speaking, there are two main forms of codependence: passive and active.9 Someone who is passively codependent is more likely to avoid conflict and confrontation, going to great lengths to keep things smooth and not rock the boat. Active codependency is often more manipulative, and an individual may try to push their partner into behaving a certain way in order to fill their own emotional needs.
Both forms of codependence have many things in common, however. Some common signs of codependency include:2
- Putting the feelings of others above oneself: Someone who suffers from codependence will often sacrifice their own feelings and wellbeing in order to make their partner happy.
- Self-worth dependent on validation from others: Self-esteem is closely tied to others’ perceptions and approval.
- Constrained ability to assert oneself: With codependence, a person will rarely stand up for themselves, and if they do, it is often followed by intense bouts of guilt.
- Ability to set and stick to boundaries is highly restricted: A person will likely allow others to “walk all over them” and be unable to deny demands made upon them.
- Fear of rejection, abandonment, and isolation: The fear of being alone can be so intense that many behaviors are molded around this. A person may go to extreme lengths to hold on to relationships.
- Accepting blame where it doesn’t belong: Codependency can cause a person to take the fall for things they are not actually at fault for. Making excuses for a partner’s addiction or resulting behaviors is an example of this.
- Trouble making decisions without others: A person may be so wrapped up in their partner’s needs and wants that they are unable to assert their own.
- Emotions that are closely tied to the partner: Codependent relationships often act as mirrors, as one partner’s emotions may dictate the other partner’s emotions. If one partner is having a bad day, for instance, so might the other partner.
- Overlooked personal values: Individuals often let their own integrity and values take a backseat to their partner in a codependent relationship.
- Loyal to a fault: Codependency can cause a person to go to extremes to protect a relationship no matter what occurs or the personal cost that may come from it.
- Extreme reactivity: Poor inner boundaries cause someone suffering from codependency to absorb the actions and emotions of those around them, reacting to their feelings and thoughts easily and often becoming defensive or threatened.
- The need to please: Individuals in codependent relationships are often people-pleasers; they work hard to be accepted and have others like them.
- Need for control: Codependency breeds a strong need to control one’s environment and people around them.
- Difficulties sharing emotions and communicating: Individuals battling codependency may not even recognize their own thoughts or feelings; thus, they often have trouble expressing them. Even if they do know how they truly feel, they are reluctant to own up to it for fear of how it might affect others.
- Difficulties with intimacy: Sex may be used as a tool for acceptance, but real emotional intimacy is often lacking in a codependent relationship.
- Efforts to be the one others depend on: Codependency can cause a person to feel the overwhelming need to be the caretaker and thus become indispensable to those around them.
Dealing with Codependency
It is important for both partners to see a therapist and undergo treatment when codependency is involved. One spouse may battle addiction and the other codependency, for example, and both will need to work through the negative and destructive emotions and patterns of behavior that are attached to each issue.
Spouses, or partners, will need to learn how not to enable a loved one who suffers from addiction. Families and spouses are encouraged to attend some form of treatment and therapy that offers help for codependency with a loved one who is battling addiction while they are also in a treatment program.10
Codependency can hamper addiction treatment and recovery if it isn’t addressed and managed at the same time as the addiction issue. Addiction treatment programs often offer support and educational programs for families and loved ones of those in treatment to help them better understand the disease of addiction and their own role in recovery going forward.11 With therapeutic intervention, a codependent relationship may be improved, and both partners may be able to recognize the dysfunctions within the relationship and move forward in a healthier manner.
Not all codependent relationships may be saved, however, as both members need to invest in change and commit to getting necessary help. Abuse often accompanies codependence, and this cannot be tolerated. Both partners in a codependent relationship will need to commit to change and work together toward recovery in order for the relationship to be salvaged.
Frequently Asked Questions
The American Psychological Association defines codependency as ‘a dysfunctional relationship pattern in which an individual is psychologically dependent on (or controlled by) a person who has a pathological addiction (e.g., alcohol, gambling)’.12 While codependency is the preferred term in literature, other derivatives such as ‘codependence’ and ‘co-dependency’ are also used.13Codependency is a widely used and contested concept.7 The use of the term began in the 1940s when it was used to refer to spouses of alcoholic partners. During the 1960–1970s, the concept of codependency was further shaped by the perspectives of Alcoholic Anonymous communities in the U.S., as an illness that affected the partners of individuals who struggled with substance abuse. The AA communities saw codependent individuals as ‘co-alcoholics’ or ‘enablers’ of their partner’s substance abuse problem.Today, the concept of codependency does not deal exclusively with relationships in which addiction is an issue, but rather with any dysfunctional relationship in which a person’s self-esteem is dependent on the wellbeing of another person. From the 1980s onward, three codependency models have been developed:7
- The personality model in which personality has a crucial role in the predisposition to the development of codependency.
- The disease model where codependency is seen as an illness that requires appropriate clinical interventions and treatment.
- The interactionist model which combines both intrapersonal and interpersonal factors in the development of codependency.
Due to the lack of clear theoretical conceptualization, codependency is not yet listed in the fifth edition of the Diagnostic Statistical Manual.14 Nevertheless, many treatment centers offer research-based treatment options that address the destructive behaviors entailed in codependency as part of the overall program.
- Codependency is a complex behavioral pattern that may have biological, psychological, and social underpinnings. Some potential causes of the development of codependency may include:15
- Living with a family member who is addicted to alcohol, drugs, gambling, or sex.
- Falling victim to emotional, sexual, or physical abuse.
- Living with a family member who suffers from a chronic physical or mental illness.
- Dysfunctional empathic responses due to genetic or neurological factors.16
The multifaceted nature of codependency may create unique challenges in addiction treatment. Treatment providers often rely on combination therapy, using several different types of therapy to effectively treat any underlying mental health issues and help modify codependent behaviors.
- While codependent individuals may not necessarily seek out relationships with individuals prone to addiction, they may tend to form relationships that reflect the dysfunctional family dynamics they were exposed to in childhood.15 These relationships may be emotionally destructive, abusive, and generally one-sided.Codependency is often a learned behavior, developed through watching and imitating the behaviors of parents or caregivers, although dysfunctional family relationships are not the only possible predictor of codependency.
- The relationship between codependency, narcissism, and empathy is a complex one. While codependent individuals are known for their propensity for helpful behaviors despite adverse consequences, some codependent traits resemble those more often associated with a narcissistic personality. Both the narcissist and the codependent rely on other people to meet their emotional needs. This is known as narcissistic supply: these individuals need external support in order to maintain a sense of psychological stability and self-worth.17Codependent and narcissistic individuals also share certain traits in regards to empathy. While it may seem contrary to the popular conception, codependents often lack appropriate empathy responses. According to Co-Dependents Anonymous (CoDA), some codependent patterns include:18
- Difficulties with understanding one’s feelings.
- Minimizing and denying one’s feelings.
- Perceiving oneself as completely unselfish and altruistic.
- Lacking empathy for others’ needs.
- Labeling others with their own negative traits.
- Passively expressing negativity or aggression.
- Therapists rely on combination therapy, the use of more than one type of therapy in treating a patient who needs help with codependent behaviors. Some therapists will prescribe medication to treat underlying mental health issues such as depression, insomnia, and anxiety. While there is no such thing as treatment for codependency, here are some general approaches:
- During treatment where codependency-related issues are addressed while working with a therapist, individuals will learn how to set clear boundaries and stick to them. Partners need to learn how to embrace self-love and take care of themselves first. Individuals must first accept themselves before they are able to engage in a healthy relationship.
- Behavioral therapies can improve thoughts that are negative and lead to harmful actions and reactions, and help individuals to explore the root of their attachment and codependency issues.10 Since codependency often begins in childhood, these early life experiences need to be fully explored and processed in order to make positive changes.
- Therapy can also improve self-esteem and build a stronger sense of self. In so doing, inner boundaries are strengthened, and relationships can become more fulfilling.
- Communication skills can be enhanced through spousal and family therapy as well. Both partners may benefit from individual therapy sessions, group sessions, and sessions that are attended together.
- Co-occurring disorders such as anxiety and depression are optimally managed and treated at the same time as codependency and addiction, as these disorders are often complexly intertwined.
- Finding one’s core self and separating personal needs from others is important in recovery, Psych Central explains.19Old patterns of behavior and thinking need to be altered.
Support groups also exist for codependency such as Co-Dependents Anonymous (CoDA), a 12-Step group. These types of programs embrace the philosophy that things are going to occur that are out of a person’s control, and the person can learn how to manage and deal with this through peer support and encouragement.
- The 12-Step Co-Dependent Anonymous groups are designed to help individuals improve their emotional wellbeing and relationships through building self-confidence and self-reliance. The support from peers in a 12-Step group can be very beneficial in understanding that there are others out there going through the same things, and they can offer hope, encouragement, and real-life tools and tips for recovery. The twelve steps are as follows:20
- Admitting powerlessness over others and that your life has become unmanageable
- Believing that a power greater than yourself can restore you to sanity
- Deciding to turn your will and life over to the care of God
- Making a fearless moral inventory of yourself
- Admitting to God, yourself, and others the nature of your wrongs
- Being entirely ready to let God remove the defects of your character
- Humbly asking God to remove your shortcomings
- Making a list of persons you have harmed and being willing to make amends to them
- Making direct amends to people you’ve wronged wherever possible, except in situations when doing so would injure them or other people
- Continuing to take personal inventory of admitting to wrongdoings
- Seeking to improve your conscious contact with God through meditation and prayer, praying only for knowledge of God’s will and the power to carry it out
- Carrying the message to other codependents and practicing the principles in all your affairs
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