How it Affects Addiction and Mental Health Intervention & Treatment Outcomes
Codependency has been the unofficial diagnosis used by substance use and mental disorder professionals when treating those who enable a loved one with an addiction or mental health concern. Codependency is not recognized as a mental health disorder by the American Psychiatric Association and is not listed in the DSM-5. The APA does list a definition for codependency (seen below). There are as many similarities as there are differences between codependency and other diagnosable disorders with codependency symptoms. An example of codependency could be a person who is codependent on another person, such as an enabler to a loved one with substance use or a mental health disorder. A person who is codependent in multiple relationships or who is dependent on others to care for them and make them feel better may be diagnosed with a dependent personality disorder. The most significant difference between dependent personality disorder and codependency is the nature of the relationship(s). An enabler that is dependent on the afflicted loved one to fulfill their codependency and dependent on other family members to care for them. At the same time, they exert all their energy and resources to the loved one with an addiction or mental health concern, who would be exhibiting dependent personality disorder symptoms and may or may not be diagnosed with a dependent personality disorder.
For simplicity and to address the relationship between the codependent enabler and the intended patient with addiction and mental health concerns, we ask that you only focus on your potential codependency to the intended patient when taking our codependency quiz or codependency assessment.
It is also important to remember that when we reference the phrase substance user, we are referring to a loved one with an addiction, a mental health disorder, or a dual diagnosis. We may also refer to your loved one as the intended patient or the loved one.
Codependency Definition
1. The state of being mutually reliant, for example, a relationship between two individuals who are emotionally dependent on one another.
2. 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). —codependent adj.
Mental Health Disorders with Overlapping Symptoms of Codependency
Dependent Personality Disorder
In the DSM–IV-TR and DSM–5, a personality disorder manifested in a long-term pattern of passively allowing others to take responsibility for significant areas of life and subordinating personal needs to the needs of others, due to a lack of self-confidence and self-dependence. It was formerly known as a passive-dependent personality.
Borderline Personality Disorder
In the DSM–IV-TR and DSM–5, a personality disorder is characterized by a long-standing pattern of instability in mood, interpersonal relationships, and self-image that is severe enough to cause extreme distress or interfere with social and occupational functioning. Among the manifestations of this disorder are (a) self-damaging behavior (e.g., gambling, overeating, substance use); (b) intense but unstable relationships; (c) uncontrollable temper outbursts; (d) uncertainty about self-image, gender, goals, and loyalties; (e) shifting moods; (f) self-defeating behavior, such as fights, suicidal gestures, or self-mutilation; and (g) chronic feelings of emptiness and boredom.
The Unintended Consequences of Codependency
When addiction and mental health disorders are present within a family system, it has a ripple effect across all members of the family and close friends. The dismantling of the family starts with the impact that addiction and mental health have on the intended patient, with or without mental health symptoms, and the primary enabler. The enabler comforts the loved one, and they become dependent on the enabler. Taking it a step further, the intended patient with presenting mental health disorder symptoms could also be dependent on drugs or alcohol. In this scenario, the dependent substance user is getting something from their drugs or alcohol as well as from the enabler. The substance user is not giving anything to the enabler, or are they? What the enabler is receiving from the substance user is psychological.
In contrast, the substance user is both psychological and physical, as in being enabled to obtain drugs and alcohol more easily. The enabler and the substance user have become codependent on one another, and the enabler is being validated for being needed by another person and feeling they are given direction and purpose in life. When you think about it, the enabler is allowing the substance user to stay sick and use the to achieve this goal. The two become enmeshed, and it is almost impossible to break them apart. Most people in life are dependent on others while maintaining healthy relationships. As you can see, this is not an even give-and-take scenario, nor is it a healthy relationship. When you arrive at our section on Family Roles, you will see how the primary enabler is the starting point of the dysfunctional family system and the roles that form.
Codependency and enabling are some of the biggest challenges professional clinicians and interventionists face to help the intended patient move through the stage of change. It is almost always the primary enabler who will ask us what we will do if their loved one says no to the intervention. There are two ways to address this question, starting with the meaning behind the question. For starters, the codependent enabler is not afraid their loved one will say no; they are worried they will say yes and the enmeshed codependent relationship will be severed. Remember, the enabler is finding comfort in their role, as is the one with addiction and mental health disorders. With that being said, the second part of the answer is that the only one who should truly be worried about hearing no at the intervention is the intended patient. The enabler and the family as a whole saying no breaks your loved ones’ two-fold issue: the codependency with the primary enabler and the dependency on the comfort provided that takes away the need to advocate for their addiction and mental health care.
When a substance use or mental health disorder is present, it is almost inevitable that codependency and enabling will occur. Families have the most difficult time withdrawing from codependency and enabling when there is a mental illness. When it is only an addiction, we witness families having a more difficult time with enabling and codependency to an alcoholic than we do with a drug addict. Families often feel that alcohol, being legal and socially acceptable, somehow minimizes the problem. This happens even as the alcoholic is suffering severe medical complications or symptoms. Even though the alcoholic and the drug addict are no different in behavior, the stereotype and the stigma of an alcoholic are somehow viewed as less of a concern than, say, a heroin, crack cocaine, or methamphetamine addict.
On the other hand, we see similar justification from families with loved ones addicted to drugs. At least it isn’t heroin, it could be worse, they could be selling drugs, they are only smoking meth amphetamines, they aren’t injecting it like some of his/her friends, etc. The point being made is that these false perceptions lead to a psychological justification for doing little or nothing about the problem. It seems that families will often try to find anything they can grab hold of to validate their plans of inaction.
Codependent Behaviors, Comfort Addiction, and Mental Health, and Prevent Family Relationships from Independence.
Family members with substance use and mental health disorders can prevent others within the family from happily living their own lives. When we start to protect the feelings of another individual, we often realize that, at some point, we were trying to protect our own feelings. Being emotionally connected to the ups and downs of another can erode our identity, integrity, happiness, and individuality.
Family members who enable or are codependent achieve something from the behavior; otherwise, they would not do it. Please ask yourself some questions. What are you being provided from this codependent relationship? What need are you fulfilling by protecting the feelings of another? What comfort is provided when your feelings become parallel with someone else’s?
Recognizing Codependency
Q. Do addiction & Mental Health Disorders hurt Family Relationships?
A. A person using alcohol or drugs with or without mental health disorder symptoms does so with the highest form of selfishness. They often prioritize their own wants and needs over those of others or anything else. Oftentimes, the addiction or dual diagnosis can cause mental health disorder symptoms or exacerbate existing symptoms. This can make addressing the situation even more difficult because there may be more of a justification to care for someone when it is believed they are suffering from mental health concerns rather than an addiction. This can sadly include mothers, fathers, siblings, spouses, coworkers, and even children. As the person allows their wants and needs to be their priority, some family members and others may start to prioritize the need to comfort them. As the loved one with addiction or mental disorders puts others second, the same people put them first. How does this happen?
A lot of the way we think can stem from our upbringing and family of origin. Much of how we behave is influenced by our beliefs, experiences, how we were taught, and what we observed early in life. In other words, codependency in a relationship involving addiction and mental health disorders runs far deeper and has been present much longer than the current dilemma. A codependent family member often behaves to allow for underlying needs to be met and to feel a purpose or be needed in the relationship. There is a sense of fulfillment a codependent receives by prioritizing another person’s needs in exchange for their own. Codependent people often have difficulty finding purpose in their own lives, while finding comfort and purpose when being there for others. Codependent family members who are enabling addiction or mental health disorders may hinder others who try to help. This is often because those suffering from codependency have difficulties asking for help while they try to assist everyone else but themselves. Some find it challenging to give up this role in the relationship. A saddening reality for some is coming to realize their loved one was only using the codependent relationship to remain comforted, to avoid accountability and consequences. One of the last things a person with mental health disorders, alcohol, or drug addiction wants is for the codependent person in their life to become independent. Before getting help, the codependent may feel the need to be there for the other person, and if not for their support, the person may get worse. With adequate education and counseling, the codependent person may realize the loved one with addiction and mental health struggles needs the codependent person more than the codependent person needs to enable their diagnosis and behaviors.
Q. Is there a benefit that one believes can be achieved with Codependency?
A. Codependency may be like lighting yourself on fire to keep another person warm.
Codependent behavior is when a person seeks to meet the needs of another. Codependency involving enabling the intended patient is often met with emotional fulfillment for one and emotionally one-sided abuse delivered by the other. So in relationships with someone who has a substance use or mental health disorder, we know they are receiving comfort and fewer consequences. We see the codependent is accepting emotional abuse and loss of identity and independence. The question is, what is the codependent enabler receiving? What reward is so great as to allow this?
When we look at the behaviors of a codependent person, they have much in common with those who have process addictions. When a family seeks out help for intervention and education for addiction and mental health problems in the home, they frequently reference the behaviors of the intended patient. Could one not view the primary enabler or codependent person as the one who needs as much help as being equally addicted to their loved one’s behaviors and needs? Codependency is similar to a relationship addiction in which it is emotionally abusive, and one side receives more benefit than the other. Like all addictions, whether process or substance, the reasons for them stem far deeper than most can identify on the surface through self-awareness and self-correction. Professional help is almost always necessary.
Q. Can Codependency on one person and their Addiction or Mental Health Disorder harm my whole Family?
A. Whether it be love, time, or attention, we only have so much of ourselves to give in a day. Offering the majority of yourself to one person can lead to resentment and conflicts with other family members. Below are some helpful ways to recognize if your codependency is comforting an addiction or mental health disorder and creating tension and anger within your family.
It is helpful to identify the reasons behind the codependency. Through intervention training and continued counseling, most come to realize they were not codependent enablers solely with the hope of saving their loved one; they were equally, if not more so, seeking to fulfill a need for themselves. When reading the examples, please try to recognize why you’re doing it rather than what you’re doing.
Q. You feel personally responsible for others.
A.
- You believe that if not for your support, they would be worse off than they are (you’re helping them).
- You think and feel responsible for other people.
- You feel anxiety, pity, and guilt when other people have a problem.
- You feel compelled to help the person solve the problem.
- You feel frustrated when your help isn’t effective.
- You often anticipate the needs of others.
Q. Your own needs are less important and are not being met.
A.
- You try to please others instead of yourself.
- You wonder why others don’t help you the way you help them.
- You have less of a problem providing help, but have a difficult time asking for help.
- You find yourself saying yes when you mean no, doing things you don’t really want to be doing, doing more than your fair share of the work, and doing things other people are capable of doing for themselves. (People Pleaser)
- You don’t know what you want and need, or if you do, you tell yourself that what you want and need is not essential.
- You find it easier to feel and express anger about injustices done to others, rather than injustices done to you.
Q. Your feelings of worth and contribution are dependent on others.
A.
- You feel safest when giving.
- You feel insecure and guilty when somebody gives to you.
- You feel sad because you spend your whole life giving to other people, and nobody gives to you.
- You find yourself drawn to people who seem needy.
- You find needy people attracted to you.
Q. You’re always at the mercy of someone else’s drama or neediness.
A.
- You abandon your routine to respond to or do something for somebody else.
- You overcommit yourself.
- You feel hurried and pressured.
- You feel bored, empty, and worthless if you don’t have chaos, a crisis in your life, a problem to solve, or someone to help.
Q. You feel powerless – even when you seem to be in control.
A.
- You believe deep inside that other people are somehow responsible for you.
- You blame others for the situation you or your loved one is in.
- You say other people make you feel the way you do.
- You believe other people are making you crazy.
- You feel angry, victimized, unappreciated, and used.
- You find that other people become impatient or angry with you for all the preceding characteristics.
Attention to one Person’s Addiction and Mental Health Impacts Other Relationships
Like addiction and mental health disorders, codependency is not a moral failing or the characteristics of a bad person. It is often earlier or current trauma, life experiences, and learned behaviors that are the cause. It is seldom that the current situation is the sole cause of the enabling and codependency. As with addiction and mental health disorders, it is helpful to identify the reasons behind the behavior and learn new coping strategies.
To begin the process, it is beneficial to understand some basic effects of relationships. It can be said that when two or more people become connected in a relationship of any form (work, romance, friendship, or family), those in the relationship will do one or more of three things:
- A person will assume some of the qualities of the other.
- A person will assume a role that complements the qualities of the other.
- A person will assume a role that acts counter to the qualities of the other.
The most important thing to understand about the previous three statements is this:
When two people connect or enter into a relationship of any type, then both parties are changed as a result of that connection. In other words, all parties have been changed to some degree as a result of being connected and/or in a relationship with someone who has an addiction or mental health disorders.
To make this a bit easier to understand, let’s replace a few words in the above scenarios better to fit the situation of addiction and mental health:
- A family member will assume some of the unhealthy behaviors of the intended patient.
- A family member will assume a role that complements the unhealthy behaviors of the intended patient.
- A family member will assume a role that counters the unhealthy behaviors of the intended patient.
Another helpful way to look at it is If you replace the words “family member” with yourself, and then replace “intended patient” with the name of your loved one.
Most people do not realize the depth of change that has taken place within themselves as a result of their relationship with someone addicted to drugs or alcohol. People affected may not see the impact it has had on other members of their family. Often, as a result, misplaced emotions and resentment are directed solely at the intended patient, over the family member who may also be equally responsible for the continued circumstances.
Codependency to Addiction and Mental Health Disorders can create the fear of change and the inability to let go of Enabling Behaviors.
People with addiction and mental health disorders aren’t the only ones who avoid intervention and treatment. Families often avoid intervention and therapeutic confrontation. Many do not realize why they are avoiding solutions to the problem. The excuses the family makes are hidden behind years and layers of family trauma, comfort-based enabling, dysfunctional family roles, and codependency. Many are unable to see the signs of codependency even when it is drawn and spelled out for them. The fear of change, hidden behind the excuse of denial, challenges many families from being able to address the addiction or mental health problem. As a result, families wait much longer than they should, hoping and believing the situation will correct itself.
The reasons behind their behaviors are far and wide, as are the various reasons families state, “it will never work” or “they will never go”. The primary reason families are fearful is that they view the intervention more as what they will be giving up than what it will provide for them and their loved ones. With any other medical concern that requires immediate or near-immediate remedy, families would not behave or respond the same way as they do when addressing an addiction and mental health.
The fear is not in the change itself; the fear lies in the unknown that comes with change. When a family acquires maladaptive coping skills over time, the coping skills often become the new normal. The longer the addiction and mental health disorders are addressed with these coping skills, along with codependency and enabling behaviors, the harder it is to change the dynamics. When families ask questions such as What is your success rate? ” or, What if they say no or make statements referencing they will never accept help, these are often fear-driven questions. The underlying fear is driven by misplaced emotions that they may actually say yes. The thought of a successful intervention can paralyze certain family members depending on their role in the relationship. A person accepting help and going away for treatment can send a translated message to their family, indicating that they now need to make different choices and change their behaviors. A successful intervention means there is no longer a hero, no longer a martyr, and no longer codependency. The intervention team and the treatment center now play the role of caretaker. A codependent enabler who is providing something to another in exchange for comfort to themselves can be threatened by an intervention and a successful outcome.
These behaviors and thoughts of the family do not make them bad people; they make them people who are caught in the grip of another’s addiction, mental health disorders, and various family roles of behavior. Family members who are emotionally attached and flooded rarely recognize this happening. In fact, the mere suggestion of examining it from this perspective can cause some to become angered. Remember, anger is often brought on by fear.
Our goal is to help families step back and see this from another perspective. If this were any other medical condition outside of an addiction or mental health problem, family and others close to the intended patient would most likely not address the situation the same way.
If you’ve avoided confronting your loved one with a professional intervention about their addiction or mental health and the need for treatment, it could be a result of you protecting your own feelings and role in the family system. When you look at all of the trouble, heartache, and consequences addiction and mental health bring to someone, you may often ask yourself why they do it. Although the reasons people do not take their psychiatric medications, do not advocate for their own care, and self-medicate with drugs or alcohol are endless, the question is, what is it providing that is so great that they would allow it to continue even in the face of extreme consequences? After all, the drugs and alcohol are providing them with something so powerful that they are willing to sacrifice anything and everything to get it.
Couldn’t the same question be asked of families who allow the devastation to continue for much longer than they would allow other problems to continue? What does the approach of allowing this to continue entail for those in specific family roles, such as hero, martyr, and codependent enabler? What does codependency and enabling provide for someone that they are willing to allow the chaos and confusion to continue and not seek professional intervention, counseling, or guidance? If the current approach did not provide something they needed internally, as the intended patients need for enabling and comfort, then they would not do it or would try something different. It is not what you are doing so much as why you’re doing it, or not doing it.
Codependent Family Enmeshment to the Addiction & Mental Health Disorders.
Enmeshment Definition
1. A condition in which two or more people, typically family members, are involved in each other’s activities and personal relationships to an excessive degree, thus limiting or precluding healthy interaction and compromising individual autonomy and identity.
Enmeshment is often a precursor to the concept of codependency. Enmeshment occurs when people are deeply intertwined and consumed by each other’s daily lives. In addiction and mental health, the primary enabler is often the one who is enmeshed with the loved one in need of help, and the reciprocating enmeshment is not always nearly the same level of intensity; that is, until the intended patient needs something. People seeking help for their loved ones who use alcohol, drugs, or suffer from mental health disorders often inquire about how to make them change or help them stop. For some, it is believed a speech from a professional will pave the way. For others, they feel hard consequences will be enough to “make” them go. What most families do not see or understand is the devastating impact it has taken on them and how their family system has been shifted to benefit the loved one who is experiencing mental health disorders, is an addict, or is an alcoholic. Sadly, many of those who call have been led to believe their situation is hopeless, and unless their loved one wants help or hits bottom, they have no choice other than to wait for them to change or stop abusing drugs or alcohol. Indeed, a family can take that approach. They can also arm themselves with intervention, education, boundaries, and ongoing counseling support to assist in the process of helping the family and the loved one in need of help.
Enmeshment can occur when people in a relationship have unclear boundaries and are unsure of what they should be. With enmeshed relationships, people feed off one another’s emotions, and tempers flare at the reaction of another doing the same. With the family at odds, the intended patient is often facing the least amount of instability and consequences. When a family comes together and forms an educated group, understanding what they are up against becomes clearer. Without boundaries, people will walk over or through us with no regard for our personal space or feelings. Having enmeshment-driven relationships in a family affected by addiction can prevent growth and change, as well as resentment and hostility with one another. Think of how many times you are speaking with other family members, often heated, and you’re talking about the addict or alcoholic and doing nothing about it.
A family requires professional insight and perspective, someone not emotionally attached or affected by the addiction. When all the family members are overwhelmed and have become accustomed to the drama and chaos surrounding the situation, it makes it more challenging to extricate themselves from it and even see a way out. Addiction is called a family problem for a reason. Not because the family is the cause of it, but because the addict helps the family to stay addicted. The family rarely sees it until things have become way out of hand.
Before anyone can learn how to do something different, they must first learn to let go of the old behavior. When someone decides to purchase a new house, they first decide to let go of the old one. The same simple principle applies to recovery for both family and loved ones with addiction and mental health. Families and those with addiction and mental health issues would love to have their cake and eat it too. Almost every person will disclose at some point in their sobriety that the goal was to figure out how to use alcohol and drugs successfully. Families who are honest in their recovery will disclose at some point how they want to learn how to control their loved ones better and not necessarily have them get better. Once a family agrees to let go of their old ideas and understands the origins of enabling, codependency, and unhealthy family roles, they will be able to allow the concept of detachment.
