Reflections on Codependency Almost 40 Years Later

Over 20 million people in the United States struggle with a substance use disorder, a health condition that can also significantly impact relationships. Loved ones close to people with use disorders may find themselves responding to the chaos and stress of the resulting behaviors with their own unhealthy patterns of behavior. Over 40 years ago, these responses were described in one word: “codependency.”

How Was Codependency Historically Defined?

The term “codependent” was first used by members of Alcoholics Anonymous in the 1950’s to describe the family members of alcoholics who struggled to manage their feelings and responses to their loved one’s use. But it was the book Codependent No More, published by Melody Beattie in 1986, that brought the term into the public’s awareness.

Some of the key features of codependency, as published in 1986, described people who:

1. Have difficulty with self-esteem.
2. Attempt to anticipate others’ needs and wonder why others do not do the same.
3. Experience a fear of abandonment.
4. Possess a need for approval, making it difficult to say “no.”
5. Take responsibility for other’s actions and feelings.
6. Attempt to control a loved one’s behavior, often as it relates to substance use.

Soon “codependency” was applied to not only the loved ones and family of those with substance use challenges, but people who experienced trauma, mental health challenges, or were raised in “dysfunctional families.” “Treating” codependency became the focus of talk shows, self-help books, and treatment programs. Eventually, the term began to be applied to any circumstances in which someone may have “cared too much” for another person.

Stigma as It Relates to Codependency

Codependency has never been recognized as a mental health disorder in any clinical diagnostic book, as the term was never scientifically validated. Despite this lack of a clinical diagnosis, scales and tests were developed to “diagnose the disease” of codependency. What once was meant to define a specific set of behaviors in a specific set of circumstances ballooned into pop psychology, which weaponized the concept and rooted it in a critical and often blaming message: “Ugh, she’s so codependent!”

This pathologizing of a caregiver’s role:

• more often came to apply to a woman’s behavior.
• became a simplistic way to demonize a person’s adaptive behaviors, without considering the entire picture.
• made it easy to rebuke loved ones for walking on eggshells around the person using substances, while downplaying a key part of the picture (the destructive effects of the substance use)

The Human Need to Care for Others

The problem with this view of codependency is that it misses a fundamental truth about what it means to be human: We are hardwired to care. As social beings, we are made to connect to people and to community, and this connection is what helps us to survive.

Sure, there can be unhealthy ways to cope and care, but what would be the perfect way to respond to the relational challenges that addiction can create? Certainly not assigning blame or labelling a person’s response to an unhealthy situation as “just as sick as the addict” or an “enabler.” Imagine bringing your loved one to an emergency room, because they just keep climbing and falling out of trees, only to be told by the nurses, “If you weren’t such a codependent, he wouldn’t keep doing this” or “they just need to hit bottom.” (This “tough love” message was another extension of “codependency” and its pathologizing of caring for loved ones with substance use disorders.)

Rethinking Tough Love

Evidence-based therapeutic models such as the transtheoretical model have identified that people could enter the process to change at any stage, if the interventions used match the level of willingness. Simply put, what motivates the person to make a change may not be “tough love,” but rather understanding and compassion. It may be setting boundaries, letting a love one experience natural consequences, and reinforcing positive change. I may be maintaining a relationship with that person but maintaining boundaries at the same time. All-or-nothing thinking is rarely the answer but can appear to be when a loved one is in crisis.

Was the “Codependency” Term Ever Helpful?

Was the “codependency” term ever helpful? Years ago, it paved the way for family members to share their stories aloud, bringing families and substance use discussions into the public eye in a new way. It encouraged those who were impacted by substance use to examine their own behaviors and advocated for the use of therapy as a tool to identify unhealthy patterns of responding to addiction and other relational trauma. It openly called for families to learn more about substance use disorders. Unfortunately, as the term was applied with a broader brush, it became a label that pathologized anyone who experienced stressful relationship dynamics as “caring too much.”

While labeling may allow a person to accept the need for a change, it can also create shame; and there is a difference between having something and being something. The term “codependent” may have moved beyond its usefulness. Language is important. It may be more productive to instead consider a vocabulary of positive change, so that in changing how one sees and treats oneself, one can influence positive changes in others.

Again, when faced with a loved one with a use disorder or mental health disorder that could be potentially deadly, most people would not intuitively know how to manage their feelings, thoughts, and responses. Many can relate to that.

Moving Forward with Compassion and Understanding

The great news is we know and understand more about how to approach family members and loved ones who are dealing with substance use in someone they care about. “CRAFT” is a compassionate, evidence-based approach to sustaining a healthy relationship with a loved one who misuses substances.

Rather than labeling your response to a loved one’s addiction, here are some things that may be helpful:

1. Understand that you are not “sick,” but you are a human being who has and may still be in a situation that may be scary, stressful, and uncertain. There is no way to manage things perfectly and there is no one answer, as not everyone’s situation is the same. It is important to listen to feedback but just as important to intentionally decide what is best for you and your relationships.
2. You can learn new ways to support your own wellbeing by treating yourself with love and compassion first, making it more natural to communicate with your loved ones in the same ways. This includes setting boundaries.
3. Understand that at any moment you have done the best you could with the tools you had, but change is possible. There are a full range of tools available for you to learn to respond to a loved one who is struggling. There will be a resource list at the end of this blog.
4. Know that there is a whole menu of things you can do to support your loved one, even while they are struggling with active use, which can reinforce positive change and pro-recovery behaviors.
5. You can learn the value of natural consequences and that you can identify how and when to allow them to unfold in a loved one’s life without completely withdrawing or shaming your loved one.
6. You can put an emphasis on taking care of your personal, mental, and physical health, by finding professional or peer support, pursuing physical activity, developing or cultivating creative interest, and getting adequate rest and nutrition.
7. You can develop new communications skills such as active listening, the importance of timing, and using “I” statements that help keep the flow of communication open between you and your loved one.

Anytime a person is willing to examine their responses to unsettling, powerless, or scary circumstances and learn new ways to navigate them, it is a meaningful step forward. It takes courage to change, especially when others around us may not. However, it’s also incredibly empowering to realize we have choices in how we respond to the chaos that addiction can create in relationships. Even more so, it is inspiring to witness the positive impact those choices can have on those we love, as we move forward through the challenging times with kindness, intention, and compassion.

Resources

• The First Responder Families Podcast: From Caretaking to Empowerment: Redefining “Codependency”
• The First Responder Families Podcast: Finding the Words: How to Act When it Feels Like There’s Nothing You can Say or Do 
  Center for Motivation and Change
• Partnership to End Addiction

Joi Honer B.A, C.A.C, C.A.D.C
Director of Alumni Services and Resources