Codependency: Let’s Not Forget Our Loved Ones
As we demystify alcohol and drug use, abuse and addiction it is natural and appropriate to focus on the
individual with the substance use disorder diagnosis. This should not come at the expense of neglecting
the family and friends who experience their own troubling condition, commonly called codependency.
Projections of the number of people in this situation vary widely. One number in common use is that for
every individual with a substance use disorder there are eight other individuals who are codependent at
some level – parents, spouses/partners, children, friends. Not all of these codependent relationships
rise to the level of a behavioral health condition. However, if there are 40 million Americans with a
substance use disorder, then by this measure there are 320 million Americans who may suffer from
codependency – nearly everyone. Perhaps a more realistic number resulted from a study by the
Newport Institute (1) suggesting that 64% of Americans suffer some level of codependency. Not all of
these result from use, abuse and addiction of alcohol or drugs. Think about it for just a moment though.
How long would it take for you to identify the person in your life who abuses alcohol or drugs? Has their
use had an impact on you at any point?
We should note that codependency is a controversial diagnosis and, in fact, is not included in the
national standard for behavioral health diagnoses (Diagnostic and Statistical Manual of Mental Disorders
Version V). Codependency was once a frequent diagnosis for families where one member suffered from
a substance use disorder. That definition has expanded to include a variety of unhealthy relationships
and perhaps that is how “codependency” in its former, frequent use is now viewed. Dependent
Personality Disorder is a recognized condition and perhaps this is where codependency resulting from
SUD is diagnosed by clinicians.
A 2022 opinion piece in the New York Times provides a very good overview of the controversy. The
author notes that all relationships are dependent at their core. What separates a healthy, functional,
temporarily difficult, strained, or very troubled relationship is not easily defined pathologically and,
regardless, does not qualify per se as a behavioral health condition. Further, the closely linked concept
of enabling promoted by decades of thinking in Al-Anon, Al-Ateen and related communities is not a
proven relationship and too often stigmatizes the family member of the person with substance use
disorder. All of this aside, it is our view that we do disservice to the family members and other loved
ones of the person with substance use disorder if we fail to address their concerns.
Reporting for the Cleveland Clinic (2) Dr. Coda Derrig defines a codependent relationship as one where
“there tends to be a severe imbalance of power. Often, one person may be giving much more time,
energy and focus to the other person, who consciously or unconsciously takes advantage of the
situation in order to maximize their needs and desires.” We all adjust our interests, likes, desires,
schedules, career trajectories activities of daily living and more in order to accommodate a caring
relationship that meets our needs for intimate partnership. In a codependent relationship all or most of
that adjustment occurs on the part of one partner while the other takes advantage.
At first the adjustments feel mutually beneficial, and the codependent partner feels as if they are
contributing. Over time, however, that contribution becomes increasingly imbalanced, and the
codependent partner loses sight of their values, responsibilities, needs and even loses sight of who they
are. As they redouble their efforts to contribute to the relationship, they can never succeed in “saving”
their partner who is manipulating the relationship consciously or unconsciously. The codependent
partner cannot do enough to satisfy themselves or their partner and matters spiral ever downward.
Dr. Derrig offers signs of codependency. The codependent partner:
• Increasingly assumes even the most basic function of their partner’s lives like getting to work on
time or even at all, paying bills, attending their family events eventually assuming responsibility
for everything and being unable to win at doing so
• Desires to change their partner especially with regard to alcohol and drug use and redoubles
effort when initial attempts fail
• Feels guilty when they take time to address their own needs
• Experiences anxiety about their partner’s behavior when they are not with them which then
increases over time
• Finds it increasingly difficult to spend time alone without their partner
• Increasingly and routinely changes and cancels plans because of the partner’s behavior
• Finds that their personal connections to family, friends, even work decline or disappear due to
the relationship and behaviors of their partner
• Find that efforts to exert control only increase the behavior in their partner that they are trying
to manage
• Lose their sense of personal space.
Eventually, the codependent has a life marked by self-sacrifice, an unhealthy focus on others and not
self, a heightened need for control regularly producing conflict, and an inability to recognize, define and
express emotions.
This series of articles is focused on codependency resulting from someone suffering from substance use
disorder. There are other causes of codependency as noted by Crystal Raypole (3) reviewing discussions
from Vicki Botnick a clinician in Tarzana, California. In the main those causes involve adverse parenting
and care giver behavior such as abuse, neglect, bullying, parental divorce. The point here is only to note
that substance use disorder is not the only cause of codependency and the resulting pathologies.
There is treatment for codependency usually under the guidance of someone with a certification in
marriage and family counseling. Often in cases where substance use disorder is involved, support
groups such as Al-Anon, Nar-Anon and their programs for adolescents can be helpful. Such therapy
involves recognizing and expressing the signs of codependency, overcoming the need to please others at
the excessive expense of self, addressing related behavioral health concerns such as anxiety or
depression, reconnecting with self and setting healthy boundaries.
“Recovery” from codependency usually involves a return to self-care. Simply stated (though not so
easily done) the codependent finds the means to be comfortable spending time alone, identifying and
experiencing their emotions, expressing and pursuing their needs and interests. Given time, attention
and effort, working closely with qualified therapists, these goals are available.
Finally, the immediate question, and the frequently offered advice, is whether or not to exit the
codependent relationship if that is possible. If that answer were simple, easy and effective then all the
current work being done in behavioral health would be much less necessary. Although ending the
relationship may be the outcome, this should not be done without guidance except, of course, where
the life and physical well being of the partner or others is in danger. To be certain, where the well-being
of self and/or others is jeopardized then action is required immediately. Certainly, this step is not taken
at the start based on the opinion of a friend regardless of how concerned they may be. Further, this
step alone, even where necessary, will not undo the long term damage that has occurred.
Too often a legitimate and important focus on the person with an alcohol or drug issue overlooks the
needs of the codependent. Although the debate about this condition in the DSM-V continues, the
individual living in a codependent environment feels the difficulties, nevertheless. The individual feels
alone, unappreciated, and does not know where to turn or what to do about their situation. Yet, they
are not alone, there is a pathway, recovery is possible. Clinical support through certified, experienced
counselors is a proven source of relief and support. Codependent communities of mutual support such
as Al-Anon (alcohol), Nar-Anon (drugs), Gam-Anon (gambling), Families Anonymous and Codependents
Anonymous have been a godsend to millions. We encourage you to reach out for support in whatever
manner is best for you. You can confide in your minister, primary care provider, the Employee
Assistance Program at work. In each case they are ethically and often legally bound to maintain your
confidentiality. They will provide solace but most importantly guide you to Counselors and mutual
support communities.
Naturally, the codependent has thoughts about how to help their loved one. We encourage you to do
so. How to do that deserves an entire article of its own which will be forthcoming in this series. The
purpose of our writing today is to encourage the codependent to think about and act on their own,
legitimate diagnosis.
1 Codependency Disorder in Young Adults; Newport Institute,2022
2 Cleveland clinic Health Essentials, January 2022
3 “What Are the Signs of Codependency?”, Crystal Rayploe, June 2021
