Now What To Do: For The Codependent
Now That I Know About Substance Abuse, What Should I Do?
For the Codependent
Gene Gilchrist
December 2024
So far, we have shown that the popular image of alcohol or other drug abuser as a street person is skewed. We have also detailed how alcohol and drug use issues cover a continuum of unfortunate to tragic outcomes. You have made a good self-assessment and faced the reality about your loved one. There is a problem. Now what? Earlier we discussed the case of the person with substance use disorder themselves. Now let’s take the case of loved ones.
Your focus is likely on intervention, but before we discuss interventions, let’s focus on the well-being of you, the codependent. In a previous article we discussed codependency, its controversies, causes and both clinical and self-help approaches. Our view is that codependency is a legitimate diagnosis with the need for focused, supported clinical treatment. Sadly, your loved one with a substance use issue faces obstacles that while very real can be overcome. Treatment is increasingly available but even with treatment and repeated attempts less than one-half of those who try achieve one year of continuing abstinence. That is not to abandon hope. After all, treatment is available and 50% of those who try do recover. There are millions of Americans in recovery today. Your support increases the odds for your loved one. Regardless of the outcome for your loved one, we encourage you to find a path to recovery for yourself.
Writing for “Very Well Mind”[1], Heather Jones provides a very good overview of codependency and approaches to treatment. Ms. Jones notes that therapy for codependency often focuses on a person's current relationship and past relationships, and any childhood trauma that might have led to the development of certain behaviors or ways of thinking. In these approaches Cognitive Behavioral Therapy can be used to help codependents recognize and change unhelpful thought patterns and behaviors.
As is the case for substance use disorder, there are group self-help communities for codependents. These include Al-Anon and Al-Ateen (alcohol), Nar-Anon (narcotics), Gam-Anon (gambling), Codependents Anonymous, and Families Anonymous. These groups are where people who are codependent can support each other, work through their treatment together, and get access to programs and resources to support their recovery. Like Alcoholics Anonymous, these groups have meetings and often have steps, traditions, promises, and service concepts.
Once you have considered your own well-being you will be very tempted to engage in an intervention with your loved one. After all, their well-being is likely what got you to this point. We encourage you to do so. Your loving action may save their lives and the lives of others they could easily harm.
There are seemingly endless articles and websites about “interventions” and we will review a few here. Any credible source will advise against doing this alone or, at least, without planning with an informed partner. Sure, some of them are selling you their services. However, there are several professional, credible, worthwhile individuals and organizations in every community in America who know what they are doing and can help. You might find these professionals through your primary care physician, your religious minister, or the Employee Assistance Program at work. You might attend an Al-Anon (Nar-Anon, Gam-Anon et al) meeting and find people who share their experience, strength and hope with you and can tell you about their experiences with clinicians. Your minster will be of great solace in your spiritual well-being. Your friend with similar experience will be a shoulder to lean on. Your clinician will be someone trained and experienced in these matters. They may be MDs, licensed alcohol and drug counselors, licensed social workers. We do not discount the importance of ministers, friends, family members. They provide solace and understanding. At the same time, we encourage you to find a licensed professional with experience in these matters. The clergy, family members and friends have their value, but the clinician is trained, educated and experienced in these specific issues. Above all, do not do this alone.
A formal intervention typically involves a carefully planned process by family and friends, partnered with a professional trained in these matters. The intervention acts as a coordinated effort to confront and encourage a loved one struggling with alcohol and other drug abuse and addiction to accept treatment. We cannot accentuate enough that an unplanned, unscripted, solo discussion with your loved one is predictably the least effective approach no matter your confidence in your relationship or your abilities.
In 1973 Dr. Vernon Johnson[2], a man of the cloth, considered interventions for alcoholics. After studying his parishioners and consulting professional studies about alcohol use and abuse he concluded:
There was not one “Major Life Altering” event that caused them to quit
The majority of their quitting involved small, non-life-threatening events involving spouses, family fights, or an illness caused by the addiction
When seeking sobriety it was a forced decision resulting from those small, life altering events
When sobriety was not sought out, the small life altering events collided quickly and caused death
There needs to be a well thought out and defined plan to help the addict to see what the consequences could be if sobriety is not sought.
Today we would disagree that death occurs quickly (although that does happen all too frequently), that major life altering events do often create an opportunity for recovery, or that a single point of intervention without a result would be failure. Dr. Johnson’s conclusion about the impact of intervention, however, has been the basis for many successful interventions over these many decades.
The Johnson Model of intervention has seven central components:
· Mediation Crew/Intervention Team: A group of friends and family members, known as mediators, comprise an easy-going group of personalities
· Planning: The best results occur when an intervention is carefully planned and organized. The last meeting should be appropriately planned and scheduled at a suitable and calm time and place for the person. However, intoxication, fatigue, and stress should not play a role
· Care-Focused: Loved ones should be assertive without intentionally hurting the person throughout the process. They should make the addict feel special and loved throughout the entire process
· Notes and Proof: Individual attendees write letters in advance outlining particular examples of how the addiction has affected their own lives. These notes must be factual, objective, and non-judgmental
· Focus on Addiction Only: Participants should only address issues about the addict’s addiction. They should not mention other issues of the past
· Therapy as the Principal Intention: The primary goal of an intervention is to motivate individuals to proceed with treatment and stay with the program for a given period. Loved ones should prepare to enforce strict consequences if the addict refuses medication and/or therapy sessions
· Options for Treatment: A team of mediators conducts research, plans their strategies and provides three treatment options to the individual after performing a comprehensive assessment.
Ideally, after a well planned and executed intervention your loved one will agree to begin the process of treatment. To be frank, this is not the most likely outcome. Rather, the process of denial is usually overcome slowly. Let us assume for the moment that your loved one agrees to treatment right away or after a brief period of consideration. Now what?
As we have discussed in the article about treatment, the options are far more varied and applicable in a wide array of circumstances. Writing in “PsycCentral”, Steve Greenman[3] and Hope Gillette provide a good, high level review of this transition from active substance use and abuse to treatment and early recovery. They argue that there are two early stages before consistent recovery – a transition stage and an early recovery stage.
They suggest that the transition stage can be a complex time as the person using alcohol and drugs adapts to not drinking, and the family adjusts to the transition of living through the end of the drinking into the beginning of abstinence. Often the family environment involves a last ditch effort to deny the problem, increasing defensiveness, and an increase in uncontrolled behaviors. After all, your loved one is not used to living without the substance as a major daily influence and the new behaviors are both new and undefined.
It may be tempting to “help” the loved one by providing reminders about treatment appointments, arranging schedules around twelve step meetings, asking questions about how things are going. All understandable and realistic supports. Remember, however, that recovery is at some point your loved one’s job not yours. It is likely that you have inadvertently and lovingly been a part of this relationship with the third party being alcohol and/or drugs. It is important to understand the difference between your support and your loved one’s responsibility at this stage. It is important that the person with the issue take responsibility for their recovery.
We sympathize with how difficult this time is for the family. As we have suggested, twelve step and other support groups are a significant source of support with the focus on you and your family members as they go through their transition period. Greenman and Gillette review four areas that you may focus on:
everyone staying “dry” and “clean”
stabilizing the out-of-control environment as needed
maintaining family support systems and routine activities such as school, church, family matters
focusing on the well-being of every individual within the family
Forward movement is the key for the person following efforts to achieve recovery and that forward movement may not be linear with each day better than the last. Perhaps the best thing you can do for your loved one is to stay focused on your recovery, model recovery behaviors such as self-help, and maintain an orderly family environment as best you are able.
As the early recovery stage begins the stress on family members continues. Early success in transitioning away from drinking and drug behaviors are often met with relapse. Nerves are on edge. Your hopes for a rapid and lasting recovery did not materialize. Family members in this situation, if they’re not getting support on their own, may become weary of the lack of attention from the person living with alcohol/drug use disorder who is busy trying to stay clean and sober. At this time, the focus might be on constructing support for both the person living with alcohol use disorder and family members with enabling behaviors.
As recovery moves forward, hidden and latent issues that fostered drinking or were created by the trauma of the drinking environment may need individual attention. At this point clinical support and self-help groups become extraordinarily important. Not only does the mental health professional become the guide for the family, but they also can become the provider of information in this stage.
Family members need to keep a strong focus on their own well-being, and this may be the best support of all for the person trying to stay clean and sober. Activities for the family may include:
continue with your own abstinent behaviors and thinking
keep your family in close contact with 12-step groups and programs
keep focus on individual recovery, seeking outside supports for your family
maintain attention for the children involved
keep a continual eye on potential challenges, such as the onset of depression, emotional problems, sleep problems, fear, and/or helplessness
engage a clinician with specific training and experience in codependency and substance use disorder
Unfortunately, not all interventions succeed. While this may be hard to hear, there is a chance your addicted loved one may refuse the treatment plan. They may erupt in anger, claim help isn’t needed, act resentful, and accuse you of betrayal or hypocrisy. It is important to emotionally prepare yourself for these situations while remaining optimistic that there will be a positive change. Again, a trained clinician will prepare you for this outcome and be there for you should that occur.
If your loved one does not accept treatment you will need to be ready to follow through with the changes you presented to them. Sometimes family members and friends are subjected to abuse, violence, threats, and emotional upheaval because of alcohol and drug problems. While you do not have control over the behavior of your addicted loved one, you can remove yourself and others from a harmful situation.
Even if an intervention fails, you and others can make changes that may help. Work with the other people involved to avoid getting caught up in the destructive cycle of behavior and take active steps to encourage your loved one to seek treatment.
It is difficult for family members when the disease takes hold. Often, family members have supported the person’s addiction without even fully realizing that was what they were doing. Don’t rescue the addict. Let them experience the consequences of their disease. Many times, people are unable to change until they are forced.
In the Big Book, “Alcoholics Anonymous” the alcoholic is presented with “How It Works” and at one point the authors say, “Many of us have said, what an order, I can’t go through with it! Do not be discouraged. No one among us has been able to maintain anything like perfect adherence to these principles.” Perhaps this codependency and intervention all sounds similarly daunting to you. It should; it is. You will not do this perfectly even with the help of a trained professional. The question is what is the alternative? A good heart will be your best effort.
Many codependents just remain in their situation. This is a sad burden for them and especially if young people are involved. The effects of adverse childhood events such as growing up in an addicted household present themselves in serious ways as adolescence and adulthood emerge. Your loved one may find treatment and recovery on their own. Currently the odds of seeking treatment are 20% and of achieving recovery less than 10%. If recovery does not occur, then what are the emotional, mental, physical and financial cost to you and other family members?
Others give up and leave the situation. Sometimes this is essential especially when abusive or dangerous behaviors are presented by the addict. Guidance from a clinical professional, a spiritual advisor, and legal counsel are very important at this point. As sad as this option may be, it is one logical step.
An intervention is difficult, emotionally wrenching and not always successful. But what disease is it for which there is an easy answer? Cancer, COPD, diabetes, heart disease – they all involve focused and often ongoing treatment, and they have similar relapse rates. The difference in the case of substance abuse and addiction is that there is no magic pill, no surgery, no radiation that will make this go away. But there is treatment, and it does work.
Only you can decide whether or not to try. Never, ever attempt intervention alone and always with advice and planning and hopefully participation by capable, experienced clinicians.
And finally, again, take care of yourself and your family members. Codependency is a real issue and requires real clinical support.
[1] Very Well Mind; Heather Jones, September 2022
[2] Vernon Johnson, Association of Intervention Specialists, May 2017
[3] PsycCentral, “The Family’s Role in Addiction Recovery”, Steve Greenman and Hope Gillette, April 6, 2022
