Overview, Causes, & Risk Factors

Codependency is a term for a set of problem behaviors in dysfunctional relationships. There is no common agreement about how to define this term. It is used in many different ways to describe many different experiences.

The idea of codependency was first formed by therapists working with people dependent on alcohol or drugs and their families. These therapists noticed that many of the substance-dependent people had partners with similar behaviors. The partners seemed to be unable to remove themselves from the problems of their impaired loved ones. They were bound to them by their determination to change or protect them. As a result, they became part of the problem.

It is unclear whether codependency is an illness or a normal response to being in a relationship with a substance-dependent person. But it is clear that treatment for substance dependence will not be successful unless both the substance abuser and the partner are willing to change their behavior.

What is going on in the body?

John’s wife, Mary, has an alcohol problem that has caused her to act foolishly in social situations. She has alienated friends, lost jobs, and wrecked cars. John responds to these incidents by trying to repair the damage she has done. Then he criticizes her and lays down harsh rules for her. She agrees to these rules at first. But eventually she violates them and returns to drinking. This just leads to another round of this seemingly endless pattern between them. She drinks, he fixes the problem. He criticizes her and sets rules. She agrees, then starts drinking again. On and on it goes.

Why would they both continue this painful and futile pattern of behavior? John feels anger at Mary for her drinking, but at the same time, he feels better about himself. He feels good about being a helper. His focus on her problems allows him to avoid thinking about his own. She is the sick one and he feels like the healthy one. Mary may resent and feel humiliated by his criticism and rule setting. But she feels powerless to change the pattern. She returns to alcohol as a quick and easy way to feel better about herself. His behavior gives her an excuse to return to alcohol.

Therapy for Mary can only succeed if John is willing to change his behavior. He needs to accept that he can never really control her drinking. When he protects her from the consequences of her drinking and then treats her like a bad child, he has only succeeded in enabling her alcohol problem. John must stop repairing the damage Mary has done with her drinking. He needs to allow her to suffer the consequences alone. If she continues to drink anyway, he either must find a way to live with her drinking or be willing to walk away from the relationship. Treatment will succeed only if this cycle of codependent behavior is broken.

What are the causes and risks of the condition?

We know very little about what causes people to fall into a pattern of codependent behavior. Some believe that it is a normal response to having a partner with an alcohol or drug problem. Others believe that some people are just more vulnerable to falling into this pattern.People who see themselves as helpers may be more vulnerable. People who have grown up with parents who have drug or alcohol problems may be more susceptible. Having a codependent partner makes it unlikely that someone addicted to drugs or alcohol will be able to recover. Violence is a common problem in codependent relationships.

Symptoms & Signs

What are the signs and symptoms of the condition?

A codependent person may show some of the following behaviors:

  • has a high energy level
  • has low self-esteem
  • has very good organizational skills
  • is competent at a wide variety of tasks and able to learn new ones quickly
  • is loyal and willing to put the needs of others before his or her own
  • never asks, “What’s in this for me?”
  • tends to overachieve
  • Diagnosis & Tests

    How is the condition diagnosed?

    Usually this pattern is better recognized by someone outside the relationship. That could be a therapist, friend, or family member.

    Prevention & Expectations

    What can be done to prevent the condition?

    The best way to prevent codependency is to recognize and treat a drug or alcohol addiction as soon as possible. The longer the pattern goes on, the more difficult it is to change.

    What are the long-term effects of the condition?

    Codependent relationships often last for many years, leading to very chaotic home situations.

    What are the risks to others?

    Children in households with codependent behavior are often severely affected. In some cases, they are physically abused or neglected. They almost always suffer long-term emotional scars as a result of their parents’ behavior. Many will recreate these experiences in their adult relationships.

    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment of people who are dependent on drugs or alcohol almost always includes the partners and affected family members. Therapists will guide the person to change the substance-dependent behavior. They will also help partners and family members understand how their own behaviors may be making the problem worse. They help them move to behaviors that can support recovery from substance dependence.

    What are the side effects of the treatments?

    There are no side effects to the treatment.

    What happens after treatment for the condition?

    Effective treatment usually leads to much better relationships and a healthier family life. But the risk of relapse from alcohol and drug dependence is high. It can be very important for people with these problems to stay involved in some type of treatment. Many people attend Alcoholics Anonymous or Narcotics Anonymous on a long-term basis. These groups are very useful in helping people maintain sobriety. Family members often find Alanon a very helpful group. This is a self-help group just for family and partners of addicts. Working with groups like Alanon can help identify and reduce codependent behavior.

    How is the condition monitored?

    For most people, long-term psychotherapy is not necessary. Groups such as Alanon can help people recognize when they are returning to their codependent behavior patterns. Any new or worsening symptoms should be reported to the healthcare provider.

    Article type: xmedgeneral