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Newsletter Volume 2, Number 5
The Relapse and Codependency Connection
My personal definition of codependency: Unwittingly supporting pathology in self and others.
I have often heard it mentioned that codependency is like alcoholism and needs lifelong attention to avoid going back to the old behavior. I tend to disagree with that because I have known numerous people with very serious problems who, after a year or two of help with education and changing their behavior, did not appear to need any additional support to avoid the troubling relationships.
For a period from 1989 through 1993 I directed a program at a psychiatric hospital that included both an inpatient and outpatient codependency program. I started the program at the request of several of the psychiatrists at the facility. The referrals to the program followed one or more attempts at suicide due to relationship issues. The referring physicians were very well aware of the lethal nature of these issues. The patients averaged more than six years of previous psychiatric treatment.
Insanity: doing the same thing over and over again and expecting different results. Albert Einstein
Most of us have heard this quote numerous times and may even believe it applies to certain isolated circumstances; however, few believe it applies to a large segment of our society’s behavior today. Doing the same thing over and over and expecting a different result defines one of the major problems of codependent behavior.
It is interesting how often I have found certain treatment staff quick to believe the patient is lying and how often they avoided an in-depth understanding of delusion.
A brief description of delusion from Wikipedia: Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define, in his book General Psychopathology, the three main criteria for a belief to be considered delusional. These criteria are:
* certainty (held with absolute conviction)
* incorrigibility (not changeable by compelling counterargument or proof to the contrary)
* impossibility or falsity of content (implausible, bizarre or patently untrue)
These criteria still continue in modern psychiatric diagnosis. The most recent Diagnostic and Statistical Manual of Mental Disorders defines a delusion as: A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture.
Signs of immaturity are a lack of boundaries and a lack of common sense. This is also true of codependency; however, it often appears as the face of a mature appearing human being unless you carefully and objectively watch the behavior. Codependency defies common sense, frequently doing just the opposite. It ignores the results of behavior and appears to live in a world of delusion. Alcoholics are known for assigning themselves good motives for seriously bad behavior. Codependents are equally adept at this deception. I believe that we see so much of this behavior in our society we become immune to identifying it.
Family and Friends Codependency
I have seen mothers and fathers that admit to giving their crank addicted daughter money on a weekly basis when they actually stated they knew she was spending every last dime on drugs. Typically, they followed with “I have to do something because I can’t let my grandchildren go hungry.”
I remember a man in his late fifties who was admitted to our hospital for inpatient detox. He was in very bad shape. He could not feed himself or even raise his head off the pillow. The only way he could drink was through a straw with help. I asked his wife how long he had been confined to a bed and she said about ten days. I then asked the obvious question how did he get the booze? She said, “He made me get it for him.”
Now I have thirty or more years of examples just like the above examples; however, these two should be sufficient. It would be expected that most normal people would see the futility in the above behaviors but - not necessarily so. So the preceding examples may seem somewhat appalling but are not necessarily the heart of the problem with codependency.
One of the most important benefits from inpatient treatment is to separate the addict from their enablers. Those knowledgeable of successful inpatient addiction treatment know that the more outside contact a patient has the less likely they will benefit from treatment. Outpatient treatment can be particularly frustrating because during a group a patient may get an understanding of their recovery needs; however, before the next session, often they have been persuaded to abandon their new understanding. Many times the only way that outpatient treatment becomes successful is if the patient is temporarily separated from their enablers. This is equally true of male enablers as it is of females.
About five decades ago a study completed in Minneapolis, MN demonstrated that when the family of a patient was involved in codependency treatment the alcoholic was twice as likely to remain sober. Another example of the power of specific treatment for the families of alcoholics came out of the Johnson Institute, also in Minneapolis, MN. When the families of active alcoholics were involved in codependency treatment at the Johnson Institute, within 90 days the alcoholic either sought help or left their family.
Treatment Staff Codependency
I have primarily worked in hospitals. I’ve worked with physicians, psychiatrists, social workers, psychologists, nursing and other specialized counselors. When I began to work in the addiction field I noticed a very high turnover in the hospital staff. The burnout rate of those working with addicts and their families was frightening. Eventually I found out that much of the burnout was due to codependency.
A few of the staff would frequently present a discharge plan to a patient like it was God’s will and without the patients input. Now, there is nothing wrong with presenting this to a patient; however, if the patient makes it clear if they are not going to follow this plan don’t beat a dead horse. Discharge plans need to be a cooperative effort between the patient and the counselor. If instead of working on an agreed upon plan the staff member keeps counseling (nagging) the patient daily with the counselor’s goal, they both start polarizing and it gets to be a contest. The staff member always loses. If they keep doing that in all their various patient treatment plans, within two years they will be burned out. Often within the first year they will start a pattern of using excessive amounts of sick leave. The common excuse is that the patient was uncooperative (bad patient). Trust me - it is not unheard of for inpatient units having a secret list of do not admit because one or more staff members have a personality conflict with a patient.
A more subtle example of the above behavior is when I had a coworker on the unit who, when he would answer the telephone and it was for a staff member who wasn’t there, would always end the conversation by saying “I will have him (or her) call you.” If the person read their message and decided there was no need to return the call, the man who took the call would start trying to get them to call and at times he even got threatening. He was a very large man; about six foot four and at least three hundred pounds. This turned into a real problem on the unit. He was obviously angry; the staff member was annoyed and would not return a call. The final resolution was when we listened to him take a message and tell the caller he would have the person call him. We discussed it with him and he agreed to substitute “I will give them your message.” This didn’t solve everything because while that one area improved his thinking was still codependent and showed up in his work in many other areas. Challenging the ingrained beliefs of the codependent person is as difficult as challenging a devout believer’s religion and equally hard to change.
Politics
A study conducted by the state of California indicated that one dollar spent on addiction treatment saved the state seven dollars. That seems like a good investment that anyone would snap up. How did the politicians react? They avoided doing anything to increase addiction treatment.
There is a distinct possibility that 80% of California prisoners have a serious chemical dependency problem and are likely to be chronic offenders without addiction rehabilitation. There has been a lot of talk and yet after decades of being aware of the problem and the tremendous cost to tax payers and the prisoners no decisive action has been taken.
Legalizing marijuana has been a popular topic for many of the politicians, both in California and at the Federal level. The various benefits have been claimed without much information on the dangers. Within the past two weeks the state of California has discovered it causes cancer. The federal government had information on their databases that cancer was caused by long term smoking of marijuana for over two decades. They clearly stated the dangers of cancer from smoking marijuana are several times that of smoking cigarettes. Now the very politicians supporting legalizing marijuana are the same ones fiercely condemning cigarettes due to negative health consequences. This is not an agenda for or against legalizing marijuana. My point is the obvious lack of common sense that may be at the level of delusion.
The Physician
In this day and age most physicians are helpful in dealing with alcoholism. There are those who believe the problem with addiction is just too much stress and the answer is anxiety relieving medications such as the benzodiazepines (Valium, Librium, Ativan, etc.) Physicians have been known to prescribe various opiates for patients also and not infrequently there have been fatal results. We have all heard the stories about entertainers who died as a result of their addiction. Many people suffer and die each year from inappropriate medication.
Again, I repeat, the physician is frequently the best friend of an alcoholic wanting help and those who are ASAM certified are especially helpful.
In Beyond Therapy, Beyond Science Anne Wilson Schaef
“I believe no one has healed in his or her logical mind.” “No one has healed from ‘understanding’ something. Yet, much of our psychotherapy is built on the belief that if we just understand something we will be all right.”
Codependents/relationship addicts always have to be indispensible. One of the major ways we make ourselves indispensible is by giving “fixes.” Unfortunately, the fixes may foster dependency and may kill the person being “fixed.”
Anyone interested in the consequents to our society from codependency should read one or more of Anne Wilson Schaef’s books.
Stephen R. Covey, The Seven Habits of Highly Effective People
Codependency is not the only name that describes the set of problems being discussed here; Stephen R. Covey covered the same set of problems and came up with an effective solution. He never called the problem codependency, although his program works well for codependency problems.
The 7 Habits
Dependence to Independence
* Habit 1: Be Proactive: Principles of Personal Choice
* Habit 2: Begin with the End in Mind: Principles of Personal Vision
* Habit 3: Put First Things First: Principles of Integrity & Execution
Independence to Interdependence
* Habit 4: Think Win/Win: Principles of Mutual Benefit
* Habit 5: Seek First to Understand, Then to be Understood: Principles of Mutual Understanding
* Habit 6: Synergize: Principles of Creative Cooperation Continual Improvement
* Habit 7: Sharpen the Saw: Principles of Balanced Self-Renewal
The Grief Recovery Institute
The Grief Recovery Institute also deals well with significant problems with codependency. Codependents avoid facing grief with almost a fanatical fervor and also do not believe it is helpful for the addict.
The Grief Recovery Institute http://griefrecoveryinstitute.com/ has many helpful articles, referrals, books and useful information.
| | Newsletter Volume 2, Number 6
Anger!!!
I believe that pathological anger has often been misunderstood by a few of the healthcare professionals and they have passed on this on to patients. Patients may spend many months or even years in attempting to hunt down and understand every example of anger they ever had, only to find in the end it is an expensive, time consuming activity that ended up leaving them more angry and/or depressed.
Two notable exceptions that come to mind are The Big Book of Alcoholics Anonymous and many of the new anger management courses. The A.A. information has often been interpreted by treatment centers in a way that defeated the effectiveness of the twelve steps. I receive a free copy of Recovery Today each month. It is also available on the internet at www.recoverytoday.net and I would certainly recommend it highly. I have no affiliation with Recovery Today. Each issue has an article on anger management that is excellent. There are other valuable columns in the paper, also.
The following is a quote from Anger Busting in the August issue of Recovery Today. Jim Baker said “I think it is time to embrace the idea that sometimes anger isn’t a symptom of the problem; it is the problem. Certainly, there may be a root cause buried in a remote, traumatic event or an abusive social history that laid the groundwork for the current destructive anger cycle. But is the same way some people embrace drugs or alcohol or eating or sex to get a temporary reduction in their level of emotional pain, others simply wrap themselves in an impermeable cloak of anger that protects them and gives them a short-lived sense of power over all threats, real or imagined. Once this pernicious relationship with anger has been hardwired into the addictive mechanisms of the brain, getting an anger addict to talk about not getting angry anymore works about as well as getting an alcoholic to not drinking anymore.” The suggestion of stopping acting out the anger and then we can work on your problem works, just as stop drinking and then we will work on your alcoholism works.
If you have worked in the addiction field you have no doubt encountered the patient who has been in therapy for years while drinking with disastrous results. Now, it isn’t news to many of you who have worked in the addiction field that when an alcoholic is in the advanced stages of their addiction, you also have an angry and depressed person regardless of their previous or present history. Any time that a person experiences the physical and psychological damage that addiction inflicts, they will feel significant anger and depression without any other cause needed. This is also accompanied by a personality disorder that frequently disappears after some months of solid recovery.
One of the conditions that I and others in the field have encountered is the person who is sober for some months or even years and still isn’t free of the pathological anger. He or she has a sponsor who urges them to attend more and more A.A. meetings and vent their anger. They feel momentarily better; and then in a short period of time they have a new collection of anger to vent. They report doing step work with their sponsor and being pushed to write and discuss in detail every last example of anger they can come up with. I believe they have missed the point of the twelve step program. The sponsor who gets much better results with a lot less effort asks the new person in recovery to write a few examples of anger and then they explore some questions such as “How did your behavior affect the relationship, the other person and yourself as a person.” This process identifies the pattern that keeps the person with a constant supply of new examples of anger to vent. This is a way out of the cycle. Just identifying examples of anger and venting has missed the most important point of the program. Many counselors and sponsors have described the process of passing this information on feels like pointing to something and the other person only can focus on your finger.
In addition to getting a sponsor who can guide the angry person as suggested by the twelve steps, there are other things that often help. In many cases involvement with the Grief Recovery Institute has been very helpful. In that case, the anger has been an effective defense for the person to deny their powerful feeling of loss. The Grief Recovery Institute has a handbook that is geared to work well with recovering addicts; and they have numerous free articles that are excellent and can be down loaded for free. They can be reached at http://www.grief-recovery.com/ Referring a person to A.A. Back to Basics can also be very effective. They can be found at http://www.aabacktobasics.org/
I am not supporting the idea that one should never be angry. I am only addressing pathological cases of anger. For those who have made progress with an anger problem, and yet don’t seem to have a real zest for life, there may be other things to consider. Anger is energy and I believe it is necessary to do something you feel passionate about. I am not talking about a career; sometimes a career can kill that passion. One man I knew starting restoring motorcycles. Some have learned to speak at A.A. and other functions. Several people have said they just had no idea and for them taking interest test are often helpful. When they find the right thing for them there is a dramatic transformation.
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