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Identifying Codependent Behavior
Often patients have told me it is hard to determine what is codependent behavior. Usually that it is because the information they have has been vague and general. Sometimes I have heard counselors say there is a fine line between healthy behavior and codependency. I have also heard this stated about alcoholism. Beware of that kind of confusing information.
I remember when a staff member complained about a patient on the unit she thought wasn’t really an alcoholic. She believed this about many of our patients, which was unusual when you consider the severity it takes to qualify a patient for inpatient treatment. She thought the only reason we diagnosed the patient alcoholic was because he had a DUI. The patient had been assessed by counseling staff, nursing staff and the physician. I picked up the chart and showed her the history and physical which included a BAL over two times as high as it takes for a DUI, a history of alcoholic liver disease, a history of blackouts and a list of other problems explained by alcoholism. Nursing staff reported significant withdrawal symptoms and signs of delirium tremors. The counselor’s assessment indicated patient gave a history of divorce and auto accidents due to drinking etc. Interesting enough her only comment was we were unfairly labeling people as alcoholic. As you can imagine it wasn’t long until she moved on to another job. Is there any doubt that this person had a codependency problem?
I remember a man’s ex-wife (they still lived together) wanted to get him into treatment. She said can you have someone do an intervention and she wanted to know exactly what would happen. When I explained in general about an intervention she said that wouldn’t work because it would upset him and he would just get worse. I spent about half an hour with her and everything I talked about was rejected by her. She was desperate and didn’t want to leave without a solution. Finally I asked her if I could talk to him on the telephone and she agreed with some fear I would be too upsetting. She called him and with a lot concern finally gave me the telephone. I found him quite reasonable and well aware of his problem. He said he didn’t know if his insurance would cover treatment because he had been in rehab before so I offered to have his insurance checked. He came in the next day, she was amazed.
Codependency is often a problem when a member of a family or a work group has a disabling personality disorder. I remember a family where both the husband and wife went through treatment and apparently both stayed sober for at least many years. The husband was extremely narcissistic and controlled the family with sudden bursts of rage. His negativity was of heroic proportions. He made nearly all of the decisions for the family and most were self destructive. He could not get along on the job so he quit. He lost their house, spent his pension, and moved several times all based emotional turmoil. His family was careful not to disagree and upset him. He returned to drinking after not drinking for more than twenty years and died within three months.
Codependent behavior tends to be reactive, consider the following.
Being Proactive Vs. Reactive
In the effective business world, you are taught that you should be proactive rather than reactive to become successful. Being proactive is a skill that takes time and effort, however, to perfect.
Definitions: Being proactive means that you are planning ahead and anticipating problems. Being reactive means that you are waiting for problems to appear before addressing them.
Pros: Being proactive can help eliminate problems before they appear and can make execution of your tasks more efficient. Being reactive can simplify the planning process, allowing you to act faster.
Cons: Being proactive lengthens the planning process and can lead to over planning as all potential options are analyzed. Being reactive can lead to unforeseen problems in execution that may require extensive time and effort to solve or correct.
Expert Insight: Leadership theorists such as John Maxwell and Ken Blanchard (see Resources) teach the importance of being proactive while maintaining a willingness to act. A balance of proper planning and effective execution is required for success.
Effects: A well-planned, proactive solution is more likely to succeed and less likely to create excess stress. With contingencies already in place, a problem faced in execution is much more easily addressed than if reactionary contingencies have to be developed as problems occur.
http://www.ehow.com/facts_5405243_being-proactive-vs-reactive.html
My personal definition of codependency is supporting pathological behavior in self and others.
| | Chronic Relapse after Treatment
Here are some of reasons patients relapse immediately after treatment.
The patient did not have adequate assessment and treatment of their problems.
Here are some examples:
There are many possibilities for psychological or mental problems not being assessed.
Studies report that when alcoholics enter treatment 40% of them have brain trauma. Obviously the lifestyle tends to make this condition more likely. Rarely are patients assessed for brain trauma.
A decrease in abstract thought for relapsing patients may not have been assessed.
The above are only a few of the possibilities.
There can be medical problems that may not have been assessed or treated as needed.
The patient can have severe liver problems that result in temporary dementia or being extremely lethargic.
The patient may have a history of multiple drug use and/or a longer more complicated history of use than reported.
The patient may not have been completely detoxed prior to their treatment and consequently cannot benefit fully from the information. Many times patients are discharged before they are prepared for the next stage of their treatment. For example, the patient had been using alcohol and Valium and the Valium hadn’t been picked up in the assessments. The patient has been detoxed for alcohol but not for Valium. His Valium withdrawal had just begun and was not completed by the time he left treatment. Or, the patient has been using crank or similar drugs and had a paranoid psychosis as a result of the use. If the psychosis was not assessed and treated, it may be a problem for up to six weeks. In a few cases there is permanent damage.
The period of withdrawal and craving for marijuana, methadone, Valium, and other similar drugs is almost always significantly underestimated.
It is pretty much guaranteed that the patient will go through the protracted withdrawal syndrome as described in “Beyond the Influence” by Katherine Ketcham. This includes neurotransmitter depletion, malnutrition, possible hypoglycemia (which usually is temporary), autonomic nervous system dysfunction, and cortical atrophy. The problems caused can be significantly reduced by proper treatment especially nutrition. The key is to be treated by staff who have the in-depth knowledge of addiction and who have made adequate treatment recommendation.
After inpatient treatment does the aftercare provide adequate support to address the patients assessed problems? Is that support for a long enough period of time to expect recovery? It is important to consider if the patient has been involved and agrees with the plan. Is it realistic for this patient? Does it consider his finances and other possible limitations?
If the patient is being treated by other physicians, have they been contacted and any medication they may have prescribed been considered as a possible relapse cause? A very high percentage patients relapse because they have been prescribed mood altering medications by another physician.
Does the patient have a twelve step sponsor that will support immediate work on the steps? Has he been offered contact with Back to Basics education? If Back to Basics educational groups are not available this information can be obtained on the internet. Many chronic relapsers have never been educated on the nature of grief as a major issue in recovery. Facing the losses caused by the addiction is extremely difficult but avoiding them is always disastrous. The Grief Recovery Handbook from the Grief Recovery Institute is always helpful; their website has a wealth of information.
This is only a short sample outlining some possibilities and a strong recommendation for seeking out staff that is well trained specifically in addiction problems. ASAM certified physicians and counselors certified by NAADAC and the state certifying agency are essential. For more information read other articles on my website and read “Beyond the Influence” by Katherine Ketcham.
Many of those who relapse repeatedly can be traced to a lack of adequate problem assessment and, of course, what is not recognized cannot be treated.
See other articles on this site for more in-depth information on specific problems.
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