Codependency is not a diagnosis
In the world of substance use treatment, the term codependency is used with such great frequency it has become almost synonymous with addiction. Parents, siblings, partners all are prone to receiving this label, or identifying with this label. But here’s the thing; codependency is not a diagnosis. This means that there is no universally agreed upon criteria that has been researched and peer reviewed.
Dependent personality disorder is a diagnosis listed in the DSM-5, but has no overlap with substance use, nor does it mention anything about being connected to someone with a substance use disorder.
The implications of a label
Since codependency is not a diagnosis, it is merely a label. One that is often applied haphazardly and with potentially damaging consequences. The concept of codependency often pathologizes care and concern and does not take into account cultural differences. The codependency view supports a highly individualistic approach to problems, a stark contrast to how many cultures view life, love, and struggles.
Further, codependency with regards to addiction has been greatly critiqued in that it maligns what are thought of as historically feminine attributes (caregiving, nurturing) while largely ignoring the systems that perpetuate the addiction cycle, i.e., government policies.
De-bunking codependent “behaviors”
Since codependency is a non-validated construct, the potential characteristics of someone who is ‘codependent’ enter into the hundreds. Each person who writes a book on the topic (and there are hundreds) adds new ideas. For the purpose of this article and because you have better things to do than read all of that, I have selected a few from the Hazelden Betty Ford website. According to the Hazelden Betty Ford Foundation, these are the hallmarks of someone who is codependent.
1. Protecting a Loved One from the Consequences of Addiction: this is dangerous and potentially life threatening. The consequence of addiction can be overdose, job loss, car accidents, and death. While there may be occasions where it makes sense to allow a person to feel the natural consequences of their actions, there are times when it simply causes more hurt, trauma, and destruction. With all other diagnoses, be they medical or mental health related the goal is avoid harm. Why should addiction be different? Lives can be saved when we help people avoid the consequences of addiction.
2. Keeping Secrets about Your Loved One's Addiction: the premise here is that because someone has a substance use disorder they are no longer entitled to privacy and dignity. If our loved one had an eating disorder or cancer, would we not respect their choices and seek their input regarding who is told and when?
3. Refusing to Follow Through with Boundaries and Expectations: on the surface, this seems reasonable. However, true boundaries are about what you need, not what you think will change another person. In codependency models they are often encouraging implementing boundaries specifically designed to change someone, for example, they must stop using. That is not a boundary, that is about control.
4. Making Excuses for Your Loved One's Behavior: what they mean is that any underlying issue connected to the addiction is irrelevant. We know that things like mental health issues, trauma, emotional and physical pain, etc., often underly substance use issues. By discounting any excuse or reason, you lose an opportunity to learn and understand about what your loved one is experiencing and what their relationship with substances is about for them.
5. Giving money that is undeserved or unearned: the very concepts of ‘deserved’ or ‘earned’ are subjective. Many parents or loved ones give money or resources that may not have been ‘earned’. Denying money or resources simply because someone has a substance use disorder is generally meant to control or serve as a punitive statement. This is not the same thing as setting financial limits based on your resources and your boundaries.
6. Viewing addiction and related behaviors as a result of something else: this is essentially a denial of a person’s individual biopsychosocial experience and seeks to blame and judge rather than understand and support.
7.Caretaking of the person who is addicted: addiction is the only condition in which the mere act of providing shelter, food, water, love, and compassion is pathologized.
You deserve a voice and a choice
How you choose to support your loved one should be based on your own boundaries, feelings, cultural considerations, and beliefs. You should not feel judged or stigmatized for what others view as ‘codependent behavior.’ If punishment and detachment worked to “cure” addiction, then there would be no addiction.
Understanding addiction and knowing how to support someone in a way that values you can be hard to navigate. If you need support, Substance Use Therapy is here. Whatever you are facing, you don’t have to face it alone.
“The opposite of addiction isn’t sobriety. It’s connection. It’s all I can offer. It’s all that will help him in the end. If you are alone, you cannot escape addiction. If you are loved, you have a chance.” -Johann Hari, Chasing the Scream
About the Author: Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, gambling, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.