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What Is Codependency Treatment?

A person who is codependent experiences emotional dependency on a relationship where they feel neededA person who is codependent experiences emotional dependency on a relationship where they feel needed. This typically occurs with a spouse or romantic partner, but codependency can also involve children, parents, or other family members.

The concept of codependency developed around women who supported husbands with alcohol use disorder. These women enabled their spouses to continue drinking by making excuses for their behavior, protecting children or friends from their husband while he was drunk, saving household finances, and shielding their husbands from other repercussions of their substance abuse. While the psychological concept has since been applied to a wider range of relationships, the original relationship model is still one of the most common: One person, who needs to feel depended on to feel loved, supports a person who struggles, often with an addiction of some kind.

Signs of Codependency

The signs of codependency include:

  • Dependency: The leading definition of codependency involves dependence. A person struggling with codependency needs others to depend on them. They depend on people in their lives needing help, structure, nurturing, support, and more.
  • Low self-esteem: A person who is struggling with codependency does not feel that they are good enough, or they constantly compare themselves to others when they experience success. Sometimes, low self-esteem manifests as bragging or feeling good about oneself, which masks shame or guilt underneath.
  • Poor boundaries: In a healthy relationship, each party will have boundaries around parts of their life that they wish to keep private or separate; this can apply to income, possessions, the body, or even thoughts and feelings. Even healthy romantic relationships and marriages have boundaries. However, people who struggle with codependency will have blurry boundaries; are unable to set up boundaries; are willing to cross boundaries when they are asked to by a partner; or, in contrast, they may have rigid boundaries and become withdrawn or resentful when the boundary is even approached.
  • People-pleasing: A person struggling with codependency will have a hard time saying “no” to requests. This is one sign of poor boundaries, and it typically leads to resentment, lashing out, guilt, shame, or feeling violated because the person pushed themselves too hard to accommodate the needs of others.
  • Strong reactions: When a person has poor boundaries, their emotional reactivity peaks. They will react much more strongly or defensively because they feel threatened by even small disagreements.
  • Caretaking: People who have a codependent relationship style feel like they constantly need to take care of others even when it is to their own detriment. They may even feel rejected if their partner does not need their help.
  • Control: People struggling with codependency over-help to feel in control of the situation. In the original model of codependent relationships between women and their husbands suffering from alcohol use disorder, these women controlled an otherwise desperate, abusive relationship by constantly “helping,” or enabling, their husbands and controlling others’ actions and reactions to their husbands. In the broader definition, a person struggling with codependency may develop their own substance abuse problems to control their moods, they may over-schedule themselves or others, or they may be bossy or emotionally manipulative to control others outside of the codependent relationship.
  • Poor communication: Because they do not have emotional boundaries, people struggling with codependent behaviors have trouble articulating their feelings or why they react strongly to certain experiences.
  • Obsessions: When a person struggles with codependency, they may spend a lot of time thinking about other people’s behaviors and relationships. This appears to tie back to anxieties and fears stemming from their own relationship.
  • Denial: People who are in codependent relationships do not acknowledge that the relationship model hurts them and the people they love.
  • Difficulty with intimacy: Emotional and physical openness to others is a problem for those who struggle with codependency. They need to appear to be strong, caring, helpful, even all-powerful providers. The person may fear appearing weak because they fear judgment and rejection. Being open and honest about relationship experiences puts this person in a position where they feel like they are not being helpful or needed.
  • Painful emotions: The stress involved in constantly overlooking personal needs to support others leads to high stress and painful emotional reactions like despair, hopelessness, depression, anger, and resentment. This can lead to paradoxically rigid boundaries.

People who are codependent in relationships may develop clinginess and lose self-sufficiency or autonomy.

Other signs to look for in a codependent relationship include:

  • The person is only happy in relationships or cannot find reasons to be happy outside their relationship.
  • They stay with partners even when they recognize unhealthy behaviors in the person that can harm both partners.
  • They offer emotional support to partners even when it is detrimental to their own mental and emotional health.

Treatment for Codependent Behaviors

The best treatment for codependency for both parties is psychotherapy. Cognitive Behavioral Therapy, or other kinds of therapy focused on understanding behaviors and changing reactions to lead to positive outcomes, helps the person who struggles with codependency, their relationships, and the people in those relationships with the codependent person. Couples therapy helps people in codependent marriages or intimate partnerships. Family therapy can help reduce the impact of codependency among parents, children, and extended family.

Other steps, which will likely be brought up as exercises in therapy sessions, include:

  • Carving out time alone to explore oneself
  • Reconnecting with work or hobbies outside the codependent relationship
  • Finding ways to say “no” to requests for help
  • Reconnecting with outside friends and family

If anyone in the codependent relationship struggles with substance abuse, it will be imperative to get treatment for this condition along with treatment for codependency.

Codependency and Substance Abuse Treatment

Codependency and Substance Abuse Treatment

A person working to overcome substance abuse needs support from friends and family; however, it is vital that this support involve boundaries in order to reduce the risk of relapse. People who struggle with enabling or codependency are not able to appropriately moderate their emotions and boundaries, and this can be detrimental to the recovery process.

People who struggle with codependency in relationship with a person who struggles with addiction may feel loved if they help the person get drugs or alcohol; they may get a sense of reward for helping their partner through serious intoxication when the person cannot fend for themselves; they may moderate their partner’s triggering or abusive behaviors by giving them a little too much of an intoxicant. In some cases, people who develop codependent behaviors grew up in a household with a parent who struggled with addiction, so they are used to the process of caring for a person while they are intoxicated and finding other ways to control their lives.

Codependency is harmful to the person who struggles with it, and it is a hard behavior to change without help. When a person struggling with substance abuse seeks help, this changes larger relationship patterns, and people who struggle with codependency may not be willing or able to change these patterns, as they feel unsafe or unloved.

The Four A’s for Codependency Recovery

Some approaches to codependency treatment involve four steps, called the Four A’s:

  1. Abstinence: Sobriety from substances is necessary if substance abuse is a problem. This also involves taking other steps, including “me time” or reinvigorating interest in hobbies, to turn one’s locus of control back to an internal focus rather than an external focus on a relationship.
  2. Awareness: Acknowledging that codependency is a problem, much like acknowledging that substance abuse is a problem, is an important step to getting help and ending problematic behaviors. Awareness includes noticing when the person engages in codependent behaviors, like controlling others or overexerting oneself for another person.
  3. Acceptance: Overcoming a mental health condition or substance abuse problem is a lifelong journey that includes therapy at various times, self-care and self-help, and, sometimes, even relapse. Overcoming codependency, like overcoming alcohol use disorder, requires accepting that this is a set of behaviors that a person may fall back on in relationships.
  4. Action: After accepting the condition and being aware of behaviors, it is important to take action to change them. Working with a therapist will help this process.

Reaching out to get help is one of the toughest steps for people struggling with codependency; they are used to people needing them, not vice versa. However, help from therapists and the support of loved ones are very important to recovering from codependency and changing relationships for the better.

Codependent relationships can be changed, and they do not have to be ended; however, this work requires both parties getting help. In some cases, this may also involve one or all people in the relationship entering treatment for substance abuse.

About The Contributor
Editorial Staff
Editorial Staff, American Addiction Centers
The editorial staff of River Oaks Treatment is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed... Read More