Addiction, or substance addiction, which includes alcohol dependence as well as non-substance addictions, is an illness that develops and takes place in the individual’s brain as a result of a stimulus that disrupts a biological equilibrium and prevents it from being restored automatically.
People with an addiction soon create a conflictual environment around themselves as a consequence of their illness. Usually, the first environment to become involved is the family, whether biological or acquired.
Family members may react in different ways, depending on the personality of each individual. However, it should be kept in mind that these reactions are driven by the illness of the addicted person, whereas the illness itself follows relatively consistent mechanisms.
The family’s adaptation to a relative’s addiction also tends to follow certain predictable patterns. Usually, these involve attempts to contain or repair the individual consequences of the relative’s behavior, without actually managing to change the direction in which they are heading.
Indeed, sometimes accompanying the person through their setbacks and disasters simply means going along with the direction taken by the illness and providing the availability, resources, and channels through which new setbacks and disasters can occur.
Over time, the family may organize itself around the addicted person’s problem through stable roles, in which each person finds a sense of purpose and a function, however useless or even counterproductive that function may be.
This situation is referred to as codependency. The term is used in the context of addiction as a play on words, but it could theoretically be applied to any situation in which the people surrounding someone, in an attempt to help or contain a problem, end up deriving more satisfaction or involvement from the roles they assume than from the results—which may be absent or even counterproductive.
In other words, family members are unable to give up their positions because, at least within those roles, they find a sense of purpose, while the addiction continues through relapses, illusions, promises, betrayed trust, and decline.
Codependency emerges particularly when an attempt is made to treat an addicted person. Instead of taking on whatever roles may actually be required to make the treatment work—often simply supervising medication and ensuring attendance at appointments—family members remain convinced of and committed to their own roles, as though recovery were supposed to depend on them.
Rather than merely hoping that they might be able to do something, family members in this situation want recovery to be connected to the role they have taken on. In doing so, they place that role ahead of the scientific functioning of the treatment itself.
By its nature, an addicted person tends to avoid treatment as though treatment were going to take away the freedom they believe they have—and which they have in fact lost—to use the substance. They may also try to manipulate family members, often before anyone else, in order to convince them that treatment is not actually necessary, that there is no illness, and that with their help they will be able to overcome the problem.
In other words, the addicted person calls on family members to take on hypothetical roles of rescuer, emotional supporter, financial provider, and so on, as though the outcome of the illness depended on them.
Family members provide money and assistance, help find a job, accommodation, and so forth because this gives them a sense of satisfaction and makes them feel that they can be decisive. This is an understandable reaction in someone who is willing to sacrifice themselves in the hope that the sacrifice will ultimately be worthwhile.
However, these forms of involvement around the addicted person do nothing more than accommodate the impulses of the addicted person, who suggests one intention in order to act according to another.
In true codependency, family members feel betrayed and deceived, only to immediately return to the same attempts, sometimes dozens of times, behaving as though the probability of success must finally be high on the next attempt, rather than thinking precisely the opposite.
In this cycle, in which the “addicted person” and the family hold hands and dance to the music played by the addicted brain, the fundamental characteristics of the illness become blurred and incorrect ideas about its nature become established:
a) that relapses are isolated episodes, each with its own reasons and dynamics;
b) that it is always possible to turn back and undo the illness—or supposed illness—with a final effort, a burst of pride, or by “hitting rock bottom”;
c) that the most important thing is to demonstrate that one is “clean” or to “get clean,” rather than being able to continue a treatment that prevents relapse.
Family that shields and conceals
This is a typical pattern in families with a medium-to-high socioeconomic status and reasonably substantial financial resources, which have been affected but not exhausted by the addiction.
In these cases, families alternate between more dramatic periods involving hospitalization, detoxification, and condemnation or expulsion from the home, and periods of returning home, repentance, and “second chances.”
Usually, the family spends money both during the first phase—on clinics and hospitalizations—and during the second, once again providing the person with cars, motorcycles, money, apartments, vacations, income, and so on, as though this kind of financial “injection” were supposed to prevent relapse.
The effect is exactly the opposite.
Furthermore, during the first phase, when the person has theoretically received treatment, the treatment is effectively guided by the patient, who chooses the quickest options and therefore those that are less useful and reliable, or not indicated at all.
In practice, the person perceives that the family wants to restore their trust and resources if they agree to undergo some kind of “test” that creates an illusion of recovery—not according to what specialist doctors recommend, but through any treatment whatsoever, chosen by the person themselves and accepted by the family rather than having no treatment at all, provided that the person demonstrates some effort.
From the standpoint of addiction, this simply means that the addicted person is steering the situation from a point at which their resources and energy have been exhausted toward a new relapse, now equipped with new resources and renewed trust.
Family that puts the person back on the right track
This is a more confrontational approach, more typical of families whose values emphasize everyone contributing to the household income and who are hostile to any form of parasitism or permissiveness, even when the family has the financial means to tolerate it.
The family believes that once the addicted person “hits rock bottom,” they will get back in line. Their attention therefore focuses on practical demonstrations of financial independence, willingness to work, and, above all, on measuring abstinence as though it were an independent variable.
A typical demand is to be able to verify on a daily basis whether drugs are being used, losing sight of the fact that, in addicted people, drug or alcohol use is generally evident from the kind of life they lead and from their ability to function and maintain relationships.
To facilitate this, families find the person a job, usually immediately—that is, when it is premature and often destined to be disappointing. They are unable to understand the gradual transition from addiction to normal functioning, through relapses that progressively become shorter and less severe.
Usually, work takes the place of treatment. As a result, the person relapses because they are not receiving treatment, and the family responds with rejection and an entirely blaming attitude.
In reality, these kinds of demonstrations, efforts, and acts of atonement are useless for preventing relapse. Indeed, they may consume resources that would be better used once the person is actually capable of demonstrating improvement—that is, after the first months of treatment.
Family that invests in respect and trust
This approach centers on the personal relationship with the addicted person. It attempts to counteract lying and manipulation by relying on respect and trust.
Family members generally provide resources, but above all they see these resources as demonstrations of love and trust. They then feel betrayed and offended when relapse inevitably occurs.
This is typical of a partner who wants to restore the situation through their role at an emotional and relational level, based on the idea: “If you love me, you have to stop.”
In these cases, treatment is often sought only after a long delay, when relationships have already become strained or damaged. Yet family members continue to hope that recovery—this time with the help of a doctor—will take place within the family, as a function of the affection they have for the relative and as a way of repaying their efforts.
Family members who follow this pattern, for example, find it difficult to accept the gradual nature of recovery. Relapses, even if limited to individual days, are experienced as total betrayals.
Changes in the person’s “lying” and “clandestine” behaviors are not understood as a gradual process, because they are attributed to the person’s moral character rather than to the illness.
The family member therefore believes that if the person wanted to be “good,” they would change from one day to the next, whereas if they continue to relapse occasionally, this means that they have made no moral decision at all.
Family that feels guilty and tries to make amends
This is a less common situation, more typical of families with a single prominent caregiver, such as a mother, who in some way feels responsible for the addicted person’s situation and believes that at least part of their unhappiness is the result of the family’s own wrong choices.
From this perspective, the addicted person is seen as “not to blame.” In reality, however, this is a way of resolving the question of who is to blame, a question that would not arise if the illness were properly understood.
Instead of blaming the addicted person and expecting them to make amends, as happens in the other models, addiction is viewed here as the consequence of a family error: the person was neglected, abandoned, or misunderstood and, as a result, sought help through drugs or alcohol.
This view usually stems from pre-existing feelings of guilt within the family, which the addicted person exploits because they understand that this approach will provide them with new resources and renewed trust.
It is typical of families in which there is a history of depression or mood disorders in general.
This is perhaps the most harmless and passive form of codependency, except for the fact that the resources the family provides as a kind of compensation for a situation they believe themselves responsible for ultimately contribute to sustaining the addiction itself.
The family’s role in treatment
In an addiction treatment program, whether for alcohol or drugs, families are often involved even before treatment begins, because of a “pathological” adaptation to the illness of their loved one.
An important aspect is to reorganize the family around the treatment, preventing certain useless or counterproductive roles from continuing to interfere with the scientific principles of the program.
It is also necessary to prevent the family members’ suffering from continuing or increasing through approaches that are themselves useless or even counterproductive.
The role of codependency therefore needs to be replaced with a role of counter-dependence, structured around the mechanisms and outcomes of treatment rather than around the individual’s ideologies or emotional roles.
By giving up the idea that they are the source of either the problem or the solution, the family can instead make a more constructive and measurable contribution to resolving the problem.