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Hayley: Codependency is likely a term that you’ve heard before. Sometimes we call couples codependent who spend all their time together, or families who stick together like glue. But, codependency is much more than spending a lot of time together and it can be extremely detrimental for everyone involved, especially when addiction is in the mix. For this episode of Straight Talk With The Doc I’m here with addiction medicine specialist, Dr. Bhatt, to talk about codependency and its link to addiction. Dr. Bhatt, like I just mentioned, codependency is a lot more than just spending a lot of time together. Can you explain, what does it mean to be codependent?

Dr. Bhatt: That’s a great question. As you said, when we speak about addiction, codependency comes up a lot. When two are more people —a relationship between a couple or a family in its entirety—are engaged with one another to point where a component—one person or a group— sacrifices themselves and basically puts their feelings and emotions on them and subconsciously fuels or further contributes to the addiction or the negative behaviors of another loved one. And so, the relationship is not balanced, the relationship unfortunately negatively progresses, and it leads to a lot of resentment, anger, and frustration.

Hayley: Okay, and what are some signs of a codependent relationship?

Dr. Bhatt: Well, it really is when one person seems to be benefiting and one person seems to continue their destructive behavior, and we often see that from people who suffer from substance use disorders. It’s often rooted in childhood or learned early on, where a person supports that individual and often contributes to that continuation of the substance use. This is often just by giving money to keep that person in that house. Often, we see a spouse or a significant other not wanting that person whose suffering with addiction to leave, and then they’ll say, “oh, you know what I’ll buy you another six pack if you stay at home.” And that negatively reinforces the actual alcohol consumption when we know that alcoholism is the problem. Often, it’s rooted in feelings of low self-esteem, low self-worth, that that person is subconsciously contributing to that addiction in order for that person to feel needed and loved and wanted. We see that pattern often to continue to manifest in different ways.

Hayley: Okay, so is that kind of how they start to form? It’s little things like lending a little bit of money or buying a six pack?

Dr. Bhatt: Probably. If you trace the actual relationship back, you’ll probably see it forming somewhere in childhood. Somewhere along the line we as children may have learned to suppress our feelings, to suppress or show that we put ourselves second. It could be because we’re dealing with somebody in the family dynamic who might have an anger issue, who might be abusive, who might be, again, a parent that might be suffering with addiction themselves, and then we learn to silence ourselves and we put ourselves second in order to shut down our emotions and not interfere with the person who’s kind of almost consuming that whole familial space with their behaviors or with their substance use disorders. And so, I see it a lot in clinical practice that most of our patients who do suffer with codependency, we do see a lot of the roots of that behavior back to childhood.

Hayley: As somebody who’s in your line of work, how often do you see codependent relationships in those that are struggling with addiction?

Dr. Bhatt: I think you can see a degree of codependency in everybody. I mean, I think when we hear the word codependency we kind of give it a negative connotation, but even healthy relationships to a certain degree, you do feed off one another and there is some need between two people in a relationship or a family. It’s just when one starts to become unbalanced and unhealthy where somebody is not progressing and people are not prospering, and it continues to fuel negative behaviors of one, and it continues to diminish the self-worth, mental health, or the happiness of another. That usually goes into this vicious cycle of what we call clinical codependency that we see with addiction. But, I just don’t want to say it exists alone in addiction. We see this in other relationships where there may be emotional abuse or physical abuse, people with destructive or antisocial behaviors, people with personality disorders, character issues, they often can engage others who might be those who lack self-worth or need to have felt to be helpful, and that again is often rooted back in childhood. When we have been exposed to people who were consuming the whole family dynamic that they put themselves second and have to step up and give themselves 110% in order to not appear selfish to give into the needs of that person who’s consuming everything. So, we see it a lot in the addiction substance use population, and it’s a big thing that needs to be addressed in order for both parties to heal.

Hayley: You just mentioned abuse. Is codependency a form of emotional abuse?

Dr. Bhatt: It can be, because, again, a lot of this is not on the conscious level. This is happening on a subconscious level. But, as I mentioned before, a lot of the time the codependent individual is suffering from low self-esteem, or their codependency has been traced back to where they feel like they have to do above and beyond and be like a martyr in self-sacrifice. But, they get something out of being needed, and sometimes subconsciously contributing to that person’s negative behavior like substance use or even the physical abuse, and then end up self-soothing or end up feeling like they’re loved or wanted, they can contribute to that person’s estate ill or sick or addictive or acting in a negative way. And so, that is a form of emotional abuse, too. It doesn’t necessarily mean there’s an intentional thing, but unfortunately the whole part of codependency is that we’re trying to demonstrate that it’s a negative relationship, and yes, it can be abusive emotionally.

Hayley: Can it ever be a good thing to be codependent?

Dr. Bhatt: The ultimate goal is that we want to take care of people, right? With people suffering with substance use disorders we never want to marginalize them or ostracize them or stigmatize them. So, they need support and they need care. To what degree that boundary is crossed, where it goes from helping to negatively contributing to furthering the addiction and further self-sacrificing, that really needs to be assessed on an independent and individual basis. So, I think for the purpose of this talk, codependency is not really healthy, and it’s when it’s crossed those boundaries or the boundaries are not maintained, one continues to self-sacrifice, develop the resentment and anger, and the other continues the negative behaviors or substance use.

Hayley: Okay. Is there a typical or a more common way that codependent relationships present? Is it often parents taking care of children, romantic relationships, even children taking care of their parents?

Dr. Bhatt: You see it in all of those things that you just mentioned. I don’t think there’s anything typical about which way that it goes versus it’s more the typical dynamics that are occurring within it. It’s a lot of, again, mixed emotions where you’ve got one person—the driver behind that person—continuing to sacrifice themselves which ultimately continues to negatively reinforce that person’s behaviors that are unwarranted or destructive to that individual. And so, it becomes very complex. Parents are supposed to take care of their children, and that’s the way that it goes. But if children develop problematic behaviors, where does it go when the parents start to self-sacrifice and start to negatively contribute to the kid’s behaviors? Similarly, in a romantic relationship, is the cause of the effect of being in love with that person and having to stand by them causing the codependency or is it somebody who had codependent traits growing up with the need to be loved, and to be needed and to be wanted to actually stay in a relationship that’s unhealthy? And again, we’re speaking in general terms here, so most of this stuff can be explored through proper assessment and evaluation and looking into the relationships individually. But, all three examples that you just gave, they’re common when it does exist.

Hayley: Okay. So, it’s pretty clear how a codependent relationship hurts the person with the addiction. It negatively reinforces their substance use. But, how does it hurt the enabler?

Dr. Bhatt: Again, the enabler is coming from a place where they had unresolved issues and the unresolved issues are often again, rooted back in childhood or through progression in their life. And even if not, even if they start to become codependent as a result of the relationship they’re now in to stay with the person they’ve since discovered has developed a substance use problem or becoming abusive. If they continue to stay in a relationship where they start to put themselves second, then they start to get angry and the resentment starts to build up and there becomes a power struggle. This is a power struggle between their emotions, a power struggle in terms of what kind of negative retaliation that can occur towards the person who’s the abuser or the person who’s using. And this continues to become a destructive relationship. Boundaries get violated, emotions get destroyed, and people start to develop multiple types of behavioral, emotional, physical issues. So, there’s a lot of consequences that can occur when somebody continues to stay in a relationship that ultimately is not benefiting either party.

Hayley: So, if somebody realizes that they are in this codependent dynamic, what kind of help is available?

Dr. Bhatt: Well, there are support groups, first of all, that are there. CoDA is one that’s based off of a 12-step model that resembles Alcoholics Anonymous and Narcotics Anonymous, that really helps match people up who are families of loved ones, or people who are in relationships where codependency has become a problem. Then there are individual therapies and other types of recovery programs that do focus specifically on codependency. I think it’s important though, to identify is the codependency is not secondary or the result of a newer relationship or one that’s just happened at that point, and it’s not rooted back in childhood. If it is rooted back in childhood that any unresolved issues be addressed, because a keen therapist, a trained family therapist, can look into what family dynamics or unresolved issues that were present in that person’s life that led to them to become codependent and engaging in or remaining in a relationship that was not only destructive to the person that they’re with, but destructive to themselves.

Hayley: So, I know this will kind of depend on the individual case, but in general, how does an individual or a family learn to let go of their old behaviors?

Dr. Bhatt: Those are very difficult things to do, but with the proper therapy and support groups it can be done. We have to be cautious though that someone doesn’t go from a passive martyr type individual to an aggressive one and someone who becomes totally assertive and selfish. So, you have to watch that pendulum from swinging from one extreme to another. But, I think the key hallmark is that if somebody—and again, we’re talking about it on an addiction podcast here—is engaged in treatment and if they’re in a treatment center or an individual therapy, speaking about it and speaking to a professional because codependency is so common in the substance use disorder population and the people who surround them, that most people who treat those with substance use disorders do know how to get help for those family members who are codependent and suffering themselves. And so, it’s just really important to reach out and tap into the resources that are there and ask. And if the loved one is engaged in any sort of treatment, go ahead and reach out and tell them what they’re dealing with and ask for help, because help is out there.

Hayley: Dr. Bhatt, is there anything else you’d like to add before we finish this episode?

Dr. Bhatt: I mean, the bottom line is that codependency is a very common thing in relationships. Just recognizing that if you’re caring for somebody or you’re living with somebody who has a substance use disorder, especially as it relates to this podcast, recognize are you starting to become angry, are you starting to become resentful, are you starting to engage in behaviors that are actually not helpful to that person that is suffering with the substance use disorder, but actually negatively reinforcing and continuing to enable them and their destructive ways. And if that’s the case, going out and looking for support groups like CoDA that I mentioned, if you google them in your local areas or look them up those are available. And if somebody is in treatment themselves, seeking help with a trained professional, even tapping into your insurance companies or not, but looking into ways that you can get matched up with trained professionals who help those family members who are struggling with someone who’s suffering with addiction and as a result, are having negative consequences themselves.

Hayley: Okay, perfect. Thank you for providing that information. Listeners, to learn more about codependency and addiction you can head to, you can also hear more podcast episodes there or wherever you get your podcasts. Thank you for listening to this episode of Straight Talk With The Doc.

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Dr. Ashish Bhatt

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  • Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.

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