Codependency in a family with a member addicted to alcohol

The Codependence in the family with alcohol addicted member

Introduction

Alcohol addiction is a disease that has the greatest emotional impact on the family. Mutual relationships in the family tend to be disturbed, and the more destructive the feelings of individual family members are, the more inappropriate their behavior is in relation to the alcohol-dependent family member. The issue of codependency in a family with alcohol addiction is of particular interest to us because family members and loved ones of an addict never appear neutral when seeking professional help. Either they influence the addicted family member favorably and adequately participate in his treatment, or their influence is undesirable due to the development of co-dependency and works against the main goal of alcohol addiction treatment – ​​permanent, consistent and complete abstinence. When working with the family members of an addict, we often hear sentences like: "I would give him everything" or "If I could, I would live her life." It is therefore not rare that the closest relatives of the addict may need more professional help than the addict himself in order to ensure effective treatment. Knowing and understanding the thinking and behavior of co-dependent persons gives professionals the opportunity to prepare for effective cooperation with relatives, to communicate constructively with them, to ensure a unified approach of all those involved in relation to the addict, and thus undoubtedly increase the very effect of professional help to an alcohol-dependent family member.

Codependency

The concept of co-dependence - co-dependency (from the English Co-Dependence) has brought many new perspectives to the addiction syndrome itself, to its understanding and to the treatment itself. Charles L. Whitfield (1991 In Laskovská, 2008, p. 8) defines codependency as "a multidimensional condition (physical, mental, emotional, and spiritual) manifested in any suffering or dysfunction that is associated with or arises from focusing on the needs and behavior of others."

Robert Subby (In Beattieová, 2006, p. 42) in the book Codependency, An Emerging Issue describes codependency as "an emotional, psychological and behavioral condition in a person that arises as a result of long-term exposure to and adherence to restrictive rules that prevent honest expression of feelings and also direct discussion of personal and interpersonal problems".

Beattie (2006, p. 47) defines codependency as follows: "A codependent person is one who allows himself to be influenced by the behavior of another person and feels compelled to control his behavior." At the same time, he talks about codependency as a partnership in addiction, and in the context of alcohol addiction, this definition is closest to us.

However, the essence of the above definitions remains the same - a codependent individual has a close relationship with a person with an addiction problem, while his emotions, experiences, behavior, attitudes and relationships with other people are clearly (albeit often indirectly) influenced by the behavior, experiences and attitudes of the person who is addicted. According to some experts, codependents want and need sick people around them so that they can be happy in a non-predatory way.

The danger of codependency lies mainly in the fact that the relatives of the dependent individual gradually lose their personal identity. In focusing on the addict's needs, they neglect themselves, take the addict's problems as their own, take responsibility for them, and thereby enable and allow them to escape their own responsibility and the consequences of their drinking. For codependents, not only their personal identity disappears over time, but their own self-esteem is lowered, reality is distorted, and many families are characterized by a complete denial of the occurrence of a problem and the existence of addiction.

In practice, we often meet relatives of addicts who not only protect their loved ones in the sense of denying their problem, but also rationalize and even defend the drinking of their loved ones (husband, wife, child). Often, family members take on the feelings of their dependent family member, become his emotional mirror, balance between the need to help and the need to separate. In retrospect, these thoughts mainly cause feelings of guilt, tension, and fear. They themselves get into a vicious circle from which they often cannot get out without the help of experts.

As Žiaková (2005, p. 171) states, it is not uncommon for a woman to claim that "in addition to my husband's drinking, I also got sick", while the caller was describing her subjectively experienced physical ailments. It often happens that, due to mental exhaustion and depression, they themselves reach for alcohol or drugs.

"The truth is that alcoholics who are themselves victims of the disease have a negative effect on people from their immediate but also distant family, that is, on those with whom they live. Relatives and friends of an alcoholic often excuse him, cover for him for a long time, because paradoxically they believe that he will get better, even though he has disappointed many times and is a permanent liar" (Mariani, 2009, p. 17). Codependent persons try to make changes that (in their opinion) would change the situation, fix it, but what they do actually only worsens the situation in the family. Unknowingly and unintentionally, they support the persistence of the problem and become part of the disease. People who were raised in a dysfunctional family and do not have the behavior patterns of a good and healthy family are more likely to become codependent.

Many factors decide whether a particular person becomes codependent or not. Kredátus (2004) points to emotional and material dependence, the weak position of the woman in the household, the isolation of the family, or the social pressure to maintain the marriage at all costs. Equally important is the work and social position of family members, the pressure of public opinion - the opinion of the environment in which the family lives. Emotional immaturity, a sense of one's own inferiority, the need to belong to a partner, weak boundaries of one's own "I", but also a deficit of interpersonal skills to solve problems also help the emergence of codependency.

The course of codependency - results of qualitative research

The aim of the qualitative research carried out by us was to find out and analyze the course of co-dependence of family members addicted to alcohol. To fulfill the goal, we set the following sub-goals:

• to define the individual phases of codependency of family members of an alcohol addict
• to characterize the individual phases of codependency with a focus on the experience and behavior of codependents in relation to a close family member addicted to alcohol

Based on the analysis of data from interviews with research participants, we present individual phases of codependency and their specific course, focusing on the experience and behavior of a codependent person in relation to an alcohol-dependent family member. According to research, but also from our experience, the following phases do not always have to occur in the order indicated, they can repeatedly return, alternate, run parallel to each other, and many codependents can remain permanently in one of the indicated phases:

Phase 1 – DENIAL The Denial phase is characterized by intense denial of the reality of a close family member's alcohol addiction. Jewett (In Beattie, 2006, p. 158) states that "reality denial is a conscious or unconscious defense we use to avoid anxiety when we feel threatened. We ignore things the awareness of which would upset our mental balance." Denial represents the shock phase, in which the codependent person tries to tell himself that nothing serious is happening. Already in this phase, defense mechanisms start up, with which the codependent person protects himself from reality. She relies on the alcoholic's promises, believes them, and although her common sense tells her that there is something wrong with the addict's behavior, she hides her true feelings and avoids unpleasant topics, or refuses to communicate with the environment.

The most frequently occurring defense mechanisms are:

• trivialization, i.e. minimizing and misrepresenting the scope and severity of the problem, such as: "...I was still telling myself that when she drinks 2 dcl wine with her colleagues at work, there is nothing wrong with that, it's normal. Others drink too, and much worse."
• making light of the situation, e.g.: "...but in my mind I made light of it and did not attach too much importance to it."
• ignoring the facts, e.g.: "And when I told the man, he just waved his hand and said that I'm dramatizing again...",
• escaping into self-pity, e.g.: "When the problems started, I didn't solve them, then I started to feel sorry for myself, my life..."

These defenses are strengthened, modified and returned repeatedly as the codependency develops due to increasing feelings of guilt, regret and low self-esteem. Accompanying emotions are mainly shock and feelings of fear, such as: "...I didn't want to believe it for a long time, and when she was first hospitalized in a psychiatric hospital and the doctor also told me about her drug addiction, I was in shock." or "When I found out he was drinking, I got scared..." Phase 2 – ANGER When the codependent person stops denying the situation, the anger phase begins. The anger he feels may be unjustified or justified. In the first case, she blames not only herself, but also God, or other people, and is characterized by statements such as: "For a long time, I was angry first at God and then at myself for raising her badly." or: "Then I was angry with myself for not getting a divorce when he was young so that he wouldn't see how drunk his father came home." However, at certain moments the co-dependent person begins to feel justified anger at the behavior of the addict, because he begins to realize that the alcoholic often lies, does not fulfill his obligations, does not keep promises and begins to manipulate other family members. Then the co-dependent person may feel that the alcoholic does not care about them and has the need to strike back and in some way punish the alcoholic for the pain he caused them.

Although the very experience of anger associated with open aggression is mostly characteristic of men, from the analysis of the interviews we identified a clear anger of the woman, which was outwardly manifested by aggressive behavior directed at her dependent partner: "...it happened that I slapped him, I also hit him with a kitchen knife, I thought that he would come to his senses and that he would get over it."

3rd phase – RESCUE

The Rescue phase has the longest course and many co-addicts, despite efforts to change not only the addict, but also their life, remain in this phase their entire lives. This period is characterized by the alternation of help to the dependent with the so-called enabling, that is, supporting his problematic behavior. The co-dependent person becomes like the savior of the alcoholic, protects him from the consequences of his drinking and gets into the position of a person who is responsible for the alcoholic. The consequence of such behavior is the "comfort alcoholic", who has no reason and motivation to change his personality, because the codependent person persistently proves to him that he takes responsibility for him by taking care of all his needs. When the situation worsens and the codependent person sees what they have caused by their enabling, increasingly intense feelings of guilt cause re-enabling.

The Rescue phase is characterized by the following behavior:

• directly supporting dependent behavior, e.g.: "...I helped her move so that she could start over and here, at home, in safety. I found her a part-time job so she could earn at least some money, she had nothing, she drank everything, even the money I gave her.", or "...at home she always has boiled, cleaned...",
• an apology, e.g.: "...I feel sorry for her, she is a sick person, her diagnosis is to blame for this behavior...", or: "I rather felt sorry for her, because I knew what kind of man she had returned to.",- justification, e.g.: "...when I came to her house many times, she was so messy that I couldn't help but clean up..., I also cooked for her, because she could barely stand on her feet, she had to eat something...", or "...he is sick, he needs my help, it is my duty.",
• trivialization, e.g.: "...he's not bad when he has a job, he can't drink for several days..."
• making promises, e.g.: "...I told myself, once he gets over it, I'll stop drinking too..."
• checking, e.g.: "...I measured how much is left of the bottle..."
• apparent indifference, e.g.: "Now I pretend that nothing is happening...", or "Now I almost don't care. My son has his own family, I'm at work all day and I have my own life. One gets used to everything."

In the field of emotions, there are sudden turns and changes in this phase. During the period of help and the alcoholic's stay in treatment, even in the first months after treatment, the co-dependent person hopes and believes that everything will be fine, as evidenced by the following statements: "At every subsequent treatment, I hoped that he would get back on his feet.", or "...when he was in treatment, I believed that he would be fine and that with my help we would be able to handle it." In relapse comes disappointment, hopelessness and despair: "When I found her bottle after about 2 months of abstinence from the first treatment, I was desperate." or "My husband continued to drink and I was desperate and on the verge of a nervous breakdown..."

However, during the entire phase, feelings of fear, internal tension, regret, guilt, shame and anger are constantly present (time-varying and of varying intensity) characterized by the statements: "...I feel terribly ashamed that sometimes I wish he wasn't here anymore, then I get angry with myself for being a bad mother and taking care of him again..." or "There is still something about me that I am afraid of." Phase 4 – SADNESS This phase follows on from the previous one, is closely connected with it, while the codependent person can often pass from one phase to another and vice versa. At this stage, the codependent realizes his helplessness and admits that he has no influence on his loved one's addiction. However, he is not reconciled to the situation and despite returning feelings of sadness, depression, fear of the future, closing in on himself and reluctance to communicate with others, he repeatedly rescues the addict, as evidenced by the following statements: "...even though I feel constant fear, such inner tension...", or "...the tension is there, sometimes depression...", "I don't feel like talking about it with anyone..." Phase 5 – HATE Anger, rescuing, sadness, long-term feelings of fear, regret, shame, and unprocessed feelings of guilt cause the co-dependent person to develop resentment and, in extreme cases, hatred towards the addict. The following statements testify to intense feelings of hatred: "...I hate her for destroying my parents' health...", but also "...I hated her for what she did to her children...". These feelings do not develop in the same way for everyone, their intensity and duration are also individual. Hate is specific especially among those co-dependents who have witnessed for many years how the alcoholic gradually destroys relationships in the family and his behavior is reflected primarily on the health of other family members. In this phase, the co-dependent person consciously creates a distance from the addict and is indifferent to his behavior and further fate: "...if he wants to drink, let him drink, let him drink himself to death." However, despite such an attitude, feelings of anxiety, fear of the future and shame are still present.

Phase 6 – RECONCILIATION The Reconciliation phase represents adaptation, coming to terms with the situation, accepting reality and focusing attention on yourself and your needs. This phase gives the codependent person the ability to realistically assess the situation, the ability to behave rationally and at the same time brings feelings of balance and happiness, such as: "...I feel balanced, even sometimes happy, I finally learned to enjoy and not feel guilty that I failed in something...", "...I don't even feel hatred towards my husband." The codependent person realizes in this phase that the alcoholic by her behavior (including enabling, promising, controlling) will not change and she must change, as evidenced by the following words: "I adapted to the situation and I know that I cannot change him.", "...I changed, not him."

For a better representation of the course of co-dependence, we present the individual phases, emotions and behavior of a co-dependent person in relation to an alcohol-dependent family member in the following diagram:

Codependency therapy

Codependency therapy is a long-term process that consists in self-discovery and the gradual growth of the personality of a codependent family member. Since it is not accepted in MKCH-10 diagnostic manuals, insurance companies do not reimburse its therapy. Therefore, it is necessary to simultaneously find other diseases in the patient's anamnesis to which reimbursements for the patient's treatment would apply. Among therapy techniques, Laskovská (2008) includes, in addition to regular and long-term visits to Al-Anon and Alateen self-help groups:

• as needed, detoxification in the sense of detaching from people, places and behaviors that block the healing process,
• individual therapy with the aim of accepting oneself and responsibility for oneself, - group psychotherapy specific for codependents, or for adult children from dysfunctional families,
• completion of educational programs on codependency,
• use of supportive treatment elements (keeping a diary, regular contact with one or more trusted people).

In practice, however, recovery itself takes place mainly in the form of regular visits to the mentioned self-help groups for family members of addicts and at the same time in the form of individual therapy with the aim of detaching from the behavior of the addicted member in such a way that it does not block the recovery process. This process requires the active cooperation of the codependent and the therapist and consists of providing consultation on ways to maintain health and resolve for yourself and your children. The goal of therapy is to make the husband/wife, partner, parent, or child of a drinking family member understand that they cannot change their addiction or their powerlessness in relation to their opinions, thoughts, attitudes, decisions and behavior, but on the contrary, they can change and "discover" power over themselves and their behavior.

Social counseling for family members of addicts

Social work as an independent scientific field has the opportunity to apply its activity in the field of addiction, primarily through social counseling at all levels - basic, professional and specialized. We agree with Pavelová's (2008) statement that professional social counseling in the field of addictions belongs not only to the competence of specialized health workers (especially specialist doctors dealing with addictions, psychologists and trained health workers), but also to social workers who have the professional and personal skills to work with an addicted client and his family.

Some of the most common questions we see from family members include:

• Where did we go wrong?
• Did we contribute to the fact that he/she started drinking?
• Can we help him/her, and if so, how?
• How did others solve a similar problem?
• How effective is addiction treatment?
• Is addiction curable?
• What will his/her return from treatment look like?
• Solve my/our own problem.
• How to proceed if he doesn't want to admit he has a problem with alcohol?
• Get a contact for possible treatment in my place of residence.
• Get information about treatment programs.
• Practical questions in the case of treatment (health insurance, social benefits, etc.).

As the aid system in our conditions is mainly set up to help the addict, his family is still not given adequate support. Relatives (especially as a result of the development of co-dependency) are dominated by feelings of helplessness, anxiety, fear and an effort to resolve the situation as quickly as possible, and are in most cases dependent on how and whether the institutional anti-alcohol treatment of their addicted member will be successful. It does not motivate them to work on themselves and, moreover, they are not provided with help in solving any problems that may have arisen as a result of long-term cohabitation with an alcoholic. The family often does not know how to behave towards an addicted member before treatment, how to motivate him for treatment, how to behave towards an abstinent member after treatment, and this very fact can be one of the causes of relapse and repeated treatments of an addicted individual. This is also one of the other reasons for the entire family to be the subject of treatment and social care, not just its sick member.

Therefore, the main goals of a social counselor in this area are:

• provide all family members with basic information about addiction as a disease and explain to them that alcohol addiction is a lifelong disease,
• provide them with information about treatment programs, the course of treatment, access to the addict in individual phases of the treatment process,
• with the cooperation of other experts, to teach them about the danger and self-destruction of their own addictive behavior, which arises as a result of long-term cohabitation with an alcohol-dependent member,
• point out the ineffectiveness of their "help" and efforts to control the addict and thus help them to work on suppressing all forms of control and its manifestations (e.g. controlling finances, justifying his drinking, measuring the amount of alcohol drunk from bottles, constantly thinking about him and fearing what could happen to him...),
• explain that such behavior makes it impossible for them to find peace and balance on their own, and only they themselves can change their behavior,
• cooperate and use the help of other people who are in a similar situation, preferably members of the self-help organization Al-Anon, provide contacts to these self-help groups,

• motivate all family members to participate in the treatment and remedial process, or offer participation in couple or family therapy with the aim of:

• eliminate their own addictive behavior,

• to strengthen the adaptive mechanisms of the family, to change patterns of interactions associated with alcohol use and to create a new "scenario" of family life,
• motivate the addict to treatment,
• support the addict in immediate treatment,
• to support the abstinent addict during retreatment in the prevention of relapses.

Conclusion

Codependency is a specific disease state with which the family reacts to the alcoholism of its member, while we can state that it has a progressive tendency. The deeper a sick family member sinks into alcohol addiction, the more intensely people around him react. From the initial denial and downplaying of the possible emergence of addiction, through anger and long-term saving, isolation, depression, but also intense hatred can occur. Helping a family with an alcohol-dependent member is a process that first of all requires understanding the course of co-dependency, its dynamics and self-destructive forms of co-dependent behavior in relation to the addict. This help should depend on the current state in which the loved ones of an alcohol-dependent family member find themselves.

Authors: Mgr. Michaela Šavrnochová, Markéta Rusnáková List of bibliographic references [1] BEATTIE, Melody. 2006. The end of codependency. Trnava: Society of St. Vojtech, 2006. 275 p. ISBN 80-7162-631-7. [2] KREDÁTUS, Jozef. 2004. The family as a system, the family as a client and patient. In Clean day: A quarterly for all those who want to live without addictive substances... ISSN 1336-4243, 2004, vol. 2, no. 2, p. 6-7. [3] LASKOVSKÁ, Štefania. 2008. Addiction to direction elsewhere, to another. In Clean day: A quarterly for all those who want to live without addictive substances... ISSN 1336-4243, 2008, vol. 6, no. 3, p. 8-9. [4] MARIANI, Juraj. 2009. Abstinence is a state of the soul. Testimony of an abstinent therapist. Liptovský Mikuláš: Bianko, 2009. 116 p. ISBN 978-80-970202-9-3. [5] PAVELOVA, Ľuba. 2008. Social work in addictions. What are his chances? In Clean day: A quarterly for all those who want to live without addictive substances... ISSN 1336-4243, 2008, vol. 6, no. 3, p. 24-25. [6] ŽIAKOVÁ, Eva. 2005. Psychosocial aspects of social work. Prešov: Akcent Print, 2005. 232 p. ISBN 80-969274-2-6.

ŠAVRNOCOVÁ, M., RUSNÁKOVÁ, M.. 2011 Codependency in a family with a member addicted to alcohol. In MÁTEL, A. – JANECHOVÁ, L. – ROMAN, L. (eds.) 2011. Social pathology and intervention social work. Proceedings of the international scientific conference. Bratislava : VŠ ZaSP sv. Elizabeth. ISBN 978-80-8132-018-7, p. 65 - 77.