Alcohol and drug addictions are progressive conditions. In most people, addictions begin slowly and grow until the addict’s life becomes increasingly unmanageable. As repeated efforts to gain control over the addiction fail, life for the addict begins to fall apart.
Alcoholism and drug abuse shatter lives. Consequences are reflected in the addicted person’s health, family life, social life, school or work relationships, legal situation, and spiritual well-being. In the face of a multitude of problems, the addicted person continues to use. Without treatment, repeated efforts to quit or cut down invariably collapse.
People with a chemical addiction can usually stop using — for a while. But most need professional help to stop for life. For some, treatment in a sheltered environment, safely removed from daily stress and pressure, is needed for recovery. Many people, however, are helped without the interruption of inpatient or residential treatment. They are able to enter recovery through an out-patient treatment program that does not take time off from work or school, or leaving families. Success in outpatient treatment, however, is largely dependent upon the extent of the support system that the person entering recovery has in place.
Addiction can be psychological, physical, or both. This is worth noting because of the seriousness of some of the symptoms of withdrawal associated with certain chemicals, including alcohol. Substances, including heroin and other opioids, have a significant physical withdrawal syndrome associated with detoxification, which is very uncomfortable but not deadly. Other drugs, including alcohol, and the benzodiazapam medications like Valium and Xanax can be lethal if the addicted person isn’t part of a medically monitored detoxification program. Withdrawal from these chemicals may be accompanied by seizures that shut down the respiratory system and cause death — sometimes as long as two weeks after cessation of use.
Given the above, one of the first interventions that I make when evaluating a person with chemical dependency, is to assess the chemicals that are being used, the frequency with which they are taken, and the dosages. With that information, I can understand if the detoxification process may be lethal or merely uncomfortable. A non-lethal but profoundly psychological addiction, such as that found with methamphetamine, cocaine and marijuana, can be just as difficult, if not safer, than detoxifying from a physiologically addictive chemical. Therefore I will take a careful history before making any recommendations or formulating a treatment plan with the patient.
In my experience, individual psychotherapy rarely helps people seeking to recover from addiction in the initial phase. I have found that people need a structured treatment program that engages them in various modes of treatment, education, and recovery-oriented tasks in the early stage of recovery, and a medically monitored detoxification is often called for. A treatment program offers a structured therapeutic experience that introduces a person to the principles of recovery. In treatment, the person learns about addiction, urges, impulses, and inserting thought before acting. Most program philosophies view addiction as a disease. My orientation is not to focus on labels, but on behavior, and how it affects the quality of people’s lives. There is certainly an abundance of research linking genetics to alcoholism and addiction in general; however, my focus is to help the individual understand that his addiction is serious enough to engage in treatment, and then to take action.
After the client completes a treatment program, which may include detoxification, I am able to work with her and her family to reinforce elements of recovery and start to address systemic issues such as co-dependency. Family and couples therapy at this time is extremely important and very valuable to ensuring recovery.
Co-Dependency
Co-dependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects a person’s ability to have a healthy, mutually satisfying relationship. Co-dependency is characterized by “one-sided” relationships that are emotionally destructive and/or abusive. Co-dependent behavior is often learned by watching and imitating other family members who display this type of behavior. Co-dependency is a prominent characteristic of a dysfunctional family.
Dysfunctional families do not acknowledge that problems exist. They don’t talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become “survivors.” They develop behaviors that enable them to deny, ignore, or avoid difficult emotions. They detach themselves; they don’t talk, they don’t touch, they don’t confront, they don’t feel. They don’t trust.
The co-dependent person typically sacrifices his or her needs to take care of a person who is sick. When co-dependents place other people’s health, welfare, and safety before their own, they lose contact with their own needs, desires and sense of self. They also lose the respect of others, including, and perhaps especially the person to whom they are co-dependent.
Co-dependent people have low self-esteem and look for anything outside of themselves to make them feel better. Some try to feel better through substance abuse, and then they become addicts as well. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.
Co-dependent people generally have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Co-dependent people often take on a martyr’s role: a wife may cover for her alcoholic husband; a mother may make excuses for her truant child; or a father may “pull some strings” to keep his child from suffering the consequences of delinquent behavior.
When the caretaking becomes compulsive, the co-dependent feels choiceless and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Co-dependent people view themselves as victims and are attracted to that same weakness in their intimate relationships.
In my treatment of co-dependent individuals, I explore early childhood issues and their relationship to destructive behavior patterns. This is an important focus because co-dependency is often rooted in a person’s childhood. Treatment interventions include education, experiential psychotherapy, and group seminars that are interactive and didactic. I try to help people identify self-defeating behavior patterns, in addition to identifying and establishing contact with feelings that have been suppressed perhaps since childhood. Examining existing family dynamics and working to reconstruct them with family members is very useful if the circumstances permit this process.
Significant change and growth is necessary for the co-dependent person and his or her family. Any caretaking behavior that allows or enables abuse to continue in the system needs to be recognized and stopped. The co-dependent person needs to identify and embrace his or her feelings and needs. These are the things that I try to help the person to work through.
