Originally posted at: https://theonlinetherapist.blog/codependency-and-addiction-why-the-disease-model-will-never-work/
The term codependency has gone through various changes in meaning over the years. Originally, it was only used to describe anyone who stayed in a relationship with a substance user and enabled that behaviour. Often called “co-alcoholics”, the classic scenario comes to mind of a woman complaining to her friends about her husband’s drinking but making sure he has a six-pack constantly at hand in the fridge: “It’s to stop him going to the bar in the evenings” would be the excuse.
These days, we understand codependency to be a much more complex affliction and one that covers many areas of our lives. Work, especially relationships and our view of the world and our place in it, can all be altered if codependent tendencies are present. The deeper meaning of the term has led many to see codependency as some form of love addiction. This is certainly true of relationships where the need to be in one can be compared with the drive to take drugs, gamble overeat, or drink alcohol. To find further similarities, we need to challenge the accepted norms around the thinking concerning addiction.
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I have never been truly convinced that the accepted view of addiction as a disease is the right one for codependency. Take for example, this statement from The Alcoholism Guide in the UK:
“Alcoholics Anonymous which brought the alcoholism disease concept to the attention of the public state that alcoholics are a special group of people. They cannot control their drinking. They have an alcohol allergy… a cause of shame for many“.
This suggests that people might “catch” the disease and need to be treated with classic medicine. The disease model of addiction states that addiction is a relapsing and chronic brain disorder, with rates or relapse at around 40% to 60% – similar to relapse rates of other chronic medical conditions such as diabetes, hypertension and asthma. The rehab approach is one of abstinence and medication to solve the problem and yet relapses are common.
When we try to think about codependency in the same terms, it would be difficult to see how a medical model could be applied and this would be my fear should codependency ever be included in the DSM. Many people working in the medical and psychology fields are still of the opinion that codependency does not exist outside of its classic use described above. They often see it as a symptom of something more “DSM diagnosable”. However, if we take a look at another school of thought around addiction, we can see that codependency and indeed other more well-known addictions find a place. The so-called Social Learning Theory or “desire” model suggests that people learn to do something, like it, it becomes a habit and they overuse it in seeking instant gratification. The social learning model contains three elements, modeling, operant conditioning and classic conditioning. We can then start to assess addiction as a habit and not a disease.
Modeling: People generally learn new skills by learning, watching others and trying it for themselves. Children often copy the behaviour of their parents (good or bad). The same principle applies to substance abuse and codependency. Many codependents come from families where codependency is generational and they learn it within the family structure from parents and grandparents. Without a viable alternative or new learning, they will model this as an adult.
Operant conditioning or the pleasure principle: Many addictions start with a pleasurable experience. This conditions the mind to try to relive this high over and over again to reinforce the experience. In the case of codependency, this high can be equated with the adulation stage, found early in a relationship. Many codependents I talk to express a feeling of addiction to the so-called “honeymoon phase” of a relationship. In relationships with self-centered people, they also feel the same addiction to the small moments of togetherness they share with such people.
Classic conditioning: Pavlov demonstrated in his experiments with dogs that pairing one stimulus with another produced a learned response. In terms of codependency, this would mean behaviour states being produced from feeling states. Many codependents suffer fear, anxiety and loneliness when out of a relationship driving them to sometimes jump into a relationship.
If we believe the above to be true, then the statement made by Stephen Covey in the 7 Habits becomes very relevant. He said: “If you can learn a habit, then you can also unlearn it”. This idea of learned behaviour fits very nicely with the whole idea of codependency. It is learned behaviour based on developmental trauma and ineffective connection with primary caregivers. This calls for awareness and acceptance of codependency and its issues (this is not always a given) and a commitment to breaking the habit.