Codependency And Addiction: Dual Diagnosis

Medically Reviewed by Johnelle Smith, M.D. on July 5, 2021

People with substance use disorders that are in codependent relationships may have difficulty making the best decisions for themselves. Inpatient and outpatient treatment can help address the causes and outcomes of both addiction and interpersonal codependence.

Dual Diagnosis Codependency And Addiction

When a person has a substance use disorder and exhibits extreme emotional reliance on a partner, it can complicate recovery.

Although co-dependency is not a personality disorder or mental illness, it can impact a person who struggles with substance use similar to a co-occurring diagnosis.

A person that either enables behavior or is a “manipulator” in a codependent relationship that struggles with addiction may benefit from additional therapy to live a healthier life in recovery.

Find out more about co-occurring mental health disorders and addiction

What Is Codependency?

Codependency is generally recognized by emotional dependence on a partner – either a romantic partner or friend.

While it is not an official mental disorder or personality disorder, the effects of co-dependency on either an enabler or manipulator can negatively impact a person with an addiction.

A co-dependent existence can occur in a romantic relationship, or with friends or children.

Any case of co-dependency will involve a party that seeks to change behavior and take responsibility for actions, which makes addictive tendencies difficult to treat.

People with codependency may also have underlying mental health concerns.

It is also believed that codependent behavior often develops from early on in a person’s understanding of healthy relationship dynamics – often due to aversion to conflict.

Signs Of Codependent Behavior

It takes two to be codependent. However, the person that is considered “passive” often enables behavior that could include developing an addiction.

Many people in codependent relationships do not recognize their dynamic as a problem.

Some signs of codependency include:

  • unevenly bearing responsibility and taking on more work for another person
  • focusing on a friend or partner’s needs far before one’s own
  • expressing hurt when efforts are not recognized
  • excessive sense of responsibility for others
  • a need to “rescue” or “fix” others — confusing love for pity
  • fear of abandonment and need to control others
  • a deep need for recognition and approval
  • guilty feelings when expressing personal needs or asserting one’s self
  • an unhealthy dependence on relationships for structure
  • difficulty adjusting to change or understanding/addressing feelings
  • chronic anger
  • chronic lying and dishonest behavior
  • poor communication skills
  • difficulty setting boundaries and issues with intimacy
  • trouble making decisions solo

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Signs Of Drug Or Alcohol Abuse

Drug or alcohol abuse creates changes in a person, physically, emotionally, and behaviorally.

Signs of alcohol or drug abuse can vary depending on the severity of use and type of drug being used.

However, general signs of a substance use disorder can be recognized due to shifts in physical appearance, lack of attention to some relationships, and changes in demeanor.

Signs of drug or alcohol abuse may include:

  • engaging in abnormally risky behavior
  • stepping back from friends or family
  • noted drug or alcohol use for normal daily functioning
  • sudden behavior or mood shifts
  • lying about substance use
  • increase in risky behavior
  • noticeable lack of personal hygiene or care for health

What Causes Co-Occurring Addiction And Codependency?

A codependent partner of a person addicted to drugs or alcohol generally tries hard to help or fix addictive behavior.

Conflict-Avoidance Behaviors

But because codependency avoids conflict and largely enables addictive behavior, a codependent partner or family member may only enable and perpetuate a substance use disorder.

Coping With Low Self-Esteem

A person that exhibits codependent behavior may also turn to drugs or alcohol as a result of low self-esteem regardless of the partner’s substance use.

Codependency is considered by some to be an addiction to fulfilling the needs of others. Both co-dependency and substance use disorders are associated with family situations where attention is withheld.

How Common Is Substance Abuse And Codependency?

There is a strong correlation between alcoholism and codependency in children with alcoholic parents. These children tend to find partners that also abuse alcohol.

The person that “enables” addictive behavior may also turn to substances as an escape in response.

What Are The Most Effective Treatments?

The person that is enabled (the “manipulator”) may find it difficult to face elements of treatment that do not cater to his or her needs as they are used to in daily life.

Effective treatments for people with co-occurring codependency and addiction can only happen when the person recognizes problems with both their relationship(s) and substance use.

Treatments for both concerns will vary depending on the substances used and level of physical dependence.

Behavioral Therapy And Group Support

In general, a combination of cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and medication for substance use and (if needed) underlying mental health concerns.

The range of counseling options will help people understand their relationship with substances and how they think about addiction and their relationships with others.

Prescription Medications

Medications that can help with withdrawals from some substances include:

  • buprenorphine
  • benzodiazepines
  • methadone
  • naltrexone

Finding Dual Diagnosis Treatment For Codependency And Addiction

Addiction recovery of any type takes strong will and perseverance. If you or a loved one is struggling with substance abuse or might be codependent with a person with a substance use disorder, then we have resources available to help.

Call our helpline for information on treatment centers, both outpatient and inpatient, that can help.

We can help find a dual diagnosis treatment program to suit any set of co-occurring life conditions to provide the best environment for recovery.

This page does not provide medical advice. See more

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Medically Reviewed by
Johnelle Smith, M.D. on July 5, 2021
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