Co-Dependency

Issues in Treatment and Recovery

Bruce Carruth, Warner Mendenhall

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317823933
• Edition: 1
• Topic: Psicología
• Subtopic: Asesoramiento psicoterapéutico

Co-dependency has finally become recognized in the late 1980s as a legitimate and a key issue in the chemical dependency field. Most of the literature available on the topic is addressed to the consumer--the co-dependent individual. In Co-dependency, leading therapists share some remarkable insights into the characteristics of the alcoholic home, co-dependents'patterns of responding to the alcoholic, and the particular problems that family members experience as a result of the environment, including fear, shame and guilt, anger, denial, and confusion. Clinical case material is used to illustrate the value of helping co-dependents through education, peer support, outpatient treatment and psychotherapy. Creative solutions for working with lesbian and gay men and children of alcoholics are also featured.

Recovery for Adult Children of Alcoholics: Education, Support, Psychotherapy

Tarpley M. Richards, LCSW

SUMMARY. COAs are a group of co-dependents who as adults exhibit many emotional and behavioral problems. Damage to a child from parental alcoholism may be mild, moderate or severe. This paper will explore characteristics of the alcoholic home and the varied responses of children reared in this environment. Three categories of problems of the ACOA will be described. These include impairment of self-esteem, failure to establish reasonable concepts of personal responsibility and difficulty in appropriately regulating sexual and aggressive drives. The value of helping the ACOA through education, peer support and psychotherapy will be discussed and illustrated through clinical case material.

Over a ten year period I have struggled to determine how best to serve Adult Children of Alcoholics (ACOAs). As a clinician I specialized in the field of alcoholism in 1971. I witnessed the beginnings of DWI programs, the mushrooming of EAP programs, the concept of alcoholism as a family disease and the coining of co-dependency as a clinical syndrome. Each of these events has given new hope to the field of alcoholism. The alcoholic person and his/her significant others have ample opportunity today to arrest chemical dependency and co-dependency in the early stages, resulting in better prospects for personal changes and eventual full recovery. Despite these opportunities, however, family members of alcoholics (COAs or spouses, the majority of whom are also ACOAs) remain very tough to treat.

ACOAs are complex and have a variety of needs to be met. I have tried and discarded, tried and modified, tried and kept interventions that held up over time or clearly did not work. I think I hoped eventually to come up with a program that would work for the ACOA patient. After all, in alcohol treatment programs there is a level of uniformity. This makes sense to me because everyone with alcoholism has the same disease. But I found that attempting to take an alcoholism model (treatment of dependency) and imposing it on ACOAs (treatment of co-dependency) produced disappointing results. Apparently my experience is not unique. I recently read an article by James La Bundy who commented: “Treatment paradigms considered highly effective in treating primary disease alcoholism did not appear transferable to co-dependency.”¹

What I have observed is that ACOAs recover through three general categories of “help”: education and information, peer support, and psychotherapy. Not every ACOA utilizes all three of these modalities, nor do the modalities seem to be in any particular order of usefulness. Much depends on what difficulties the ACOA has and how she/he connects to the recovery process. The following vignettes illustrate how varied ACOAs are in their response and how important it is for the clinician to be flexible and attentive to the individuality of each ACOA patient.

MARY

Mary was referred to treatment by an EAP counselor. She was a self referral whose chief complaint was depression. The counselor suspected both Mary's parents were practising alcoholics. Mary was consciously oblivious to this possibility even though she spoke openly about their being “drunk all the time.”

Mary was a highly functional worker with a demanding job she handled well. She was married to a man who, educationally and occupationally, was strikingly secondary to her. She had a history of involvement with “disgusting” men and never had any friends throughout her life. She referred to her parents as her best friends. Actually, her relationship with her parents was based on Mary's caretaking activities of them which clouded intense feelings of abandonment, rage and guilt over hating them.

At the suggestion of the EAP counselor Mary first attended an Al-Anon meeting. She left midway through. She said she felt so upset she thought she would die if she had to sit there one more minute. She could not remember anything about the meeting and what had upset her so much. The counselor had also given Mary a book on ACOAs. Mary's response was horror: “My parents may drink a lot but they are not alcoholics,” she said, miffed. To press the issues further seemed fruitless to the counselor. Mary was willing to accept a referral to an individual therapist.

Mary's path to recovery began with psychotherapy. After a year or so in treatment she was able to hear information on alcoholism. She started gradually attending seminars on ACOAs and reading ACOA literature. It was several years, though, before Mary was able to attend another Al-Anon meeting. Without first “growing up” in psychotherapy, Mary was not capable of utilizing peer support. To paraphrase La Bundy, people must experience peering before peer support can be a help.² For Mary to recover from damage sustained growing up with alcoholic parents, she needed to utilize all three modalities of recovery: first, psychotherapy; next, information; and finally, peer support.

PEGGY

Peggy is a free-lance writer. Her father was an alcoholic and died of liver cirrhosis. No one in the family ever talked about his drinking. As the years went by the family became more isolated. Peggy excelled in school and was a popular, if infrequent, social friend. When she was 20 she befriended a woman 15 years her senior, fell in love with her and subsequently became involved in a gay lifestyle. She is now 35 years old. She is happy with her relationship and feels loved and nurtured.

Peggy read an article on COAs ten years ago and has kept up with nearly every COA publication since. She says she is not in pain and has no wish to change her love life, her work, her cordial, if distant, relationships with family and friends. She does say, however, that the reading she has done on COAs has changed her life, in that she has been able to understand many aspects of her family life which were a mystery to her. She finds reading about the experiences of others to provide her with an inner peace she has not known before. She continues to work through her early experiences by including COA issues in her writing, both fiction and non-fiction.

Peggy feels no need for support through peers who are ACOAs, nor is she interested in psychotherapy. Her life is orderly and satisfying and her work is rewarding. She does not appear to be harming herself or others. Her recovery began and continues with information and education on alcoholism and COAs. She made good use of an educational cure.

ARLENE

Arlene is a 45-year-old enthusiastic, outgoing woman who grew up with a practising alcoholic mother. She lived in the “Bible Belt,” an area of the United States where drinking is frowned upon and alcoholism in women is still considered morally reprehensible in the community. In the ′50s when Arlene was a teenager she was very popular with both girls and boys. She was best friends with several girls and was the “ear” to everyone's problems. She cleverly disguised the fact that although she appeared open because of her humor, sympathy, and receptivity, she never revealed anything personal about herself. This worked for her until she was 31 years old.

About this time, Arlene's mother began to experience severe physical deterioration from alcoholism. Arlene, now married with four children, began to commute 1,000 miles every few months to “get mother squared away.” Gradually Arlene developed colitis and ulcers. Her physician, after taking a careful family history, recommended she attend Al-Anon. That was 10 years ago.

Arlene continues to be active in Al-Anon. She always had friends. In Al-Anon she learned how to share herself both with other Al-Anon members and with the friends to whom she had been such a support and comfort over the years. Through Al-Anon she learned mutuality and interdependence in relationships. She continues to have a good marriage and her children arc healthy and stable.

Arlene has never read a book on ACOAs. She has not attended specialized ACOA/Al-Anon meetings. She has not been in psychotherapy. She never denied her mother's alcoholism; somehow she overcame her shame enough so that she could engage in supportive peer relationships and establish a trusting, loving relationship with a man. Al-Anon helped Arlene sort out appropriate responsibilities and allowed her cathartic experiences. She feels satisfied with her continuing recovery.

Many books have been written on the traits ACOAs share. Pointing out commonalities is very important because this validates that the environment in the alcoholic home is damaging to the well-being of children. However, where “help” and “how to recover from the experience” is concerned, differences in ACOAs must be taken into consideration. In terms of adult life problems, a “family hero” and a “scapegoat”³ are likely to have little in common. The hero will more often than not be president of a corporation while the scapegoat may be in prison.

In evaluating the ACOA clinically, one needs to go beyond description. For example, that COAs have impaired self-esteem has been well addressed by Black and Woititz.⁴,⁵ Behaviorally, low self-esteem can be expressed in disparate ways: isolation from peers, chaotic lifestyle, sado-masochistic relationships and compulsive over achievement. Each of these expressions of low self-esteem requires a different remedy. A person who has spent a lifetime in relative isolation would probably not follow a suggestion to attend an Al-Anon meeting. Placing a chaotic person in an ACOA group would likely serve only to blow the group apart.⁶

This paper will address the varying impact an alcoholic parent may have on the child and will focus specifically on how education, peer support, and/or psychotherapy serve the difference between as well as the commonalities among ACOAs.

PARENTING IMPAIRMENT RESULTING FROM ALCOHOLISM IN THE FAMILY

Parental alcoholism has an impact on children. The characteristics of the alcoholic home should be viewed on a continuum. In order to qualify as an alcoholic home, there must be some of the characteristics present. The degree to which the characteristic is present is the variable.

Parental role instability. An intoxicated parent cannot fulfill parental responsibilities. In some homes intoxication is continuous and the alcoholic loses all ability to function as a parent. In other families the alcoholic binges; the parent may function admirably for several months only to go on a binge and drop out of sight. In still other families, intoxication is a rare event. The parent sort of muddles along, functioning marginally.

Parental undependability. The alcoholic parent may be consistentl...