by Robert Weiss PhD, MSW, CSAT

 

Riddle Me This?

If my beloved wife of twelve years received a cancer diagnosis and we had two kids under the age of seven, would anyone label or judge me for doing everything possible—even to the point of giving up important parts of my life—to keep my family stable and relatively happy? If I took on two jobs, quit my exercise program, resigned from the company softball team, and stopped seeing friends to address this unexpected family crisis, would anyone in my life call me out as enmeshed or enabling? And if I went to a therapist for support, would my therapist ask me to explore the ways in which my dysfunctional childhood might be pushing me into an “unhealthy obsession” with my wife’s cancer diagnosis?

Of course not.

Instead, friends and family would show up on my doorstep with flowers, home-cooked meals, and sincere offers to help with childcare, shopping, yard work, and housecleaning. Meanwhile, my therapist, clergy, and employer would understand and accept that my family is in crisis, that I love them, and that I must give of myself in an extraordinary way, even if that looks a little obsessed or makes me seem a bit nutty at times. And if any of these supportive individuals felt that I was overdoing my attempts at caregiving, possibly to my own or my family’s detriment, they would not chastise me. Instead, they would nudge me toward caring for myself as well as my family while offering gentle advice about how I might care for my loved ones more effectively. They wouldn’t stand back and judge me; they would lean in to help.

Unfortunately, things are different when it comes to addiction.

In contrast to the story above, let’s say my spouse of twelve years became addicted to alcohol and prescription painkillers. Let’s say she lost her job because she was drunk and high at work. Let’s say that because of her addiction I can no longer trust her to adequately care for our kids. What happens now when I take that second job, stop going to the gym, stop hanging out with friends, eliminate my recreational activities, and start to obsess about her drinking and using, all while paying the family bills and caring for our children? Will my friends and family, my employer, my clergy, and my therapist support this degree of caregiving and caretaking while empathizing with my frustration and exhaustion?

Most likely they will not.

In the addiction world, support and therapy for a loving spouse (or parent) typically involves judgmental head-shaking, tut-tuts, and expressions of concern about the caretaker’s problem, with that problem being identified as dysfunctional attempts to love, save, rescue, and heal the addict and the family.

Move over empathy; make way for judgment.

How is this helpful? Why do we pin the stigma of addiction on the addict’s family as well as the addict? Why do we negatively label hard-working, deeply loving, intensely loyal, profoundly afraid, nearly exhausted loved ones of addicts as codependent or worse? Is this the kindest and most effective way to invite them into the healing process? Does this represent the empathetic, non-judgmental embrace that such people clearly need and deserve?

No wonder it’s tough to keep family members of addicts involved in treatment. These are individuals who’ve spent months or even years trying to keep the family afloat, with hardly any thanks for their efforts, and now we’re talking to them (or maybe at them) in ways that cause them to feel blamed, shamed, and at fault.

For years, I have listened to therapists and counselors talking about how difficult it is to work with the wives, husbands, and parents of addicts. I consistently hear statements like:

  • They don’t want to own up to their part in the problem.
  • They view the addict as the sole source of the problem, and that makes it hard to help them.
  • They don’t see how their attempts to be caretakers are making things worse.
  • They may be sober, but they’re every bit as sick as the addicts, and sometimes sicker.
  • They just can’t stop rescuing, and that causes more problems than it solves.

Ouch!

But what if loved ones of addicts aren’t so difficult to treat? What if “the problem” lies more in how we conceptualize them? What if our primary model for treating them has misunderstood and marginalized them in ways that simultaneously confuse them and cause them to feel unnecessarily blamed and shamed? What if we prejudge loved ones of addicts as codependent, and therefore driving a dysfunctional family system? What if that “diagnosis” pushes them into a reactionary state where they feel they must defend their actions and tell us where the real problem lies, which, in their mind, is with the addict? What if we then we go round and round with them, playing pin the tail on the pathology?

I find it hard to understand why we choose to initiate therapeutic relationships with painfully overwhelmed and under-supported loved ones of addicts by thrusting a negative, pathological view of caregiving on them. And then we expect them to not only embrace this concept but to start working on it immediately. And when they act out against this model, we call them difficult, which reinforces our belief that they are as innately troubled as the addicts they love.

Codependence

Nearly all loved ones of addicts are currently treated using some form of the codependence paradigm, which is heavily focused on the ways in which childhood trauma can (and often does) affect adult relationships and life. The general belief of the codependence model is that people who end up loving, partnering with, and staying with addicts are people who experienced similar trauma in childhood, usually by growing up with an alcoholic, addicted, or mentally ill parent or caregiver.

Essentially, codependence says those who survive early-life dysfunction tend to carry that forward into their adult lives, usually by bonding with and becoming dependent on people who, over time, neglect, abuse, and let them down in similar ways—thereby mirroring to some degree their past relationships, losses, and trauma.

Rather unfortunately, the codependence model ignores certain aspects of caregiving loved ones’ lives.

  • What about their years of feeling confused, anxious, overwhelmed, and fearful about the future of their addicted loved one, themselves, and other members of their family?
  • What about their grief for how their lives have turned out?
  • What about the fact that they have been victimized in their own homes, sometimes for years on end, by an addict who is more willing to lie, manipulate, and keep secrets than to face the truth?

In my experience, these factors must be considered. So, even when caregiving loved ones have been “doing it all wrong,” I think that it’s not a good idea to tell them that or to blame them in any way for facilitating and perpetuating someone else’s dysfunction. Because doing that can drive them away from much-needed therapy.

In 25 years of providing addiction treatment, I have never once felt comfortable applying the codependence model to loved ones of addicts. This model’s early-treatment emphasis on pathologies that pre-date the addiction, rather than on the current trauma of living with an active addict, has always, to me, felt misplaced and misguided.

So I spent much of the past several years researching codependence while hoping to find or develop a more loving and useful way of approaching partners loved ones of addicts. After reading pretty much everything ever written about codependency and conversing with countless colleagues at every level of clinical addiction treatment, I reached a couple of significant conclusions:

  1. There is not now, nor has there ever been an official diagnosis for codependence. With good reason.
  2. There are no commonly accepted criteria for “diagnosing” codependence, as the model has evolved and split over the years.
  3. Codependence treatment as it is commonly practiced inappropriately explores and emphasizes, in the early stages of treatment, past trauma while ignoring or downplaying the current crisis.
  4. Countless “codependents” have been coached to walk away from an addicted or otherwise troubled loved one, often with disastrous results. Many stay angry about this for the rest of their lives.
  5. Despite many, many adaptations and versions, codependency at its core asks loved ones of addicts to question their actions and motivations in ways tend to feel alienating and dismissive of their experience.
  6. However it is conceived of and practiced, codependence tends to feel blaming, shaming, and pathologizing rather than welcoming. Because of this, loved ones of addicts often walk away from treatment before a therapist can help them.

As I see it, the primary shortcoming of the codependence model is that it automatically assumes loved ones of addicts are re-enacting unresolved early-life trauma by partnering with or raising an addict. In actuality, that may or may not be the case. Either way, telling these individuals early in the treatment process that they are damaged by trauma and that’s why they’re partnered with an addict and behaving in ways that are enabling (maybe even causing) the addiction is usually not something they’re ready to hear or process, even if it’s all completely true.

Thus, caregiving loved ones of addicts will often respond to the “diagnosis” and therapeutic suggestions of codependence with statements like:

  • My spouse/child/sibling is addicted, and you’re telling me that I’m the one with the problem?
  • What do you mean I’m enabling the addiction and making it worse?
  • Detach with love? What does that even mean?
  • I work three jobs, give away all my free time, and forgo self-care to help this family survive, and you tell me I’m the one with a problem?

To reiterate, codependence causes loved ones of addicts to feel blamed and shamed for the addict’s dysfunction, and that can be incredibly alienating. Often, it drives these loving individuals away from treatment before they can benefit, even a little, from the therapeutic process.

The codependence paradigm is deeply flawed. It’s just that simple. A more empathetic model that understands why loved ones of addicts stay in their relationships and behave as they do is sorely needed. Instead of blaming them for resisting a path that feels innately wrong to them, maybe we should find a less intrusive, less shaming way of supporting them.

Prodependence: The New Paradigm

Prodependence is an attachment-focused (rather than trauma-focused) term I’ve created to describe relationships that are healthfully interdependent, where one person’s strengths fill in the vulnerabilities of the other and vice versa, with this mutual support occurring automatically and without question.

Rather than blaming, shaming, and pathologizing caregiving family members of addicts for loving too much, or for enabling instead of helping, prodependence celebrates their desire to love and help. With prodependence, there is no shame or blame, no sense of being wrong, no language that pathologizes a loving caregiver. Instead, there is recognition for effort given, plus hope and useful instruction for healing.

As with codependence, prodependence recognizes that when that when a caregiver’s actions run off the rails and become counterproductive (enabling, raging, controlling, enmeshing)—and yes, this happens quite a lot when a person is trying to care for a deeply troubled loved one—measures can be taken to put the relationship back on track. However, prodependence does not imply that a caregiver’s dysfunctional behaviors arise out of any past or present trauma or pathology of their own (regardless of whether they have such issues). Instead, prodependence views their actions as an attempt to maintain and/or restore their family and their relationships.

To treat loved ones of addicts using prodependence, we need not find that something is “wrong with them.” We can simply acknowledge the trauma and the inherent dysfunction that occurs when living in close relationship with an addict. Then we can guide them toward loving more effectively, with better self-care and boundaries.

Prodependence does not ever consider efforts made to help a loved one get well as pathology, even if those attempts to help are misdirected and ineffective. Under no circumstance does prodependence imply that love is or can become pathological. Instead, prodependence acknowledges that loving an unpredictable person who blames, lies, seduces, manipulates, and gaslights to maintain an addition or some other dysfunction can make pretty much anyone look crazy over time. Because that is the type of behavior that puts people in crisis. And people in crisis can look crazy.

Interestingly, prodependence recommends and implements the same basic therapeutic actions as codependence—a fresh or renewed focus on self-care coupled with implementation of healthier boundaries. That said, the models approach this work from vastly different perspectives.

  • Codependence, as a deficit-based trauma model, views loved ones of addicts as traumatized, damaged, and engaging in unhealthy caretaking behaviors as a result of that.
  • Prodependence, as a strength-based attachment-driven model, views loved ones of addicts as heroes for continuing to love and continuing to remain attached despite the debilitating presence of addiction.

Instead of blaming, shaming, and pathologizing deeply attached caregivers, instead of telling them that their actions are being driven by unconscious attempts to heal their unresolved trauma, prodependence says, “You’re a wonderful person for putting so much effort into helping your addicted loved one. It’s possible, however, that you’re not doing that as effectively as you might. And who can blame you for that? It’s hard to worry about loving someone in the best possible way when you’re in the middle of a disaster zone. If the house is burning down, you grab your loved one and drag that person out of the fire, and you don’t worry about whether you’re grabbing too hard, or in a way that hurts. Now that you’re in therapy, though, we can slow things down and figure out how you can help the addict more effectively—in ways that might be more useful to the addict and your relationship, and that won’t cause you to feel so overwhelmed.”

That is the essence of the prodependence model.

 

Reframing Codependent Traits vs. Prodependent Traits

Codependent Traits Prodependent Traits
Enmeshed Deeply involved
Externally focused Concerned about the welfare of others
Enabling Supporting
Fearful Worried
Lacking healthy boundaries Eager to care for a loved one
Can’t say no Chooses to say yes
Obsessed with the addiction Determined to protect the addict/family
Living in denial Unwilling to give up on a loved one
Angry Fearful of further loss with no control
Controlling Trying to be heard
Hyper-vigilant Anticipating problems

 

Prodependent treatment of loved ones of addicts recognizes and accepts, first and foremost, that these individuals are in crisis, and they are likely to behave accordingly. As such, they will show emotional lability. They may also exert superhuman effort with household chores, childcare, doctor’s visits, home health care, and earning extra money to pay for everything. And they behave in these ways as an expression of love and attachment, not pathology.

In short, the prodependence model encourages therapists and clients to celebrate the natural and healthy human need to develop and maintain intimate connections and to provide ongoing, uninterrupted support to loved ones—even in the face of addiction or some other profoundly troubling life issue.

For more information on Prodependence, visit my website, Prodependence.com, or purchase my recently published book, Prodependence: Moving Beyond Codependency.