The Disease Models of Alcoholism and Codependence
According to researchers O'Farrell and Feehan(1999), the family disease approach is the best known and most widely used form of treatment. Looking at the disease model not only in terms of physiological addiction but also from the standpoint of genetics of the disease of alcoholism has become important in treatment. The definition of the disease of alcoholism given by members of the American Society of Addiction Medicine(ASAM) is as follows: Alcoholism is a primary disease.....characterized by....impaired control over drinking, preoccupation with alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial(Bean-Bayog and Blume, 1990). Research supports the belief that alcoholism is a complex genetic disorder of both multiple and environmental influences. Research also suggests that genetic markers may be associated with the varying types of the disorder and the severity of the disorder. The markers that have had repeated studies implicating them are the A1 allele of the DRD2 gene and specific allele of the ALFH2 gene(Ketlenios,1998).
In looking into the dynamics and treatment involving the female partner of the recovering alcoholic, it is essential to examine the psychological concepts of the "illness" of codependence. According to Ceramic(1986) the proposed definition of codependence is: Codependence is a recognizable pattern of personality traits, predictably found within most members of chemically dependent families, which are capable of creating sufficient dysfunction to warrant the diagnosis of Mixed Personality Disorder as outlined in the DSM-IV.
In 1990, the National Council on Codependency developed the following definition: "Codependency is a learned behavior, expressed by dependencies on people and things outside the self: these dependencies include neglecting and diminishing of one's own identity. The false self that emerges is often expressed through compulsive habits, addictions and other disorders that further increase alienation from the person's true identity, fostering a sense of shame" (Whitfield 1991,pg.10). Wegscgeider-Cruse(1989) suggests one core concept, "other focus/ self-neglect" and four codependent subconcepts, "family of origin issues", "low self worth", "hiding self" and "medical problems".
According to Cermak(1991), the defining criteria for codependency include: 1. Control of both self and others 2. Taking responsibility for meeting others' needs to the point of self neglect. 3. Distortion of boundaries related to separation and intimacy with others. 4. Enmeshed relationships.
O'Brian and Gaborit(1992), advocated codependency as having to do with the appropriateness of interpersonal relationships and self autonomy. These researchers have enumerated five factors related to codependency which include: caretaking; other referring; surrendering the self; faulty communication skills, and lack of autonomy.
Current unhappiness from growing up in a family that was troubled, chemically dependent or overwrought with problems in which thoughts and feelings were not expressed and discussed and in which affection was not openly displayed, is considered under the broad heading of family of origin issues. Individuals who grow up in such families learn roles that include codependent relating(Wegscheider- Cruse,1989).
Thoughts of self-hatred and self criticism and feelings of shame, self-blame and humiliation are included in codependency(Hughes-Hammer,Martsoff and Zeller, 1998). Researchers Fossum and Mason(1986) indicate that shame evolves in individuals as a result of being raised in shame bound families.
According to Whitfield(1989), codependency includes the use of a positive front to cover and control negative emotions with repression of feelings. Thus a false self emerges.
The aspect of medical problems in the codependent has merit. A codependent individual has a sense of current ill health when compared with families and friends. This is accompanied by worry and preoccupation with real or imagined health difficulties and impending body failure(Hughtes-Hammer et al, 1998). Researchers Gotham and Sher(1996), showed that physiological complaints or symptoms were significantly correlated with total codependency scores(r=.24 N=467 P<.0001). Hinkin and Kahn(1995), in their study found that wives of dental patients had signifi- cantly fewer symptoms when compared with wives of alcoholics.
Of importance here in the furthering of the discussion of codependency is an exploration of feministic thought as it relates to power in relationships and, more specifically, to codependent behavior.
According to Hare-Musin and Marcode(1986) feminism is futuristic in calling for social change and for changes in both men and women. Feminists have been con- cerned about the family because the family is the primary beneficiary and focus of women's labor as well as the source of women's most fundamental identity, that of mother. Feminists view the socially constructed role differences between the sexes as the basis of female oppression(Eisenstein,1983). Guilligin(1982) sees women's concern with relationships as the need to please others when one lack of power.
Feminist researcher Collins(1998) has found that gender role behaviors and the problems associated with them result from the impact of one's position in the social hierarchy. Miller(1986) describes in detail how the personality characteristics ascribed to subordinated-dominated groups develop as a result of prolonged exposure to a limiting role. She proposes that the masculine gender role behavior results from exposure to the privileges and benefits of the dominant position and serves to maintain men's dominant status and justify the exploitation of others. Feminine gender role behaviors may be adaptive efforts to cope with or survive the realities of life in a sub- ordinate position.
Hare and Marcode(1990) have described in their works how those in power support the use of rules, discipline, control and rationality whereas those without power value relatedness and compassion. They point out that in marital conflict men call for rules and logic whereas women request caring and compassion.
According to Guilligan(1982), independent assertion in judgement and action is considered to be the hallmark of adulthood - but it is rather in their care and concern for others that women have both judged themselves and are judged. The conflict between self and other thus constitutes the central moral problem for women which poses a Dilemna whose resolution requires a reconciliation between femininity and adulthood. The "good woman" masks assertion in evasion, denying responsibility by claiming only to meet the needs of others; while the "bad woman" forgets or renounces the commitments that bind her to self deception and betrayal. It is precisely this Dilemna -the conflict between compassion and autonomy, between virtue and power- which the feminist voice struggles to resolve in its effort to reclaim the self and to solve the moral problem in such a way that no one is hurt.
Authors Beattie(1981) and Schaef(1986) in their work appear to see the one disturbing consequence of the recognition that women have difficulty living at the center of their own lives to be the recent phenomena of giving women the diagnosis of codependency. This is considered because they put others' needs ahead of their own and do not feel entitled to pursue their own goals. This "illness" labels women as sick for demonstrating the very traits that are culturally presented as proper female behavior. Bepko and Krestin(1990) and Lerner(1985) acknowledge that women are trained to be self-efficacious and conflict-avoidant, and then move into to discuss how women can change their lives in the direction of being more independent and authoritarian without renouncing their skills and interests in re- latedness as a key element in their lives.
Although the state of codependent behavior can be ascribed to most women, it is felt by this author as well as others(Cermak1986, Whitfield 1991and Cruse 1989) that the disease of codependency is most clearly related and most often seen in those dealing with a family member with addiction.
According to Cermak(1986), treatment of codependency involves helping clients to understand that when they say they are codependent, they are accepting that they are powerless over areas of their lives they have tried to control. Education is an important cornerstone of therapy. Teaching assertiveness training and communication skills is seen as vital. A tremendous amount of internalization will occur as the client stops blaming low self esteem on outside causes and starts recognizing that it comes from having done violence to her own feelings , having lived life controlled by compulsions, and having sacrificed integrity for the sake of security. Many clients experience profound depression as part of the grieving process. The relief that comes from no longer feeling responsible for the chemical dependence within the family will invariably be accompanied by a sense of loss. The client must relinquish her illusion of being powerful enough to force the chemical dependent to become and remain sober.