Drug dependence affects not only drug users themselves but all of the people in their social context, especially their family2,4.

Codependency, a learned or survival behavior, refers to a psychological problem that enables drug users and their family members to engage in mutually destructive habits and maladaptive coping strategies to maintain a sense of balance or homeostasis3,4

The codependent loses control of his own life and his own limits, and invests all his energy in the rest of the people, has a great need to be useful and pays a very high price for it16.

To distinguish the codependency construct from healthy caretaking behaviors, Fuller and Warner (2000) suggested that codependency be operationally defined as an excessive focus outside oneself related to a stressful family environment15.

Highly codependent individuals adapt their behavior in such a way that they allow it to affect their personal and occupational lives by changing or cancelling plans, hiding the user’s behavior from the rest of the family, lying or excusing the user’s behavior, and expressing a desire to change their own behavior without managing to do so16,4.


The literature review reveals the stressors responsible for development of codependent behavior which are discussed as follows:

  • alcoholic parents17
  • an outcome of childhood abuse.18
  • family stress (family with an alcoholic, father with mental illness or father with physical illness)
  • alcoholic spouse

Hughes-Hammer, Martsolf, and Zeller (1998) found that codependency consists of five factors including other focus/self-neglect, low self-worth, hiding self, family-of-origin issues and medical problem.

Codependency refers to a learned or survival behaviour in dysfunctional families with resulting neglect of one’s own needs and excessively focusing on others.

Codependency refers to a learned or survival behaviour in dysfunctional families with resulting neglect of one’s own needs and excessively focusing on others.

Codependency refers to a learned or survival behaviour in dysfunctional families with resulting neglect of one’s own needs and excessively focusing on others.

Codependency refers to a learned or survival behaviour in dysfunctional families with resulting neglect of one’s own needs and excessively focusing on others.


A study conducted in women with alcoholic spouse reveals that not all addicts’ wives experienced codependency; women with a high level of neuroticism and low level of openness and agreeableness were more vulnerable to the stress of living with an addict and to codependency1.

According to five-factor model of personality Neuroticism refers to the degree of negative emotions, insecurity, vulnerability and anxiety1.


Symptoms associated with codependency are:

  • hiding oneself14
  • medical problems14
  • low self-worth (self-criticism, self-blame and shame)14
  • an intense need to help4,5
  • difficulty setting boundaries6,7,8
  • asserting their own needs because of low self-esteem6,7,8
  • poor emotional control6,7,8
  • self-blame 6,7,8.
  • prioritization of others’ needs1,11,12
  • exaggerated care taking behaviors1,11,12
  • obsessive involvement with others1,11,12
  • Self-neglect
  • having trouble in intimate relationships are frequently reported by addicts’ families, especially their wives 1,11,12


Codependency is a form of inappropriate relationship, it can be modified once the codependent accepts the help16. It is important for families to receive specialist treatment in order to contribute to the recovery process.

A research shows that The Tele-intervention Model and Monitoring of Families of Drug Users (TMMFDU), based on motivational interviewing and stages of change, aims to encourage the family to change the codependents’ behaviors, proves to be effective in changing codependent behaviors among compliant family members of drug users9.



  1. Panaghi L, Ahmadabadi Z, Khosravi N, Sadeghi MS, Madanipour A. Living with Addicted Men and Codependency: The Moderating Effect of Personality Traits. Addiction & Health. 2016;8(2):98-106.
  2. Denning P. Harm reduction therapy with families and friends of people with drug problems. J Clin Psychol2010; 66(2):164-174.
  3. Steinglass P. Systemic-motivational therapy for substance abuse disorders: an integrative model. J Fam Ther 2009; 31(2):155-174
  4. Bortolon CBSignor LMoreira Tde CFigueiró LRBenchaya MCMachado CAFerigolo MBarros HM Family functioning and health issues associated with codependency in families of drug users. Pubmed. 2016 Jan;21(1):101-7. doi: 10.1590/1413-81232015211.20662014.
  5. Gómes A, Delgado D. La codependencia en familias de consumidores y no consumidores de drogas: estado del arte y construcción de un instrumento. Psicothema 2003; 15(3):381-387
  6. Noriega G, Ramos L, Medina-Mora ME, Villa AR. Prevalence of codependence in young women seeking primary health care and associated risk factors. Am J Orthopsychiat 2008; 78(2):199-210.
  7. Doba K. Nandrino JL Dodin V, Antoine P. Is there a family profIle of addictive behaviors? Family functioning in anorexia nervosa and drug dependence disorder. J Clin Psychol 2014; 70(1):107-117.
  8. Beattie M. The new codependency: help and guidance for today’s generation. New York: Simon & Schuster; 2009.
  9. Six-Month Outcomes of a Randomized, Motivational Tele-intervention for Change in the Codependent Behavior of Family Members of Drug Users

Cassandra Borges Bortolon, Taís de Campos Moreira, Luciana Signor, Bárbara Léa Guahyba, Luciana Rizzieri Figueiró, Maristela Ferigolo, and Helena Maria Tannhauser Barros

Substance Use & Misuse Vol. 52 , Iss. 2,2017.

  1. Graham AV, Berolzheimer N, Burge S. Alcohol abuse. A family disease. Prim Care. 1993;20(1):121–30.
  2. Uhle SM. Codependence: contextual variables in the language of social pathology. Issues Ment Health Nurs. 1994;15(3):307–17.
  3.  Kenny ME, Donaldson GA. Contributions of parental attachment and family structure to the social and psychological functioning of first-year college students. J Couns Psychol. 1991;34(4):479–86.
  4. 23. Costa PT, McCrae RR. Domains and facets: hierarchical personality assessment using the revised NEO personality inventory. J Pers Assess. 1995;64(1):21–50.
  5. 31. Hughes-Hammer C, Martsolf DS, Zeller RA. Development and testing of the codependency assessment tool. Arch Psychiatr Nurs. 1998;12(5):264–72.
  6. International Journal of Psychology, 2016
  7. DOI: 10.1002/ijop.12271
  8. Testing a model of codependency for college students
  9. in Taiwan based on Bowen’s concept of differentiation
  10. Shih-Hua Chang
  1. Shih-Hua Chang International Journal of Psychology, 2016 DOI: 10.1002/ijop.12271Testing a model of codependency for college studentsin Taiwan based on Bowen’s concept of differentiation.
  2. Rotunda R, West L, O’Farrel T. Enabling behavior in a clinical sample of alcohol-dependent clients and their partner. J Subst Abuse Treat2004; 26(4):269-279.
  3. Evidence of codependency in women with an alcoholic parent: Helping out Mr. Wrong. Lyon, Deborah; Greenberg, Jeff. Journal of Personality and Social Psychology, Vol 61(3), Sep 1991, 435-439.
  4. Irwin, H. J. (1995), Codependence, narcissism, and childhood trauma. J. Clin. Psychol., 51: 658–665. doi:10.1002/1097-4679(199509)51:5<658::AIDJCLP2270510511>3.0.CO;2-N
  1. International Journal of Psychology, 2016
  2. DOI: 10.1002/ijop.12271
  3. Testing a model of codependency for college students
  4. in Taiwan based on Bowen’s concept of differentiation
  5. Shih-Hua Chang