Codependency, Enabling, and Addiction

You searched for codependency because the household has organized itself around someone else's use, and you are afraid the word means the love is the problem. SAMHSA's updated TIP 39, the 2020 protocol on substance use disorder treatment and family therapy, asks counselors not to answer that search with a label. The executive summary says most families are trying to adapt. They are trying to keep a steady state, sometimes called homeostasis. Sometimes the effort includes behavior that actually supports the substance use. The summary says this is sometimes called enabling. It then says to avoid blame, shame, and judgmental labels, and it gives the examples "co-dependent" and "enablers." Offer education, empathy, and support instead. The words get explained here. They do not get assigned to you.

If you are in danger, call 911. If you are in a mental health crisis, call or text 988.

Why SAMHSA tells clinicians to drop the word

A counselor note in chapter 2 is blunt about codependence. The term originally described spouses of people with alcohol use disorder. It has come to mean any relative of a person with any behavioral or psychological problem. The note says the word has been criticized for pathologizing caring, particularly empathy and self-sacrifice, functions that have traditionally been cast as women's roles. Despite how common the word is, the authors SAMHSA cites, Klostermann and O'Farrell, found no consensus in the field. Usage runs from a shorthand label for family members affected by someone's substance use disorder to a synonym for a personality disorder. Little scientific inquiry has focused on codependence. The note's conclusion is that it is best to avoid the term with clients and when discussing families.

SAMHSA does not present codependence as a clinical diagnosis. It records that some people use the word as if it were a personality disorder, and it treats that slide as a reason to stop using the word, not as a finding that a caring relative has a personality disorder. A quiz that scores you as codependent is not the protocol. A partner who is exhausted is not, on this evidence, a diagnosis.

Chapter 1 adds the history. Early residential programs brought family members in, especially spouses, to explain how the family had contributed to the substance use. The protocol says it is no accident that "co-alcoholic" and "codependent" were applied to spouses. The stance was often "them" versus "us," family versus people in treatment. Family psychoeducation started in that climate. TIP 39's later chapters ask programs to leave it.

What enabling describes, without the insult

The same manual still needs a plain account of behavior that props up use. Chapter 2 says most families try to keep things as normal and consistent as possible, and in doing so may behave in ways that make substance use more likely. Sometimes that is called enabling. The behaviors are described as normal and, in a way, adaptive. The counselor's job is to help the family learn healthier patterns, not to criticize them for trying to keep the household standing.

The note on enabling behaviors uses a specific picture. Parents of an adult son who misuses prescription opioids might keep giving him money, let him live at home, and bail him out of jail. Those acts keep him from the negative effects of the misuse, which can make it easier to continue and can give him less reason to seek recovery. The parents do it because they love him and do not want him to suffer. They think they are doing the right thing. TIP 39 says enabling is a common, normal reaction. Do not shame, blame, or lecture. Help the family see why well-meant help can work against recovery, and help them find ways to support the person without supporting the use.

A second picture is a mother whose drinking means she cannot pick up a younger child, manage bills, or keep the house. A teenage daughter takes on those jobs rather than trying to get her mother to stop. The daughter is trying to keep the family functioning. The protocol says that can look illogical, because it lets the drinking continue, and that it is also typical. Members do their best to survive and to prevent more disruption. Enabling that grows from that effort may look counterproductive. It is still adaptive. The family roles guide lays out SAMHSA's exhibit of child and spouse patterns, including the pattern it calls the enabler. The exhibit's name and the executive summary's warning can sit in the same book. Describe what people do. Do not pin a slur on them for doing it.

The protocol also notes a gender pattern without turning it into a rule about every woman. Women are often socialized to be caretakers and to avoid confrontation. A mother or daughter may feel it is not her place to criticize someone's use, and may take up caretaking instead. If those beliefs are part of the family problem, TIP 39 says they may need to be addressed in treatment. That is a clinical question. It is not a finding that care itself is the disorder.

Adult children can fall into the same effort to keep balance, including enabling, in families that are chaotic and unpredictable. The parenting guide covers the parent who is in recovery. The boundaries guide covers information, privacy, and limits with people who are still using. The guide for relatives covers the practical side when the person does not want care. Money, housing, and jail are examples in the protocol, not a checklist for your kitchen. Which costs to keep paying is yours to decide with the people who know the danger, not a slogan from a summary.

What to do with the worry

Partners, in the same chapter, may feel anger, stress, anxiety, hopelessness, shame, stigma, or isolation. Both partners may need help when substance use is in the relationship. Treatment for either one affects both. That is an argument for welcoming the family, not for diagnosing the person who showed up worried.

Your own support is allowed to be for you. The family support guide covers mutual-help groups relatives use whether or not the person in treatment attends. The family therapy guide explains the clinical service, including the limits: the person in care defines who attends, and joint sessions are generally not recommended after intimate partner violence. If there is violence or a threat, get emergency help. Do not wait for a family hour to become a safety plan.

The forgiveness guide covers a separate topic. Being told to forgive, or to stop being "codependent," is not a treatment plan. TIP 39's direction is education without shame.

Search FindTreatment.gov if you want a program that works with families and can tell you whether family sessions fit. Call (800) 653-9376 if you want help looking for that kind of program.

Additional Resources

Sources cited on this page:

• SAMHSA TIP 39, Chapter 1: Substance Use Disorder Treatment: Working With Families (NCBI Bookshelf)
• SAMHSA TIP 39, Chapter 2: Influence of Substance Misuse on Families (NCBI Bookshelf)
• SAMHSA TIP 39: Substance Use Disorder Treatment and Family Therapy (2020 update, GovInfo PDF)
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions