The Disease within all Addictive Diseases

1. The Disease within all Addictive Diseases CAPTASA -- January 25, 2008 By Carol Cannon, M.A., C.A.D.C.

2. Broad Definition of Addiction Addiction is anything a person makes highest priority in his/her life, over and above other priorities, doing it to his own detriment or the detriment of the people closest to him and continuing to do it in the face of obvious negative consequences.

3. Addictive Issues Primary conditions (dependencies) Substance addictions Non-chemical addictions Related patterns (codependencies) Depression, dysthymia Compulsive worrying, anxiety Troubled relationships Chronic low self-esteem Lack of identity Lack of boundaries

4. Primary Addictions • Ingestive substances • Activities & processes • Interpersonal relationships • Thoughts & feelings

5. Categories of Clean Addictions Activities: work, exercise, shopping, gambling,dangerous or exciting hobbies and sports, caretaking,procrastination, talkaholism, jokeaholism, electronic addictions Interpersonal relationships: sex, romance, and relationship addictions;rescuing and repairing people; and family enmeshment Thoughts & feelings: mindsets like pessimism,negaholism; fixating on “causes” or belief systems; emotional states like rage, chronic misery, anxiety and mild chronic depression

6. Workaholics . . . • Are harried, hurried • Live to work rather than work to live • Get high on multi-tasking • Operate in hyperdrive • Routinely over-commit (double book) • Compete with the clock • Become irritable when interrupted • Are addicted to stress and intensity

7. Religion Addicts . . . • Seek relief in their beliefs • Use religion like a narcotic • Abuse themselves with church doctrines and standards • Make being right & righteous their sole source of meaning, identity, and value • Have trouble accepting their fallibility • Beat themselves (and others) up with guilt

8. Romance Addicts Are . . . • Addicted to the drug-like high of falling in love • Stimulated by the excitement of the hunt • Hooked on the accoutrements of romance • Likely to move on when the high wears off • Inclined to be involved in serial marriages or simultaneous affairs • Uncomfortable unless they have one or more “candidates” waiting in the wings

9. Relationship Junkies . . . • Think they’re nobody unless somebody loves them • Make being in a relationship their sole source of meaning, identity, and value • Expect partners (and even friends) to devote themselves to them exclusively • Think they own their partners— “parent” them • Fear nothing worse than abandonment • Control partner to avoid rejection, thus creating the very thing they fear most

10. Sexual Addiction Is . . . • A pathological relationship with sex, sexual thoughts, or sexual behavior which makes the mood-altering behavior more important than family, friends, work, and values • A loss of contact with reality through denial and delusion • Loss of control despite serious life consequences

11. Compulsion Obsession The next drink The next high The next meal Image management The next project The next cripple Power/perfection The next affair The adrenaline rush The next insult Image management Being right & righteous Alcoholism Drug dependence Overeating Anorexia/bulimia Workaholism Caregiving Control Sex, love, romance Excitement Misery (negaholism) Perfectionism Religion (legalism)

12. Prevailing Theories Roommate Theory: a codependent is someone who has a problem with someone who has a problem Reaction Theory: a codependent is someone who has developed discrete symptoms of his/her own as a result of living with an alcoholic or addict Historical Theory: a codependent is someone trained in childhood to cope with dysfunctional people and un- consciously looks for “sick” partners in the present Developmental Theory: a codependent is someone whose adverse life experiences blocked optimal development and made him/her vulnerable to addictive substances, activities, and people

13. BIOLOGICAL PREDISPOSITION (Hereditary) Increases vulnerability by 4 X PSYCHO-SOCIAL SET-UP (Environmental) Increases vulnerability 2-4 X RELIEF Continued use of addictive substance or activity FIRST OPPORTUNITY TO “USE” Transgenerational Cycle of Addiction & Codependence X Symptoms: Arrested development Repressed emotions Xanax Busy-ness Food/no-food Volunteering School Perfection Caretaking Job - Affair Pain Anger Hurt Fear Shame Guilt Good Stuff Children divert growth energy into defending themselves or caretaking parents Nurture Children to High Self–Worth & Social Effectiveness Portrait of Codependence “STUCK” BETWEEN AGES 0-12

14. Immaturity + repressed emotion spontaneous age regressions = dysfunctional relationship behavior = dry drunk syndrome = codependence

15. “Dry Drunk” Irresponsible Irritable Critical Controlling Insistent Hard-to-please Codependent Needy Moody Demanding Arbitrary Impatient Tantrum-like behavior Boss or colleague?

16. The Transgenerational Cycle The addictions (chemical or clean) of parents lead to The neglect and abuse of children which creates Internalized pain and shame in the child which results in Vulnerability to anything that feels good which leads to Self-medicating to relieve pain & shame

17. Underlying Issues (Symptoms of Codependence] Compulsive Caretaking/Control Religion Addiction, Perfectionism Alcoholism/Drug Addiction (1) Immaturity (2) Undue shame (3) Repressed emotion (4) Lack of identity Eating Disorders Misery Addiction Sex and/or Relationship Addiction Excitement, Risk-taking (Intensity Addictions) Workaholism Achievement Addiction

18. Thus, codependence may be seen as the disease within all addictive diseases!

20. Could this be the elusive “ism”? Bill W: “I think that many oldsters who have put our AA ‘booze cure’ to severe but successful tests still find they often lack emotional sobriety. Perhaps they will be the spearhead for the next major development in AA—the development of much more real maturity and balance.” “The Next Frontier: Emotional Sobriety,” Grapevine, January 1958

21. Codependence in the Twelve & Twelve “He [the willing person] made a beginning . . . when he commenced to rely upon AA for the solution of his alcohol problem. By now, though, the chances are that he has become convinced that he has more problems than alcohol, and that some of these refuse to be solved by all the sheer personal determination and courage he can muster. They simply will not budge; they make him desperately unhappy and threaten his newfound sobriety.” p. 39

22. Twelve & Twelve Descriptions con‘t “It is from twisted relations with family, friends, and society at large that many of us have suffered the most. . . . The primary fact that we fail to recognize is our total inability to form a true partnership with another human being. Our egomania digs two disastrous pitfalls. Either we insist upon dominating the people we know, or we depend upon them far too much. . . . Always we tried to struggle to the top of the heap, or to hide underneath it.” p. 53

23. Twelve & Twelve Descriptions con’t “Our demand for emotional security, for our own way, had constantly thrown us into unworkable relations with other people. Though we were sometimes quite unconscious of this, the result always had been the same. Either we had tried to play God and dominate those about us, or we had insisted on being overdependent upon them. Where people had temporarily let us run their lives as though they were still children, we had felt very happy . . . . When we had taken the opposite tack and had insisted, like infants ourselves, that people protect and take of us, . . . then the result had been equally unfortunate. . . . We had failed to see that though adult in years we were still behaving childishly.” p. 115

24. WARNING Undiagnosed, untreated codependence may compromise sobriety, contribute to relapse, or cause the abstinent addict/alcoholic to switch from one addiction to another.

25. Codependence: growing up depending on someone who’s depending on something that’s not dependable.

26. Codependence: the disease of being an immature child in an adult body!

27. Codependence: two or more sick people getting worse together!

28. Codependence: a pattern of painful dependence on people and on approval for safety, self-worth, and identity.

29. Codependence is the social, emotional, spiritual pathology that occurs when children are reared in an environment characterized by high stress and low nurturance.

30. Codependence is the pain in adulthood that comes from being wounded in childhood and leads to a high probability of relationship problems and addictive or compulsive behavior. It is a combination of imma-ture thinking, feeling, and behaving that generates an aversive relationship with the self (self-loathing), which the codependent person acts out through self-destructive or unduly self-sacrificial behavior.

31. Risk Factors for Codependence • Growing up in the midst of addiction and abuse • Living with an active alcoholic, workaholic, relationship junkie, sex addict, etc • Early trauma and loss—death, deprivation, divorce (experienced as abandonment) • Living in an emotionally repressive or oppressive environment • Enmeshment (lack of boundaries) within the family or social system

32. Dr. Timmin Cermak places codependence within the framework of mixed personality disorder, a condition which exists when an individual does not qualify for a single personality disorder diagnosis but has marked traits of several of the personality disorders. “Codependent Personality Disorder”in DSM Language

33. Since most members of chemically dependent families exhibit a recognizable and predictable pattern of traits, and since this fits our definition of codependence, we can use the following criteria to diagnose the presence of Codependent Personality Disorder:

34. Continued investment of self-esteem in controlling oneself and others in the face of adverse consequences • Assumption of responsibility for meeting others’ needs while failing to acknowledge one’s own • Anxiety and boundary distortions within relationships • Enmeshment with personality disordered, chemically dependent, other codependent, or impulse disordered individuals • Three or more of the following: excessive reliance on denial, frozen feelings, depression, hyper-vigilance, compulsions, anxiety, substance abuse, victim/abuser behavior, stress-related medical illness, staying in a pathological relationship for two or more years without seeking help

35. Symptoms to Be Addressed • Difficulty experiencing appropriate levels of self-esteem • Inability to set functional boundaries and practice healthy self-care • Inability to assess others realistically or present oneself authentically in relationships • Lack of moderation, tendency to act in the extreme • Immaturity—regressing to childish behavior at inopportune times

36. Therapeutic Focus Key “codependency” issues • Developmental arrest • Repressed emotion, frozen feelings Recovery goals • Unloading backlogged pain and shame • Learning to experience appropriate levels of self-esteem • Learning to set functional boundaries and practice healthy self-care • Addressing issues of immaturity, growing up, achieving healthy interdependence • Learning to assess others realistically and present oneself authentically in relationships • Learning to practice moderation

37. Therapeutic Process • Catharsis of repressed emotions to relieve depression, anxiety, and backlogged anger • Reduction of shame that sabotages self-esteem and self-care • Facing and grieving losses • Addressing “attachment” problems—learning to connect with others while maintaining healthy boundaries • Gaining mature coping skills through a remedial program of character development called the Twelve Steps

38. Issues Being Addressed • Backlogged feelings • Unrecognized, unrelieved shame • Emotional deprivation • Insatiable neediness • Attachment problems • Delayed development • Social & emotional immaturity • Spontaneous regressions

39. What is “Recovery”? • Recovery is a maturing process—a remedial program of identity and character development • The process begins with abstinence from primary addictions and codependencies, which requires a viable support system • The process involves moving through the stages of human development using simple, strategic, spiritual principles (the Twelve Steps)

40. Recommendations • Inpatient treatment of primary addiction/s • Rigorous aftercare plan and monitoring • Assessment and treatment planning for codependency issues and non-chemical dependencies • Individual and group therapy or residential care (no less than two weeks), as needed for codependence and clean addictions • Appropriate twelve-step support groups • Occasional retreats or tune-ups

41. Regarding treated alcoholics/addicts who have trouble staying clean: “To the extent that they overlook child abuse trauma, the impact (of treatment) may be transitory—often resulting in temporary abstinence but typically failing to resolve the pain that motivated the substance abuse in the first place. In the absence of trauma resolution, the survivor may easily return to familiar tension-reduction or avoidance devices, including alcohol and/or drugs.” Dr. John Briere, Child Abuse Trauma, p. 147

42. Addiction and codependence are contagious diseases that don’t go away unless people do something to make them go away. But recovery is possible, and it’s contagious too!

43. the BRIDGE T O R E COVE RY Recovery is possible! 1745 Logsdon Rd Bowling Green, KY 42101 Toll-free (877) 866-8661