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CORK Bibliography: Co-Dependency

62 citations. 1997 to present

Prepared: March 2009

Angres DH; Talbott GD; Bettinardi-Angres K. Healing the Healer: The Addicted Physician. Madison CT: International Universities Press, 2001

A detailed discussion of alcohol and other drug problems and its treatment in physician populations. Topics that are addressed include: interventions with physicians; discussion of the Rush Medical Center and Talbott programs; continuing care and reentry; relapse and recovery; the medical "marriage" and recovery. There is also special attention to the special issues affecting women physicians, codependency; as well as consideration of co-occurring psychiatric illness, and legal issues arising for the physician touched by substance abuse.

Atkinson SJ; Fischer JL. Factors affecting codependent's support group attendance. Alcoholism Treatment Quarterly 14(1): 11-20, 1996. (17 refs.)

The purpose of this study was to determine the degree to which factors associated with participation in codependency support groups are similar to factors that influence participation in other types of self-help or support groups. Pile-up of stressors and the denial of a problem were found to be the strongest predictors of group attendance. Other factors found to be related to the decision to seek help in support groups were encouragement, availability, and recognition of addictions in oneself or in family members.

Baker DA. Substance abuse among college students with disabilities: The relationship between adult children of alcoholics and codependency. Dissertation Abstracts International 57(7): 2850-A, 1997

This study had several purposes: (a) to determine the prevalence of substance abuse problems among college students with disabilities; (b) to determine if there was a relationship between substance abuse problems and being an adult child of an alcoholic (ACOA) among college students with disabilities; (c) to determine if there was a relationship between substance abuse and being codependent among college students with disabilities; and (d) to determine if there was a relationship between being an ACOA and being codependent among college students with disabilities. The number of participants in this study included 312 college students with disabilities who attended school in the United States. Twenty postsecondary institutions were randomly selected by categorizing them into time zones and drawing five institutions from each time zone. Frequencies were taken to determine prevalence of substance abuse problems, with 50 percent of the participants being classified as substance abusers. Male college students with disabilities had a higher prevalence of substance abuse than did females. Males who were ACOAs had a higher prevalence of substance abuse than did males who were nonACOA. Chi square analysis indicated a significant relationship between being a male ACOA and having substance abuse problems. Similarly, a significance was found for those subjects who were ACOA and classified as substance abusers. No significant relationships were found between codependency and having substance abuse problems or being an ACOA. Recommendations are discussed.

Borovoy A. Recovering from codependence in Japan. American Ethnologist 28(1): 94-118, 2001. (82 refs.)

In this article, I explore the appropriation of the notion of "codependence" in Japan, as alcoholism increasingly becomes a subject of social concern. Codependence is pathologized in the 1980's American popular psychology, which regards accommodation to social relationships as a compromise of the self. Yet, in Japan, the notion resonates with postwar national ideologies of the normal--that is, of Japanese society as held together through family-like intimacy and highly cultivated sensitivities to social demands. Japanese women who define themselves as codependent must forge a distinction (blurred by dominant cultural ideology) between socially valued interdependence and "unhealthy" or systematically exploitative forms of asymmetrical ties. Forging this distinction allows women to reject exploitative demands of society while continuing to function within familial and neighborhood communities. To the extent that women can forge distinctions between "dependence" and "codependence", they may be better able to resist state and social demands that come at their expense.

Burris CT. Stand by your (exploitive) man: Codependency and responses to performance feedback. Journal of Social and Clinical Psychology 18(3): 277-298, 1999. (41 refs.)

Codependency-typified by extreme reliance on relationships, particularly with exploitive individuals, as a means of personal fulfillment -- is a personality syndrome believed to develop, in part, from dysfunctional parenting. Based on this characterization, it was reasoned that codependency would be associated with inadequate parental bonding. It was also reasoned that codependent persons would be more attentive and responsive to an exploitive than to a nurturant other, whereas the opposite was expected for noncodependent persons. Support was found for both of these predictions: Questionnaire data revealed an association between codependency and high maternal control and/or low maternal care. In a laboratory procedure modeled after Lyon and Greenberg (1991), high and low codependents evidenced predicted, markedly different changes in mood as a function of whether they received positive or negative feedback from either an exploitive or a nurturant source. Evaluations of the source differed similarly. Based on these results, a model for understanding codependent persons' persistence in abusive relationships is proposed.

Crothers M; Warren LW. Parental antecedents of adult codependency. Journal of Clinical Psychology 52(2): 231-239, 1996. (19 refs.)

Two aspects of codependency were investigated among 442 undergraduates. First, parental antecedents were examined by subjects completing measures of codependency, perceived parental dysfunctions (compulsivity, chemical dependency, and codependency), and parental styles (coercion, control, and non-nurturance). As expected, correlations between adult codependency and parental coercion, control, non-nurturance, and maternal compulsivity were significant. However, correlations between codependency and parental chemical dependency were not significant. A multiple regression analysis identified parental codependency and maternal coercion as significant predictors of subject codependency. To examine the second aspect of codependency, which assumes that codependency was identified over 40 years ago by Karen Horney, subjects completed a loss of self measure which correlated highly with codependency.

Cullen J; Carr A. Codependency: An empirical study from a systemic perspective. Contemporary Family Therapy 21(4): 505-526, 1999. (62 refs.)

To empirically investigate the construct validity of codependency, differences between young adults on a measure of codependency on theoretically relevant variables were examined. Compared with individuals who scored low on codependency, those who obtained high scores reported significantly more family of origin difficulties and parental mental health problems, problematic intimate relationships including relationships with chemically dependent partners, and personal psychological problems including compulsivity. Contrary to prevailing theoretical predictions the high codependency group did not contain more individuals whose parents had alcohol or drug abuse problems, or a higher level of childhood physical or sexual abuse. These results suggest that co-dependency is one aspect of wider multigenerational family systems problems which are not unique to families where drug and alcohol abuse or physical and sexual abuse are major concerns.

Dear GE. The Holyoake Codependency Index: Further evidence of factorial validity. Drug and Alcohol Review 21(1): 47-52, 2002. (10 refs.)

The Holyoake Codependency Index (HCI) is a 13-item self-report scale that measures codependent traits. The HCI contains three subscales that correspond to key themes within the codependency literature and that were derived from factor analysis using a clinical sample of mainly females. The factor structure was subsequently replicated with an all-female general community sample. In this study the factor structure was replicated using a mixed-sex sample of 107 undergraduate university students and 378 other people who were snowball sampled from the student sample, and was found to hold for both male and female participants.

Dear GE; Roberts CM. The Holyoake Codependency Index: Investigation of the factor structure and psychometric properties. Psychological Reports 87(3 Part 1): 991-1002, 2000. (23 refs.)

The Holyoake Codependency Index is being developed to measure the extent to which a person endorses codependent beliefs and attributions. A 28-item pilot version was administered to 39 male and 268 female clients of a family counseling agency. Factor analysis, used to identify the shortest version with acceptable reliability, yielded a 13-item final version comprising three subscales (external locus, self-sacrifice, and reactivity). The subscales correspond to key themes within the literature on codependency. Scores on each subscale correlated significantly in the predicted direction with relevant measures of psychological functioning, providing initial evidence of construct validity. The 13-item scale was administerjed to a general community sample of 303 women and the factor structure was fully replicated. Internal consistency of the subscales ranged from .74 to .84 with the family counseling sample and from .73 to .83 with the general community sample.

Dear GE; Roberts CM. The relationships between codependency and femininity and masculinity. Sex Roles 46(5-6): 159-165, 2002. (32 refs.)

Feminist writers critical of the codependency model have argued that codependency refers to an overly strong conformity to the traditional feminine role. Canonical correlation analysis using data from 192 first-year university students found a moderate association between codependency and gender-role identification. The specific nature of this association varied with different aspects of codependency. External focus (approval seeking) was associated with high scores on the negative aspects of femininity and low scores on positive aspects of masculinity. Self-sacrificing was associated with high positive femininity and low negative masculinity. Women scored higher than men on one aspect of codependency: external focus. Although the data are broadly consistent with a feminist critique of codependency, the relationship between codependency and gender-role identification appears to be more complex than previously suggested.

Edmundson R; Byrne M; Rankin E. Preliminary outcome data on a model treatment group for codependence. Alcoholism Treatment Quarterly 18(1): 93-107, 2000. (20 refs.)

A group treatment model was developed to assist individuals address interpersonal and relational issues associated with codependence. The model consisted of twelve group sessions utilizing a set curriculum developed by the authors. Results indicated that patient perception of locus of control and codependency improved significantly by the end of treatment and that these gains continued to improve a six-month follow up.

Farmer SA. Entitlement in codependency: Developmental and therapeutic considerations. Journal of Addictive Diseases 18(3): 55-68, 1999. (10 refs.)

The purpose of this article is to explore the way in which narcissism is manifest within codependent individuals. Although codependent clients present themselves as needy, self-effacing, and overly deferent to others, many of their behavior patterns are actually a manifestation of a subtle form of narcissistic entitlement. Codependents see others as extensions of themselves, rather than as individuals in their own right, and frequently have unrealistic expectations about their relationships. Successful treatment must include an understanding of the developmental underpinnings of their symptoms. Effective psychotherapy also involves maintaining a difficult balance-holding out the expectation of mature adult functioning while simultaneously understanding and accepting clients' initial inability to relate in such a fashion.

Ferrari JR; Curtin-Davis M; Dvorchak P; Jason LA. Recovering from alcoholism in communal living settings: Exploring the characteristics of African-American men and women. Journal of Substance Abuse 9: 77-87, 1997. (26 refs.)

African American men (n = 33) and women (n =32) residing in a self-governed, communal-living aftercare program known as Oxford House were surveyed on sociodemographic, personality, recovery, and setting attribute variables. Women, compared with men, were more likely to report sexual abuse as an adult, be diagnosed with an eating disorder, engage in writing bad checks prior to recovery, and claim a stronger perception that Oxford House provided a structured and safe setting. Men, in contrast to women, were more likely to have engaged in drug sales and residential theft prior to recovery, claim less self-doubts about controlling their future life, and report greater attempts at rebuilding interpersonal relations and working on 12-step programs. Men and women did not differ significantly in self-reports of co-dependency. Results indicate that gender-specific and culturally-sensitive characteristics upon treatment entry and in the course of recovery should be considered in communal facilities such as Oxford House.

Ferrari JR; Jason LA; Nelson R; Curtin-Davis M; Marsh P; Smith B. An exploratory analysis of women and men within a self-help, communal-living recovery setting: A new beginning in a new house. American Journal of Drug and Alcohol Abuse 25(2): 305-317, 1999. (20 refs.)

In the present exploratory study, women without children (n = 13) and women with children (n = 23) were compared to men (n = 35) on demographic and self-reported variables on entering a communal-living, self-help recovery program called Oxford House. Men were more often hospitalized for their addiction than either group of women, and men and women with children were older and had been previously hospitalized longer for their addiction than women without children. There were no significant differences among groups in terms of their codependency on others, and men felt a stronger sense of camaraderie with other residents than women with or without children. Men and women with children also tended to feel they shared more in the decisions within their house than did women without children. Further, with partial correlates (controlling for the number of children), women with children indicated that the greater their self- reported codependency, the less accepting they were of their children and the more depressed they were about their parenting abilities. Dysfunctional characteristics of the children also were related to negative characteristics in the children reported by their mothers. In short, men and women with and without children entering an Oxford House have similar profiles, yet women with children have additional stressors associated with parental responsibilities.

Fuller JA; Warner RM. Family stressors as predictors of codependency. Genetic, Social, and General Psychology Monographs 126(1): 5-22, 2000. (41 refs.)

Codependency has been defined as an extreme focus on relationships, caused by a stressful family background (J. L. Fischer, L. Spann, & D. W. Crawford, 1991). In this study the authors assessed the relationship of the Spann-Fischer Codependency Scale (J. L. Fischer et al., 1991) and the Potter-Efron Codependency Assessment (L. A. Potter-Efron & P. S. Potter-Efron, 1989) with self-reported chronic family stress and family background, Students (N = 257) completed: existing self-report codependency measures and provided family background information. Results indicated that women had higher codependency scores than men on the Spann-Fischer scale. Students with a history of chronic family stress (with an alcoholic, mentally ill, or physically ill parent) had significantly higher codependency scores on both scales. The findings suggest that other types of family stressors, not solely alcoholism, may be predictors of codependency.

Gemin J. Dangerous liaisons: On the systemic self-production of codependent identities. Journal of Applied Communication Research 25(2): 132-149, 1997. (88 refs.)

This essay uses Anthony Wilden's semiotically-based communication theory and Kenneth Gergen's concept of social saturation to explain the resilience of codependency discourse. Its resilience is attributed, in part, to an "autopoietic" (self-producing) logic, internal to codependency discourse itself, which produces the idea of "codependent identities" by radically separating "self" from "other". In turn, the exclusivity that this separation creates is orchestrated by the manner in which the concept "boundary" is defined throughout the discourse. It is argued that the exponential increase in the codependency phenomenon rests on She ability of ifs discourse to ironically confer a clear sense of identity. This clarity simultaneously codes the experience of interpersonal ambiguity associated with the transition from modernist to postmodern consciousness as pathological and thus in need of repair and control.

Gemin J. Manufacturing codependency: Self-help as discursive formation. Critical Studies in Mass Communications 14(3): 249-266, 1997. (72 refs.)

In spite of criticisms of its basic premises, the exponential increase in the discourse of codependency represents a remarkably resilient social movement. This essay argues that its resilience may be attributable not to its success in helping people overcome something called "codependence," but to the manner in which its "discursive formation" co-opts discourses, even those critical of its basic premises, so as to continually reproduce the idea of, and desire for, the "codependent" identity. This essay examines the operations of this discursive formation focusing, in particular, on how it deploys a moral topography, one that codes experiential ambivalence negatively, creating a fear of others in the process.

George WH; La Marr J; Barrett K; McKinnon T. Alcoholic parentage, self-labeling, and endorsement of ACOA-codependent traits. Psychology of Addictive Behaviors 13(1): 39-48, 1999. (50 refs.)

Traits reputed to characterize adult children of alcoholics (ACOAs) and codependent individuals were assessed among psychology undergraduates (n = 281). Students self-reporting alcoholic parentage were no different from controls on these traits or on self-reported drinking. Null effects are attributed to sample characteristics and to systematic inattention to discriminant validity concerns in the original trait formulations. Alcoholic parentage did affect willingness to self-label as ACOA and codependent. Also, regardless of parentage, participants who self-labeled as codependent scored higher on the signature traits than participants who did not self-label as codependent. This result is discussed with respect to recruitment pressures and self-fulfilling-prophecy effects engendered by the widespread dissemination of the ACOA and codependency concepts.

Gotham HJ; Sher KJ. Do codependent traits involve more than basic dimensions of personality and psychopathology? Journal of Studies on Alcohol 57(1): 34-39, 1996. (33 refs.)

Objective: Despite widespread use of the term codependency, empirical evidence regarding its construct validity is generally lacking. This study analyzed the construct validity of codependency as measured by Potter-Efron and Potter-Efron's Codependency Assessment Questionnaire (CAQ). It attempted to determine the CAQ's factor structure and whether there are any unique relations between symptoms of codependency and parental alcoholism after controlling for basic dimensions of personality and psychopathology. Method: Participants were 467 (246 male, 221 female) young adult children of alcoholics and controls who contributed complete questionnaire data at the fourth wave of a longitudinal study of factors related to alcohol use and abuse. Results: The CAQ showed reliability and basically a one dimensional structure, and CAQ scores were significantly related to family history. Although much of this relation between family history and codependency was accounted for by neuroticism and symptoms of general psychopathology, a small, but significant, association between family history and codependency remained even after statistically controlling for personality and psychopathology. Conclusions: The authors conclude that, although there may be unique aspects of the purported codependency syndrome that are related to a family history of alcoholism, most of the relation between codependency and family history appears to be "explained" by general negative affectivity.

Hanninen V; Koski-Jannes A. Narratives of recovery from addictive behaviours. Addiction 94(12): 1837-1848, 1999. (38 refs.)

Aims. The purpose of this study was to look for the ways in which people who have recovered from various addictions understand and present their change process. Materials. The research material consisted of 51 autobiographical stories of people who had been able to quit their addiction to alcohol, multiple drugs, binge eating, smoking, sex and gambling. Methods. The basic logic of each narrative was first defined The narratives were then categorized according to what they presented as the key to recovery. Composite stories were then constructed and analysed with regard to their emotional, causal, moral and ethical meanings. Findings. The analysis revealed five different story types among these self-narratives: the AA story, the growth story, the co-dependence story, the love story and the mastery story. All of them helped to make the addiction and recovery understandable, they released the protagonist from guilt and had a happy ending by which the values of the story were realized. Each story type was told predominantly by representatives of a particular gender and addiction. Conclusions. As there are several ways out of addictive behaviours there are also several ways to construe the change. People who try to quit addictive behaviours could be encouraged to make full use of the cultural stock of stories in creating an account that fits their own experience of defeating their particular addiction.

Harkness D. Testing Cermak's hypothesis: Is dissociation the mediating variable that links substance abuse in the family of origin with offspring codependency? Journal of Psychoactive Drugs 33(1): 75-82, 2001. (69 refs.)

This is a pilot study of substance abuse in the family of origin and its relation to offspring dissociation and offspring codependency. Cermak contends that substance abuse in the family of origin exposes offspring to trauma, that exposure to trauma in the family of origin engenders offspring dissociation, and that dissociation is the process underlying offspring codependency. Assuming that substance abuse in the family of origin exposes offspring to trauma, this experiment tested the hypothesis that dissociation mediates the relationship between substance abuse in the family of origin and offspring codependency. Although it was found that substance abuse in the family of origin, offspring dissociation, and offspring codependency were associated, no support was found for the prediction that dissociation mediates the relationship between substance abuse in the family of origin and offspring codependency. Replications are called for.

Harkness D. To have and to hold: Codependency as a mediator or moderator of the relationship between substance abuse in the family of origin and adult-offspring medical problems. Journal of Psychoactive Drugs 35(2): 261-270, 2003. (66 refs.)

This pilot study explored the putative role of codependency as a mediator or moderator of the relationship between substance abuse in the family of origin (SAFO) and offspring medical problems in a counterbalanced multiple-treatment experiment with a heterogenous sample of adult males and females. Codependent attitude and behavior were moderators that attenuated the relationship between SAFO and two measures of acute offspring medical problems, but codependent behavior amplified the relationship between SAFO and chronic medical problems. Challenging replications are called for.

Harkness D; Cotrell G. The social construction of co-dependency in the treatment of substance abuse. Journal of Substance Abuse Treatment 14(5): 473-479, 1997. (50 refs.)

Co-dependency has become an important concept in the treatment of substance abuse, yet there is still disagreement about what it means. The meaning of co-dependency is important because it shapes public perceptions of helping behavior and affects the treatment that persons with addictions receive. However, some observers have criticized co-dependency, arguing that the concept is gender biased, denigrates women, and blames innocent victims of substance abuse. This investigation examined the social construction of co-dependency in the treatment of substance abuse by asking substance-abuse counselors three questions: (a) what do they mean by co-dependency, (b) to what extent does co-dependency mean women, and (c) to what extent do they agree. The findings suggest that co-dependency is a reliable social construction that substance-abuse counselors use to describe persons of both genders.

Harkness D; Manhire S; Blanchard J; Darling J. Codependent attitude and behavior: Moderators of psychological distress in adult offspring of families with alcohol and other drug (AOD) problems. Alcoholism Treatment Quarterly 25(3): 39-52, 2007

This study explored a model of codependent attitude and behavior as moderators of the relationship between AOD problems in the family of origin (AODF) and offspring self-reports of psychological distress in a counterbalanced multiple-treatment experiment with a small heterogeneous sample of adult males and females. Three-directional hypotheses suggested by the literature were tested. Codependent attitude and behavior buffered somatization, as predicted by the model, but exacerbated anxiety, hostility, and paranoid ideation. Our findings suggest that codependent attitude and behavior may be adaptations that protect AODF offspring from somatic distress, not the broadband expressions of offspring neuroticism reported in the literature. Owing to the small size and self-selection of our volunteer sample, replications with larger samples are called for.

Harkness D; Swenson M; Madsen-Hampton K; Hale R. The development, reliability, and validity of a clinical rating scale for codependency. Journal of Psychoactive Drugs 33(2): 159-171, 2001. (74 refs.)

This investigation examined the reliability and validity of a rating scale for codependency in substance abuse treatment. The investigators developed an example-anchored rating scale to operationalize codependency as substance abuse counselors construe it in practice, and recruited 27 counselors for a counterbalanced multiple-treatment experiment. Counselors were randomly assigned to one of four continuing education workshops for rating-scale training. and asked to evaluate codependency in five videotaped cases. Semistructured case interviews were videotaped with a male and a female from five adult populations to vary the gender and codependency of cases: (1) outpatients in treatment For addiction, (2) outpatient spouses, (3) members of Codependents Anonymous, (4) United States Bureau of Land Management smoke jumpers, and (5) college students majoring in business or economics. To control for gender effects, one workshop presented male cases, one workshop presented female cases, and two workshops presented cases of both genders. To control for order effects, the assignment of videotapes to workshops was randomized to counterbalance the order in which counselors viewed them. The findings suggest that the rating scale yields reliable and valid evaluations of codependency without appreciable gender bias.

Hoenigmann-Lion NM; Whitehead GI. The relationship between codependency and borderline and dependent personality traits. Alcoholism Treatment Quarterly 24(4): 55-77, 2006

This study explored the relationship between the concept of codependency, a term originating in the field of addictions, and DSM-IV (APA, 1994) descriptions of dependent and borderline personality disorders. Seventy-five undergraduates (16 men and 59 women) were administered the Potter-Efron Codependency Scale (Potter-Efron & Potter-Efron, 1989), the borderline and the dependent scales of the MCMI-II (Millon, 1987), and the Dysfunctional Attitude Scale (DAS, Weissman, 1979). Pearson Product Moment correlations were computed and revealed a significant positive correlation between codependent and borderline traits and a significant but weaker correlation between codependent and dependent traits. Codependent and borderline personality traits were also similarly correlated on specific cognitive schema assessed by the DAS. These findings are one of only a few first empirical tests of the relationship between borderline personality disorder, dependent personality disorder and codependency, possibly indicating that codependency may be a combination of disorders already extant in the DSM-IV.

Hughes-Hammer C; Martsolf DS; Zeller RA. Depression and codependency in women. Archives of Psychiatric Nursing 12(6): 326-334, 1998. (31 refs.)

Seven million American women are depressed, and 40 million Americans, primarily women, have been labeled as codependent. This study aimed to identify the prevalence of codependency in women undergoing treatment for depression, examine the relationship between codependency and depression, and determine which of the symptoms of codependency are most highly predictive of depression scores. Depression and codependency were measured in a sample of 105 depressed women by using the Beck Depression Inventory and the Codependency Assessment Tool. Descriptive statistics, Pearson's Product Moment Correlation, and multiple regression were used for analysis. Of these depressed women, 36% were moderately to severely codependent. Depression and codependency were strongly related, with the significant gamma =.92 (P <.001). Of the codependency subscales, Low Self-Worth and Hiding Self correlate most strongly with depression; Other Focus/Self-Neglect added the least-independent- explanatory power. Thus, future research should be directed toward the relationship of codependency to power, alienation of self, and personality disorders.

Hughes-Hammer C; Martsolf DS; Zeller RA. Development and testing of the codependency assessment tool. Archives of Psychiatric Nursing 12(5): 264-272, 1998. (34 refs.)

Codependency constitutes a significant health risk, particularly for women, because codependent women are often involved in abusive and potentially harmful relationships. Individuals who are identified as codependent can engage in therapy and gain knowledge and freedom from such relationships. However, there is no reliable and valid measure of codependency that is consistently used to identify these individuals. This article describes the development and testing of the Codependency Assessment Tool, a multivariate tool that conceptualizes codependency as a construct comprising five factors: (1) Other Focus/Self-Neglect, (2) Low Self-Worth, (3) Hiding Self, (4) Medical Problems, and (5) Family of Origin Issues. The instrument has excellent reliability and validity. Its test-retest reliabilities = .78 to .94; Cronbach's alpha = .78 to .91. Criterion validity was determined to be established by using known groups; construct validity was established by comparing the codependency dimensions with depression.

Ingersoll K; Dawson K; Haller D. Family functioning of perinatal substance abusers in treatment. Journal of Psychoactive Drugs 28(1): 61-71, 1996. (34 refs.)

This prospective study examined family characteristics of perinatal substance abusers enrolled in an intensive outpatient treatment program both during and after treatment. Data is provided on family functioning in three areas: current family, family of origin, and love/partner relationship, and at six time points up to 24 months postdischarge. Standard family assessment measures, including the Self-Report Family Inventory (SFI) and Family-of-Origin Scale (FOS) were utilized to measure current family functioning and family of origin health, respectively. A new instrument, the Relationship Assessment Form (RAF), was used to measure the level of unhealthy, codependent behaviors in the subject's love/partner relationship. A mixed model repeated measures ANOVA was used to determine if subjects' family functioning changed over time. Multivariate and univariate methods examined differences between the subjects in the current study and previously reported means for the SFI and FOS. Results were that perinatal substance abusers' perception of the overall health of their families of origin remained stable over time. Subjects rated their families of origin as more pathological than community adults, but similarly to adults presenting for psychotherapy. Although current family functioning was relatively stable, SFI scores that changed worsened over time after treatment. Perinatal substance abusers scored more pathologically at intake than normal, nonclinic families, but were similar to families presenting for family therapy on the SFI. In contrast, enduring changes of greater magnitude occurred in the subjects' self-reported codependent behavior over time. All RAF scores that changed moved in the direction of healthier, more autonomous functioning. Change and stability in aspects of family functioning may be due to specific factors of the treatment program, which are discussed. Standard family measures may need further refinement for use in this population. Recommendations for clinical programs and future research are provided.

Johnson B. The mechanism of codependence in the prescription of benzodiazepines to patients with addiction. Psychiatric Annals 28(3): 166-171, 1998. (13 refs.)

This article, from an psychoanalytic perspective, addresses the manner in which addicted individuals may utilize the physician relationship to secure drugs. Parallels are drawn to the relationship of family members and addicted individuals, and the family's style of interactions that have been characterized as "codependency." Case examples are provided from clinical practice and the literature.

Lindley NR; Giordano PJ; Hammer ED. Codependency: Predictors and psychometric issues. Journal of Clinical Psychology 55(1): 59-64, 1999. (14 refs.)

This study examined the relationships between codependency and age, gender, self-confidence, autonomy, and succorance, which is the quality of soliciting emotional support from others. The study also tested the validity of the Spann-Fischer Codependency Scale (Fischer, Spann. & Crawford, 1991). Ninety-five undergraduates completed a demographic sheet, the Adjective Check List (Gough & Heilbrun. 1983). the Spann-Fischer Codependency Scale, the Go-Dependents Anonymous Checklist (Whitfield, 1991). and a questionnaire developed for this study based on the work of Hemfelt, Minirth. and Meier (1989). As predicted, codependency was negatively related to self-confidence and positively related to succorance. However, contrary to expectation, a negative relationship between codependency and autonomy was not found. In addition, low self-confidence was the strongest predictor of codependency. Finally, all three measures of codependency were strongly related, attesting to the convergent validity of the Spann-Fischer Codependency Scale. Future studies should further investigate the role of emotional autonomy and codependency and should begin to utilize an experimental approach, making predictions regarding the behavior of codependent and noncodependent persons in experimental situations.

Loring S; Cowan G. Co-dependency: An interpersonal phenomenon. Sex Roles 36(1/2): 115-123, 1997. (11 refs.)

An alternative perspective to the clinical model of codependency is that codependency is contextual and reflects inequality within a relationship. This study examined whether the evaluation of codependent behavior depends on the context of the relationship, i.e. the reciprocity of the person's partner, and the gender of the stimulus person. College students (N=32), 46% non-Caucasian) read one of six scenarios in which the codependent stimulus persons' behavior was held consistent, but he reciprocity of the partner and the gender of the individual were varied. The stimulus person and her/his relationship were rated significantly more healthy in the reciprocal condition than in the nonreciprocal condition. Codependent female SPs were judged less healthy but better partners than codependent male SPs. Judgments of codependent behavior and persons are contextual in nature, may reflect inequity within relationships, and to some extent, depend upon the gender of the codependent person.

Mancuso FM. Codependency in nursing students: Recognition and modification of behavioral characteristics. Nursing Connections 11(3): 55-60, 1998. (9 refs.)

Recent literature estimates that there are approximately 21/2 million nurses; of these a significant number may exhibit signs of codependency, a behavior pattern that impedes an individual's ability to relate to others on mature level. Codependency develops in dysfunctional family systems and manifests itself in compulsive behaviors that make life painful and work emotionally difficult. Often, constructive communication is difficult as codependent persons tend to feel low self-esteem and low self-worth. Nursing students may exhibit characteristic codependency traits among fellow students in the classroom, in the clinical setting, and in interactions with faculty. Nurse educators, through their own self-awareness, introspection and knowledge of the behaviors and characteristics of codependency, can facilitate more effective communication with all nursing students to promote healthier interactions and relationships. Techniques to modify one's method of interacting with others have clear potential for improving professional as well as personal relationships.

Martsolf DS; Hughes-Hammer C; Estok P; Zeller RA. Codependency in male and female helping professionals. Archives of Psychiatric Nursing 13(2): 97-103, 1999. (30 refs.)

The purpose of this study is to determine and compare the prevalence of codependency in a group of 77 female and a group of 72 male helping professionals. Relatively low rates of codependency were observed in this sample, and the five-factor structure of the Codependency Assessment Tool (CODAT) was replicated. Males showed slightly higher codependency than females on the total CODAT and on the Hiding Self and Family of Origin Issues subscales. The CODAT was shown to be relevant to both males and females. Further research is needed to determine if a general population of male and female subjects would yield similar results.

Martsolf DS; Sedlak CA; Doheny MO. Codependency and related health variables. Archives of Psychiatric Nursing 14(3): 150-158, 2000. (42 refs.)

Codependency is a controversial concept especially for feminist scholars who are concerned about pathologizing traditional female roles, This study's purpose was to determine: (1) the prevalence of codependency in a sample of older women who because of age may ascribe to traditional roles; (2) how the Hughes-Hammer/Martsolf theoretical model of codependency relates to other health variables; and (3) whether previous findings about the relationship between codependency and depression replicate, Survey design was used with a sample of 238 women (ages 65 to 91) attending a flu shot clinic. Subjects completed the Codependency Assessment Tool, Beck Depression Inventory, Quality of Life Scale, Perceived Health Report, Measurement of Patient Functional Abilities, and Illness Prevention Screening Behaviors Checklist. Of these women, 99% had low codependency scores. Statistically significant correlations existed between codependency and perceived health (p < .01), and functional ability (p < .01). Codependency was not significantly correlated with illness prevention behaviors and quality of life. Codependency and depression, as in previous studies, were significantly correlated (r = .446, p = .0001). Using analysis of variance, 3 codependency subscales had significant positive effect on depression: Low Self- Worth, Medical Problems, and Hiding Self. Further studies should examine the degree of ascribing to traditional female roles in women dealing with codependency issues

McInnis-Perry GJ; Good JM. A psychoeducational codependency support group for older adults who reside in the community: Friends supporting friends. Journal of Gerontological Nursing 32(8): 32-42, 2006. (36 refs.)

Older adults with loved ones who are dependent on alcohol or drugs often experience the adverse effects of a codependent relationship. Many experience anxiety, low self-esteem, depression, and suicidal thoughts. A pilot psychoeducational codependency support group was developed to promote well-being and reduce the adverse effects of codependency among older persons. The study participants were a voluntary convenience sample of 22 older adults (ages 65 and older) residing in the community. A pretest and posttest were administered. Six 90-minute group sessions based on a curriculum developed by the authors were held during a 2-month period. Yalom's Therapeutic Factors were used to evaluate the group process. Results indicated that older adults benefit from a psychoeducational support group format and that codependency issues can be reduced.

Messner BA. Sizing up codependency recovery. Western Journal of Communication 60(2): 101-123, 1996. (48 refs.)

Rhetorical examination of codependency-related, self-help literature can benefit communication scholars and the recovery industry alike. This analysis uses a dramatic lens to explore Beattie's bibliotherapeutic portrayal of codependency and codependency recovery. From this vantage point, Beattie's "stylistic medicine: for codependency recovery is depicted as a three-step, rebirth experience. Codependents must first "name their pain" by recognizing the codependent pollution within them. Second, they must engage in purification through mortification and surrender to God. Finally, they can move forward toward redemption from codependency by mastering God's lessons. Through these means they can be reborn as "recovering codependents.".

Meyer DF. Codependency as a mediator between stressful events and eating disorders. Journal of Clinical Psychology 53(2): 1107-116, 1997. (36 refs.)

This study examines the similarities between excessive codependency and eating disorders, as well as exploring the association of each to stressful events. Undergraduate women (n equals 95), aged 18 to 35 years, were given The Codependency Assessment (CA) questionnaire, The Eating Disorder Inventory-2 (EDI-2), the Differentiation of Self Scale (DS), and a demographic questionnaire. Thirty-three percent of the participants in this study indicated that they had a close association with an alcoholic family member. Furthermore, 34 percent reported experiencing a chronic stressful event such as parental divorce, physical and/or emotional abuse, or family illness. Chi-square analyses were performed to determine if participants from the codependent and noncodependent groups differed in their experiences with an alcoholic family member, or exposure to a chronic stressful event, and to assess if codependency had an association with an alcoholic family member without the stress variable. Results indicated that women who reported experience with an alcoholic significant other or a chronic stressful situation exhibited higher levels of eating disorders. However, parental alcohol abuse did not seem to result in differences in reported eating disorder symptoms. In addition, women who had more characteristics of codependency also had more eating disorders. These findings indicate a development sequence, whereby codependency mediates the relationship between excessive stress and the development of an eating disorder.

Noriega G; Ramos L; Medina-Mora ME; Villa AR. Prevalence of codependence in young women seeking primary health care and associated risk factors. American Journal of Orthopsychiatry 78(2): 199-210, 2008. (55 refs.)

Codependence as a relational problem that often, but not necessarily always, occurs in conjunction with familial alcoholism. Previous research has shown that various etiological factors resulting from recurring stressful circumstances experienced in childhood or adulthood may contribute to this relation. Another factor arises out of the "submission script" that may be assumed by women living within a culture that typically promotes unequal power between women and men. To examine the prevalence of codependence and its predictors, a cross-sectional study was conducted among a population of 845 young women seeking primary health care in Mexico City. Odds ratio prevalence (ORP) was used to estimate the strength of possible association between codependence and exposure to several factors. A prevalence of 25% of codependence was found. Multivariate analysis revealed that women with a submissive cultural script were nearly eight times more likely to develop codependence than those without this programming. Other relevant factors were having a partner with probable alcohol dependence, a father with alcohol problems, physical and sexual mistreatment by a partner, and a history of emotional mistreatment.

Olmsted ME. "If you don't become one, you'll marry one": Close relationships of adult children of alcoholics. Dissertation Abstracts International 58(8): 4493-B, 1998

The increased risk for alcoholism in adult children of alcoholics' (ACOAs) is well documented. Academic literature and the experience of self-help movement suggest that ACOAs have unique emotional problems, psychological problems, or both, particularly regarding their close relationships. This study was designed to evaluate assumptions about ACOAs' close relationships. New scales that measure parental and partner alcoholism (AUS-Parent and AUS-Partner) were used in conjunction with the Short Michigan Alcoholism Screening Test (SMAST). A normative, non-clinical sample of married couples was studied through questions about codependency; marriage to alcoholics; stability of close relationships; and satisfaction, discord, adjustment, aggression, jealousy, and intimacy in close relationships. Differences between the SMAST and AUS-Partner suggested that the SMAST measures problems associated with alcohol use and the AUS-Partner measures alcohol dependency. Male and female ACOAs were more likely to report that their partner is alcohol dependent, but ACOAs and non-ACOAs did not differ on the other relationship variables. Relationships in which at least one partner is alcoholic were less stable and the way in which these marital problems manifest themselves depends on which partner has the alcohol problem. The authors conclude that the pilot-study results suggest that being an ACOA may affect some individuals negatively, but that there is a growth enhancing effect on resilient ACOAs.

Public Domain

Parker FM; FaulkD; LoBello SG. Assessing codependency and family pathology in nursing students. Journal of Addictions Nursing 14(2): 85-90, 2003. (23 refs.)

Codependency is believed to develop in dysfunctional family systems and manifest itself in compulsive behaviors that make life painful and work emotionally difficult. The purpose of this study was to assess the relationships between self-reported family pathology and scores on the Codependency Assessment Inventory (CAI) and to determine the prevalence of family pathology and codependency in a sample of nursing students. A descriptive correlational study of a sample of 35 southeastern and southwestern associate and baccalaureate nursing programs was used. Nursing students completed the CAI and a demographic questionnaire adapted from previous research. This study found relationships between family pathology and Codependency traits. In this sample, Codependency was identified as a severe problem for only a small number of the nursing students. The typical student earned a score on the CAI in the average range. While general information about Codependency would be beneficial for almost all nursing students, significant interventions involving individual counseling may be best reserved for those most affected. Research efforts to determine if codependency is a disorder separate from other behavior pathologies would be especially beneficial.

Peled E; Sacks I. The self-perception of women who live with an alcoholic partner: Dialoging with deviance, strength, and self-fulfillment. Family Relations 57(3): 390-403, 2008. (64 refs.)

The purpose of the present study was to learn about the self-perception of women who live with alcohol-addicted partners. It was hoped that avoiding to label the women in advance as codependent would facilitate a better understanding of their lives and self-perceptions. The qualitative naturalist methodology used was based on a feminist framework. In-depth interviews with 10 women living with alcoholic partners were conducted and analyzed. The findings revealed 3 central dialogues around which the women's self-perceptions evolved-with deviance, with strength, and with self-fulfillment. Findings are discussed relative to the ongoing discourse between the codependency approach and other social, psychological, and gender conceptions in this domain. Clinical implications and directions for future research are offered.

Prest LA; Benson MJ; Protinsky HO. Family of origin and current relationship influences on codependency. Family Process 37(4): 513-528, 1998. (53 refs.)

This study investigated codependency in Caucasian individuals within the framework of Bowen's Family Systems Theory. The sample consisted of a group of couples, in, which one member of the couple was a recovering alcoholic in an aftercare program, and a group of matched, comparison couples. Participants completed a demographic questionnaire, the Friel Codependency Assessment Inventory, and the Personal Authority in the Family System (PAFS) Questionnaire. The findings confirmed that codependency levels were higher in clinical than, in comparison couples. Moreover within the clinical group, there was Little difference between alcoholics and their spouses with respect to dysfunction in their families of origin, current families, or their codependency levels. The findings further suggested that the etiology and function of codependency are different in clinical and nonclinical families. In the clinical sample, the family of origin and current relationship characteristics were related to codependency in patterns consistent with previous theory and research. For the nonclinical sample, however the findings contradicted conventional codependency theory. The findings suggest that, in contrast to clinical populations, codependency in nonclinical populations has some links with favorable characteristics of family functioning.

Roehling PV; Gaumond E. Reliability and validity of the Codependent Questionnaire. Alcoholism Treatment Quarterly 14(1): 85-95, 1996. (7 refs.)

The validity and reliability of the Codependent Questionnaire (CdQ), a new measure of codependence, was examined. In Study 1, using 48 undergraduate students, the CdQ total score displayed high levels of internal consistency (alpha = .86) and test retest reliability (r = .80). In Study 2, the CdQ was administered to forty-two outpatient psychotherapy clients. Client CdQ scores correlated .53 with therapists' ratings of their clients' codependence, demonstrating criterion related validity. Convergent and discriminant validity was examined by correlating CdQ scores with the Millon Clinical Multiaxial Inventory (MCMI). The CdQ correlated positively with clinical disorders sharing common characteristics with codependence (borderline, dysthymia, anxiety, passive-aggressive) and had a non-significant or negative correlation with disorders reflecting characteristics incompatible with codependent behaviors (anti-social, narcissistic).

Roehling PV; Koelbel N; Rutgers C. Codependence and conduct disorder: Feminine versus masculine coping responses to abusive parenting practices. Sex Roles 35(9): 603-618, 1996

This study supported the hypothesis that codependence reflects a stereotypically feminine coping strategy to environmental stressors, while conduct disorder represents an alternate coping response reflecting stereotypically masculine behaviors. High school students (N = 218; 81% Anglo-American, 8% Asian-American, 5% Hispanic-American) completed measures of femininity/masculinity, codependence, conduct disorder and unhealthy parenting practices. Multiple regression analyses revealed that codependence is related to parental abuse and femininity (R = .50). A marginal relationship between codependence and parental alcoholism was mediated by parental abuse, calling into question the validity of the codependence construct. Conduct disorder was related to parental abuse, masculinity, parental alcoholism, and gender (R = .62). The tendency to label stereotypically feminine coping strategies as pathological, while ignoring a more prevalent and destructive masculine coping strategy is discussed.

Rotunda RJ; Doman K. Partner enabling of substance use disorders: Critical review and future directions. American Journal of Family Therapy 29(4): 257-270, 2001. (32 refs.)

Substance use disorders affect not only the identified client but significant others as well. Dyadic and family dysfunction is typically associated with a family member's alcohol or drug abuse. One area of research interest based on clinical conceptions of these families is that of partner support or coping in response to the addiction. Female partners of male alcoholics have received much of this clinical and research attention, and have alternatively been labeled as codependents, co-alcoholics, or enablers. Broadening the therapeutic emphasis beyond the impaired individual underscores the systemic notion that a loved one's addiction necessarily affects spouses and partners, and that partner responses may in turn affect drinking or drug behaviors. The present article contrasts the enabling and codependency constructs, reviews empirical studies of enabling, and offers a conceptualization of partner responses to addiction that could enhance future research efforts and clinical applications in this area.

Rotunda RJ; West L; O'Farrell TJ. Enabling behavior in a clinical sample of alcohol-dependent clients and their partners. Journal of Substance Abuse Treatment 26(4): 269-276, 2004. (37 refs.)

Substance use disorders affect not only the identified client but significant others as well. Clinical work and some research suggest that partner responses to drinking may either facilitate or hinder treatment acceptance and recovery efforts. Female partners of male alcoholics have received much of this attention, and have been labeled as codependents or enablers. We administered a clinically derived assessment tool, the Behavioral Enabling Scale, to 42 alcoholic clients and their partners enrolled in a couples counseling program to determine the extent of specific partner behaviors that might reasonably be thought to reinforce drinking or hinder recovery. Results indicated that, among other findings, the majority of both clients and partners reported the partner took over chores or duties from the alcoholic client at some point during the relationship, drank or used other drugs with the client, and lied or made excuses to others to cover for the drinker. Moreover, particular relationship beliefs were associated with higher behavioral enabling scores, providing clear direction for cognitive and behavioral interventions. It is argued that efforts to understand and treat alcohol dependence will be more productive if partner behaviors are incorporated into assessment and intervention procedures.

Schultz OB. Flashing your brights: A Christian pastoral response to alcohol and other drug problems. Journal of Ministry in Addiction & Recovery 5(1): 37-55, 1998. (3 refs.)

The Law/Gospel or sin and grace dialectic gives a sound framework for making practical, pastoral interventions with individuals in trouble with alcohol and other mind altering drugs. The simple concept of "Flashing your brights" refers to taking action about someone else's problems without taking responsibility for them. Drivers often "Flashing their brights" at oncoming motorist whose headlights are switched off. The one flashing is caring without being co-dependent. Five methods of flashing brights in the delusion darkness of the chemically dependent individual are detailed.

Stafford LL. Is codependency a meaningful concept? Issues in Mental Health Nursing 22(3): 273-286, 2001. (48 refs.)

This articles reviews definitions of codependency, discusses issues related to the validity of the codependency construct, and summarizes efforts aimed at producing instruments to measure codependency. Also, implications of this concept as related to psychiatric nursing education, practice, and research are discussed. The concept of codependency has achieved a prominent place in the psychiatric, psychological, and addiction literature in a remarkably short time. Although the term was first developed in the substance abuse treatment arena, specifically referring to the wives of men who abuse alcohol, codependency has more recently been used almost generically to describe a dysfunctional style of relating to others. The manner in which definitions of codependency have become increasingly inclusive are probably related to continuing input from both the fashionable self-help movement and from some psychiatric perspectives. A number of questions can be raised to assist psychiatric nursing educators, practitioners, and researchers examine the phenomenon: (1) Is codependency a useful explanatory construct for the distress, dysphoria, low self-esteem, and other negative affects that certain individuals often experience? (2) Could the codependency concept simply represent an arbitrary, artificial grouping of affects and behaviors observed in many persons who have unresolved family-of-origin issues that lead to disturbed interpersonal relations? (3) Is it ethical to encourage an individual to accept that he or she is codependent and to seek treatment for this "disease" or "health problem?" (4) Does it make sense to conduct research on treatment interventions for codependent persons before the construct has achieved a universal operational definition?

Stanley S. Co-dependency: Personality correlates in spouses of alcoholics. Indian Journal of Social Work 65(2): 213-226, 2004. (36 refs.)

One hundred and fifty co-dependent spouses of alcoholics were compared with an equal number of wives of non-alcoholics. Instruments to assess their self-esteem, neuroticism and pessimism were administered. Data analysis showed that the co-dependents had lower self-esteem and manifested greater levels of neuroticism and pessimism than the subjects of the reference group. The findings substantiate the stress hypothesis of co-dependency, which advocates that the stress of living with an alcoholic is responsible for the personality deficits seen in the spouse. Implications for therapeutic intervention have been discussed.

Stanley S. Marital dynamics in alcoholism: Implications for gender aware de-addiction management. Indian Journal of Social Work 59(4): 1019-1033, 1998. (43 refs.)

This study compares marital dynamics between wives of alcoholics and those of non-alcoholics, who were matched on key socio-demographic variables. Poor marital adjustment and higher conflict levels were seen in alcohol complicated marriages. Further, these wives reported less marital satisfaction, cohesion, consensus and affectional expression and a higher prevalence of violence and verbal aggression. Implications for social work intervention have been discussed which indicate the need for heightened gender sensitivity in de-addiction management.

Straussner SLA; Brown S, eds. Handbook of Addiction Treatment for Women. San Francisco: Jossey-Bass, Inc., 2001. (Chapter refs.)

This edited volume, with 24 chapters and 31 contributors, covers the spectrum of issues related to addictions and addictive behaviors in women. Introductory chapters considers women's use of alcohol and other substances historically, current epidemiology of substance use, assessment, diagnostic issues and general treatment. Separate chapters address the issues pertinent to sub-groups of women, by racial/ethnic group membership, different phases of the life cycle, sexual orientation, and other special circumstances, such as being homeless, or in the criminal justice system. It also considers non-substance addictions: gambling, eating disorders, sexual addiction, spending addiction, and relationship addictions. It also considers the impact on women of living with addicted persons.

Taleff MJ; Babcock M. Hidden themes: Dominant discourses in the alcohol and other drug field. International Journal of Drug Policy 9(1): 33-45, 1998. (41 refs.)

This article outlines five dominant discourses in the alcohol and other drug (AOD) field, and presents recommendations to counterbalance their detrimental effects on AOD therapy. The themes include: (1) blaming the client for AOD treatment that fails, a discourse that is reinforced in the philosophy of Alcoholics Anonymous (AA), which is often a mandatory component of treatment programs; (2) blaming the victim for their addiction; (3) equating closeness in personal and family relations with pathology and codependency; (4) supporting the notion that knowledge of the addictive process must be gained through "real" experience, rather than professional research and higher education, and supporting a dominant strategy of applying simple slogans in front-line AOD interventions; and (5) believing that addicts cannot be trusted. Recommendations for developing a special vision that challenges dominant assumptions with critical thinking include: (1) increasing a counselor's openness and curiosity; (2) summoning multiple assumptions, and seeking explanations that challenge propositions, about AOD treatment issues and clients; (3) using high-grade quantitative and qualitative empirical data; (4) delaying snap judgments; (5) reducing overconfidence and attachment to any one AOD idea or theory; and (6) using cognitively complex approaches to client interpretations.

Teichman M; Basha U. Codependency and family cohesion and adaptability: Changes during treatment in a therapeutic community. Substance Use & Misuse 31(5): 599-615, 1996. (22 refs.)

Codependency is a significant factor in the understanding of addiction to psychoactive substances. The present study examined changes in the level of codependency and perceived family relationships of drug-using residents in the three therapeutic communities in Israel in the course of their treatment. The findings indicate significant changes in both the level of codependency and the residents' perceptions of their family relationships between the beginning and the reentry stages of their treatment. On the other hand, no significant associations were found between their level of codependency and their perceptions of their family relationships. The findings are discussed in relation to the nature of addiction, the family processes, the treatment in the therapeutic community, and the addicted person's perseverance in that community.

Thomas EJ; Yoshioka M; Ager RD. Spouse enabling of alcohol abuse: Conception, assessment and modification. Journal of Substance Abuse 8(1): 61-80, 1996. (51 refs.)

This article presents a conception of spouse enabling of partner alcohol abuse, a review of its dysfunctions, and an approach to assessment and modification to reduce spouse enabling behavior. Based on experience with its use in unilateral family therapy with many spouses of treatment-refusing alcohol abusers, procedural guidelines, treatment methods, two case examples from a crossover experimental dyad, and clinical results for the two cases in the dyad are described. Also presented are practice issues, characteristics of spouse enabling as they relate to disenabling intervention, and areas of possible application of the disenabling program.

Tosone C. Women and relationship addiction. IN: Straussner SLA; Brown S, eds. Handbook of Addiction Treatment for Women. San Francisco: Jossey-Bass, Inc., 2001. pp. 170-186

This chapter attempts to bridge the between the clinical writers terminology and lay public writers terminology surrounding relationship addiction. The author applies psychoanalytic theories to the understanding of relationship addiction. Psychoanalytic theory provides a comprehensive explanatory model for understanding woman's thought process and behavior in such relationships. Accordingly, this chapter uses case material to illustrate the theoretical concepts and to assist clinicians in identifying the syndrome and establishing treatment goals and a course of treatment.

Velleman R; Copello A; Maslin J, eds. Living with Drink: Women who Live with Problem Drinkers. New York: Addison Wesley Longman Ltd, 1998

This book is organized around the stories of women whose lives have been touched by the heavy drinking of men in their lives. Six women's stories are recounted.

Wright PH; Wright KD. The two faces of codependent relating: A research-based perspective. Contemporary Family Therapy 21(4): 527-543, 1999. (27 refs.)

Using an overview of the controversial concept of codependency as a backdrop, the paper summarizes outcomes of a project devoted to developing and applying a technique for assessing codependent relating. Results support the clinically based contention that there is a pattern of relating in dysfunctional relationships that warrants the label "codependent," and that some (but not all) cases of such relating stem from a distinctive codependency personality syndrome. These results gave rise to a perspective that combines a relational process with a dispositional view of codependent relating, and proposes that codependency may be either endogenous (chronic) or exogenous (reactive).

Zelvin E. Applying relational theory to the treatment of women's addictions. Affilia 14(1): 9-23, 1999. (18 refs.)

This article discusses the application of relational theory to the treatment of women's addictions. It compares traditional models with relational models, and it discusses the relevance of relational theory to women's addictions and codependency issues. It also suggests gender-specific treatment approaches in which women's relational strengths are used to promote recovery.

Zelvin E. Women affected by addictions. IN: Straussner SLA; Brown S, eds. Handbook of Addiction Treatment for Women. San Francisco: Jossey-Bass, Inc., 2001. pp. 487-511

The premise of this chapter is that women who have significant relationships with addicts of all kinds are inevitably in emotional pain and that the clinician's helping them make cognitive and behavioral changes and get in touch with and work through their feelings is crucial to their functioning and to their emotional well being. Main topics discussed in this chapter include the following: (1) scope of the problem; (2) historical perspectives; (3) the invisible women affected by addictions; (4) characteristics of affected women; (5) assessment; and (6) treating affected women. Case examples are provided. Women's addiction. Epilogue

Zetterlind U; Berglund M. The rate of co-dependence in spouses and relatives of alcoholics on the basis of the Cermak co-dependence scale. Nordic Journal of Psychiatry 53(2): 147-151, 1999. (20 refs.)

To create a basis for empirical studies of co-dependence in substance use disorders, Cermak in 1986 suggested a model for diagnostic criteria similar to the DSM type of criteria. In the present study the Cermak criteria were applied to 41 relatives of alcoholics. To validate the co-dependence scale, the following instruments were used: Coping Behavior Scale, Hardship Scale, Symptom Checklist (SCL- 90), Trait Personality Questionnaire (TPQ), and The Interview Schedule for Social Interaction (ISSI). The optimal cut-off was 2 of 4 main criteria and 3 of 10 psychiatric symptoms. With this cut-off point, 44% of the relatives met the criteria of co-dependence: 17% males and 83% females. Go-dependence defined in this manner was related to coping style (fear withdrawal) and hardship of the relationship but not to the severity of psychopathology or personality. In conclusion, it was possible to measure the concept of co-dependence and validate it against coping style and hardship.

Zuboff-Rosenzweig L. Degree of similarity concerning abuse within the family backgrounds of Al-Anon members and controls. Alcoholism Treatment Quarterly 14(4): 81-101, 1996. (6 refs.)

This study examined the degree of similarity in the backgrounds of members of the Al-Anon self help group. The main hypothesis, that there be a significant difference in the degree of abuse in the backgrounds of Al-Anon group members when compared to a control group, was supported. A statistically significant difference between Al-Anon and control groups was found in each of six sub-groups researched which included physical abuse, sexual abuse, verbal abuse, codependency, mood of the family of origin, and drinking in the family of origin. The secondary hypothesis, that there would be a greater incidence of codependency found in the Al-Anon group than that found in the control group, was also supported. The questionnaires used with both study groups are included in the appendix.